04080023 (2) CITY OF CUPERTINO +`� �? sews w Rt z'e`e a `ch aia'�"v%.'A^ 4"rt,'m;y%8�� ro'z,'.
BUILDING DIVISION PERMIT £.,Cm.�NTRACTOR INFORMA'1I0 N
BUILDING ADDRESS: PERMIT NO.
CONRAD ROOFING SERVICE 04080023
744 RQIRTND9T_T1 WY
• OW NER'S NAME: PERMTIB9UE DATE
ONE:
SANITARY OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
app LICENSED COMAACnOR'SDECLARATION Job Descriptio LC®
w I hereby efOrm Net I em licensed under provisions of Chapter 9(commencing CC
with a ion 7")or Division Sof NC Buil<IEC
ProfcssiomC da,and myliccnsc is
n• mmu merr 2 6SZ
REROOF W/ASPHALT SHINGLES
^_o Dam GnnAUG Zy 2004
ARCHITECI-S WF
ON
undcrsund my plans shall be used as public records
7yU
;ay Licensed hereby oval BUILDING
OWNER-BUILDER DECLARATION
F 00 1 hereby.('Sete on 1 am exempt from the Cnnvns Co License Law for the
pO followingmason.(Section]11]1.5.Business and Pmfcssinm Code:Any city orcounty
m which myuims a permit us ennswel,alter.;mprnve,demnlich,nr¢pair any swnure
m
Hispoor it)its issuance,also requires the applicant for such permit to File a signed statement
Nat he is licenacd pinimuuo the Pmvisens nr the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuat on
(commencing wish Section 7000)of Division 3 of be Business and Profeuinas CMe)or
..
that he is exempt tlemfmand m the basis for the alleged exemption.Any violation of
Section]031.5 by any applicant fora permit subjects the applicant to a civil penalty of 3Iglllier00 - Occupancy Type
out more Nan fiae hundred delta.(S500). � ,
❑1,as owner of the pmperty,or my employees with wages as their auto compewrlon,
will do die work,and timuuome is not intended offered I...le(Sce.J044,Business Required Inspections
and Proroadoru Codc:The Conmaofs License Law does not apply toe an owner of q P
propeny who builds or improves dtemon.and whodoessuch work himself orthmugh his
awn employees,provided that such improvements are not intended or offered forsxle.If.
however,Ne building or improvement is sold within one yearof c mpleuon,the owner
Wilder will have the Wrden of proving Rod he did not Wild our improve for purpose of
sale.).
❑1,as owner of Ne properly,am exclusively convecting wit licensed contractors to
romuuct the project(Sec.7014,Business and Profetions Code:)The Commucom s U.
come Law does not apply to an owner or property who Wilds or improve hamon,and,
who contracts for such projects with a contraclor(a)licensed pursuant in the Convector's
License Law. '
❑lam.,mord .der Sec. ,B 6 PCreathis ream.
Owner Data
WORKER'S COMPENSATION DECLARATION -
1 hereby of ird under penalty of perjury one Oldie following declarations:
I have and will mrintain a Certificate of Consent a self-Insure for WorhM1 Cowden-
station,
o d en-
137W
ion,sa provided for by Section 3]00 of do Labor Code,for the performance of the
rk for which this permit is issued. '
1 have and will maintain Workers Compensation Insurance,u required by Section
of the Labor Cock,for the performance of the work for which this permit is issued.
y Workc/ep Compensedglrmu ce artier and Policy number ore:
her. J"CA'� l `M.� Pali : Z�r 00011ys
CERTIFICATE OF EXEMPT MWORKERS'
COMPENSATION INSURANCE
(This section need nor he completed if the permit is Rome hundred dollars(SNO)
or lcsaJ
1 anify that in the perfmmancc of the..,it for which this permit is issued.1 shall nut
employ any person in my manner so as to become subjev0a the Wmkena Compecomon
Laws of California,Date
Applicant
NOTICE TO APPLICANT:IL aflcr making this Ccnir..ic or Exemption,you should
become subject o the Worker's Compensation provisions Of the Labor Code,you mum
.J z forthwith comply with such previsions or th;x permit shall W deemed mated.
z O CONSTRUCTION LENDING AGENCY
Ihereh affirm that there its convection lending[—d y g aycrtcy for the performance of
�i the work for which this permit is issued(Sec.3097,Co.C.)
IT]Q Lendcls Name
z Lender's Address
V Q 1 cenffy that I have read this application and stain that the above information is
wF correct.l agree to comply with all city Nd county ordinances and mate lawn mladng to
0building convection,and hereby audition mpmaermute of this city to enter upon the
Ushove-mentioned property for inspection purposes.
91.
(We)agree to save,indemnify and hep hamd=the City or Cupertino against
0, liabilities,judgments,casts and expenses which may in any way secure again said City
in
of to
mnfiM
V^' APPLICAeNTOLINDEgSTANDS AND rWILL COMPLY WITH ALL NON-POINT Issued by: D
SOUR ULA
Re-roofs
ignntum of Applic HAZA DOUS MATERIALS DISCLOSURE Data Type of Roof
W ill the applicant or future building occu dist some or handle haruduus material
asdefined by tho Cu
efinepertino Municipal Code.Chapter 9.12.and the Health add Safety
cotle.Section 25532(a)] All roofs shall be inspected prior to any roofing material being installed.
❑Tea l�
W If 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
it hazardous air contaminants as;defined by the Bay Area Air Quality Management all new materials for inspection.
istrict]
p Yes
I have mad the havardnus materials mquiremcnu under Chapter 6.95 of the Carrot. — �_ L[^O( a
Of.HeuOM1&Safety Codm 25
Critic.Semo505,8su
533 and 25534.1 undcrnd that if me Wilding 7 7
does not commonly have a tenet.Nat it is my responsibility to notify the occupant of Ne
umm swhich tart xmetpriarwiemanecnraccoiRcate o,s, 7 gnature of Applicant ale
ll1tUI/ncr is,authomad ent Da¢, All roof coverings to be Class "B"or better
ag .
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artme
JOB ADDRESS: "'YjJ �•p .
OWNER'S NAME: PHONE # Z- Z9 3�
GENERAL CONTRACTOR: FAX # -O y- 9 76 6
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following 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
Community Development Department
Building Division
t'
JJ City of Cupertino
i 10300 Torre Avenue
' Telephone: (408)777-3228
CITY OF
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.
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: �C.I nyl
Job Site Address: 4 y
Roofing Company Name: 6-0
AP
plicant s Signature: ��✓ �— Date:
Greg teal
Building Official
Revised 1/30/03
Printed an Recycled Paper
i
CITY OF CUPERTINO
' REROOF o q- `' �" 2-3
CUPEkTINO PERMIT APPLICATION FORM
APN# 31 ,Z 21 O , t Date:
Building Address:
Owner's Name: Phone#:
a lc a„\_ S-I-�o r-, —3 Vf — 7 91 g
Contractor: Phone#: License#:
Corte-e � 2oacl S-CA4'� Z-`14 7615 2-11 b�Z
Contact: Phone#: Cupertino Business License#:
KI IL, C rcvl.\kn, 2So-2940 1--L-0 -7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Oe-Asphalt Shingles R*'Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 2- ❑ Provide I.C.B.O.Report#
V'To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: Tx-vf- o;-C- Z 4-t,�t ow= c-".
.tom+ \k 30 IL_ C�_It �o c. Elk -d" L .
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plannin if
there are anres
tri on
Cost of Project: 7/ Zip Type of Con�tqkjo Occupancy
Qty. 'f\
A llea[r e Fee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILDING
ENERGY Energy BUILDING
SEISMICRE Seismic Fee Res BUILDING
SEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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