09040096 CITY OF CUPERTINO
BUIL,DINGDIVISION PERMIT �1}' TI�t� f? �' RI�lr `
PERMIT NO.
BUILDING ADDRESS:
20135 FOREST AVE,
,ETERU
PERMIT ISSUE DATE
OWNER'S NAME:
-ft#:fAi2At.2CONTROL NO.
1iJiA,D4P'13'B11TZ3 RG-.-
831) 273-1837
BUILDING PERMIT INFO
ARCHITECr/ENGiNEER: BLDG ELECT PLUMB MECH
v p z LICENSED CONTRACTOR'S DECLARATION Job Description
UI hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
'may in full force and effect RE—RF T/0 WDSHKS FILL SHTNG AS NDED 40LB FLT
z License Class G 3�l Lic.tY T
F- Date
Contractor I NSTL
ARCHITECTS D R
.�
< I understand my plans shall be used as blic cords MTL TILE C L SA S Q
�yU
WI- Licensed Professional
O
0 W OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
`t a o following mason.(Section 7031.5,Business and Professions Code:Any city or county
.4m which requires a permit to convect.alter,improve,demolish,or repair any structure
4— prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
_Z r Ft.Floor Area
that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq
�y r (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
814000
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500). 31633070 . 00
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended oroffered for sale(Sec.70".Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Sec .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as required by Section
I n
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carti � Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I cenify that in the performance of the work for which this permit is issued,l shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z ► CONSTRUCTION LENDING AGENCY
Fr I hereby affirm that there is a construction lending agency for the performance of
�ithe work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z Lender's Address
I certify that I have read this application and state that the above information is
LUL"
correct.1 agree o comply with all city and county ordinances and state laws relating o
0 V building convection,and hereby authorise representativos of this city to enter upon the
above-mentioned property for inspection purposes.
W
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date
►-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b,':
SOURCE REGULATIONS.
Re-roofs —
S' u t/Contrac °are
Type of hoof
HAZARDOUS MA ALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofE shall be inspected prior to any roofing material being installed.
O Yes °
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or 1.building occupant use equipment or devices which
it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
LAstrict?
Yes rrm
I have read thehazarrials requirements under Chapter 6.95 of the Califor-
nia Health&Sarety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
�r
;�n;or
�authzcd
must be met�to of a Certificate of Occupancy. Sig llrt:o Appl ieant Date
All ro cov rings to be Class"�."or better
agent Dam
CITY OF CUPERTINO
RF,ROOF
1
CUPEkTINO PERMIT APPLICATION
APN # Date:
Building Address:
Owner's Name: R��{- Phone #:
q 0 9 1 —Z-7 v5
HOA: Yes ❑ No ❑ If yes, provide letter from HOA
Contractor: Phone #:jfCj� 3 Ga -�1
Fax #: Lfvi' 6-" /-3
Cupertino Business License #: Contractor License #:
Type of hoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
-la- Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) 1W Other (Specify) .�+r�� t•S1.k-
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
-Pa.- o`ir wok Apkes -I;c� ckee: -i,..� .As nx�Z �E� %bc 4tc -1 ►+`'�'�`�� -c-4 1 �^It
s�s�er. PC( Glass �- s 7
Residential C] Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet inclex.
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
— 4 ���
Signature
Revised 02/05/09
CITY OF C-UPERTINO
REROOF
CITYCUPEt�TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg St�mdards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
:2, 7 1REROOFRES Re-roof Residential B 1SFDWLROOF
/ 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must ag:•ee to comply with 2007 IBC Standards
and manufacturers specifications on r:-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be apph2d 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 arty 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/ "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: �064 CA,,!Vk4,11
Job Site Address: ZJ -
Roofing Company Name:
Applicant's Signature: Date: _���
Greg Casteel
Building Official C
Revi ted 07/30/08
Community Development
;'. 10300 Torre Avenue
- Cupertino CA 95014
Telephone(408)777-3228
CITY OF �
;UPE�TINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT #
20l 35' ' fr
OWNER'S NAME: ,�/ PHONE #
GENERAL CONTRACTOR , A.(, S' ,,. FAX #
I am not using any subcontractors: -
Si Lle
t Date
Please check applicable subcontractors and com th ollowin information
SUBCONTRACTOR BUSI14ESS 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
r Contr r Signature Date