05110135 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT .CONRACCORr^INFOR TION
BUILDING ADDRESS: EM ROOFING PERMIT NO.05110135
21199 OROGRANDE, 2T,
OW NER'S NAME: PERMIT ISSUE DATE
DANIEL CUNNINGHAM 843 7T
NE: SANITARY NO, CONTROL NO.
(650) 363-8388
ARCHITECTENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 C= 0
lOo LICENSED CONTRACTOR'S DECLARATION Job Description
u C 1 thumb,affirm dust 1 am licemcd umkr provisions of Chapter 9(mmmcncing p
i with Section 701101 of Division 3 of the Business and Professions Code.and my licenx is
in full forceandeT ��� 1.�6 REROOF- /;D\SINSTALL PRIES . TL
i License Clay Lie.. TT 11 UUVV�tIj
Da¢ Gm DECL Lf1q u
RCHITECrS DECLARATION
f� I understand my plana iltail he road u public rtcortu
JyU
sw� Licensed Pmfestianil DEC 5
cO3 OWNER-BUILDER DECLARATION v ZUU
F 1 hereby affirm that I am exempt from the Conwctars License Law for the
no following reawn.(Section IID 1.3,Business and Professions Calc:My city or county p� A
5$ which mm luira permit w ennm es,alter.Mmv
pe,dcmolim.ar mpoir any summit. la js sat�Sr7a n813000
_Z< prior in itsicmnce.also,requires theappliunt forsuch permit to filch signed sonsmcnt �A5k
E o Nat he is licenod Pursuant to the provisions of the Contraclm's Uccnm law(Chapter 9 Valuation
e� (commcmingwith Semon I000)ofDivhsion3o(the BusinmudProfessions Cadc)ur tlHtl V
$ that be's exrsvpt therefrom and the buil far the alleged eaemptim.Any violation of
Session 701.5 by ury applicants far a permit subject the.pplicvn w a civil penalty of ( Occupancy Type
not mom than five hundred Jonah(S500).
❑1,u owrcr of die pmpmy,a my employer wish wags u Heir sole compenUOan.
will o the work and lhemwcum is notimmaded ooQered Intrinsic(See.'.Bunn.
and Profesaans Cade:The Contractors License Law does hal apply w an osvor of _ Required Inspections
property who Mi Ids m improars mcomm i and w M dos itch wort himself or though his
Own employees,provided that such improvements art not intended oroRened forsala IL
however,the building or improvement is sold within ores year of completion.the Owner.
Wilder
will haw the burden of proving that M did not Bald or improve for purpose of
ark.).
❑1,as owner of the pmpemy.am aclusiwly contacting with Bcemed contactors an
consume,the pmjen(Sec.IOU.Business and Profession Cade:)Rbc Consne mr's U. _
come law dam not apply M an owner of pra son"M Wilds or improves themon,and
who contract for such pmjeet with a conuxaor(s)licensed pursuant m the Couaesors
License Law.
❑lam cramp,under See .B k P C for this reason
Owren Date
WORKERS COMPENSATION DECLARATION
1 hereby all under Penally of perjury cm of the following dcclandmor
1 haw and will maintain aCenuftom ofCmucm in self-insure fee WarYers Compen.
,on,as provided for by Section 3700 of Our Lahr Code,for the perfarmance of On,
work for which this permit is issued.
❑1 haw and will maintain Workers Compcvaaon Iruurmc,to rryuitN by Section
3100 of dte Labm Code.for lite performance of U¢wmkfa which this pewiluissued. '
My wmr :e CC�Rn . lmunne orti�tW�1'i number am:6o y
Cartier. T/'C p
CERTIFlGTE OF EX NPMON FROM WORKERS'
COMPENSATION INSURANCE
(Thu mediae recd Out hecourplmod If the pewit is far.hundred dollars(5100)
or less.)
1 certify tha,in the performance of tic wart for which this Formil't issued.I shill not
employ any person in my manorm as to became subject to the wmrt Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
became subject in the Wohers Compensauan pmviaom a the labor Cadc you mesa
.J O fonhwi0t comply with each provisions o this permit dull he domed revoked,
z' CONSTRUCTION LENDING AGENCY
[--� I hcmby affirm that there in.coruuumnn lending agemT far the iteif..of
CL> the work fm which this Parma Is usurd(Sec.3097.Civ.C.)
4 Landers Name
z Lenders Address
IJ Q I certify that 1 have read this application and mule Osu the above information is;
IL F annum.1 agree w comply with all city hod comty ordinances and scale laws relating to
0 building conmuction,and hereby auhoris representatives of this city in enter upon the
H
above-mentioned u
property for inspection purpos.y (We)agave in save,indemnify and kelp hawkm the City of Coalition against try
Uz �iabBlOa.ladgmanu.cost anaapcnsn whim may in anyw+yamue hgaimtmtid C
n eormalmoce of thegrenung of thispewit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ��fL 3
SOURCE RESa
C/IlIJff
L(A?3�OS Re-roofs
S of PI' Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applians m futum building occapamsmre orhsndle hanrdous material
u define by the Cupertino Municipal Code.chapter 9.13,and the Hohh and Safely
otic.sectiw zss3zU)?
❑Yes 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil himacb m it anumimnts u dc0ncd by Rhe Bay Ara Air Quality Managcntem all new materials for inspection.
District? p
❑Yrs ON. f
Ihave realthe hvardwns Z5 15.2553 and! s534.
534.1 udcombia.93aflii Gilding
hdoesush.,,.nit,Cods.latices est,I,i myrapers53a.l Wnobind recap Wilding ji�
mqu rot curs which
have s tenon that It u my mxpof.ce u w notify the aecupanl of Ov: J.
¢yuirtmcnt which musthe d ' rte issuano ofa fertifwate o(�<�aory a� SI re fAppricant' Date
Ow est rise gent ��DateJ All roof coverings to be Class"B"or better
sm
Community Development
10300 Torre Avenue
Cu ertino CA 95014
Telephone(408)777-3228
CITY 0, Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
L D S/tl
OWNER'S N C — PHONE #/6 pp
GENERAL CONTRACTOR Entd�c FAX # So _
I am not using any subcontractors: - /t LZ 710,"
ignature Date
Please check applicable subcontractor and complete the followin information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
to ; Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N O Fax: (408) 777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: Zf l c(cf- O e o q v c.,A c1 , P L
Roofing Company Name: n— tL-? 12.o O Cl Yi q
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
Z14-t
REROOF bS"(( -3
CUPERTINO PERMIT APPLICATION FORM
APN # J/Z ` 7 016 Date:
dd o�
Building Address:
2-112cf oro ,rcl-V, d e ft-
Oner's Name: Phone#:
a n 'e C m 6 .5,0 61,V F 9y1sa
Contractor: Phone#: License #:
C-M dZao ," -5-0 ?!03 838 77 26
Contact: Phone#: Cupertino Business License#:
Ed D4 0"i a C(0., o) & 08
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles C�C Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings O✓GCC ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential Commercial ❑ y2 oS Q3 may, a ; n s i/ /9-ew 1'-ce g 7-L
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
I 000 !2 -3
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING