09040110 CITY OF CUPERTINO `.
BUILDING DIVISION PERMIT . R� � � MT�� .
BUILDING ADDRESS: PERMIT NO.
10109 RANDY LN SHRULL ROOFIN
OW NER's NAME: PERMrr ISSUE DATE
ATA]I�l�T��l W74Fc3 A TcUSTFS'EJNE: (NVA CONTROL NO.
(4 08) 84 7-5 09 0
ARCHIIEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u0p LICENSED CONTRACTOR'S DECLARATION Job DescriptionY V C I hereby affirm that I am licensed under provisions of Chapter 9(commencing
L z Um with Section 7000)of Division 3 of the Business and Professions Code,and my license is
in full fore and effect�- �
RE—RF FV SHKS INSTL 7,/16 OSB 30YR COMP CLS A
z License class_ _ 3 Lie.n 5-,?y5-j?
:M
F p pate Contractor a.$K f/a+L 2 5 S Q
LQ ARCHITECTS DECLARATION
g< I understand my plans shall be used as public records
DyU
OLicensed Pnrfcssional
01 OWNER-BUILDER DECLARATION
j:aO
I hereby affirm that 1 am exempt from the Contractors License Law for the
i p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K a g which requires a permit to construct,alter,improve,demolish,or repair any structure
yZ y prior to its issuance,also requires the applicant for such permit to file a signed statement
_`e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
I- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 8 5 O 0
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
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(5500). 316240,-:11 . 00
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business ns Required Inspections
and Professions Code:The Conuactor's License Law does not apply to an owner of q p
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.).
❑I,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's u.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts far such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I]I have and will maintain a Certificate of Consent to self-insum for Worker's compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
workf r which this permit is issued.
have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance rricr and Policy number am:
Carrier: STAT L N t Policy
No.: 1.9 S
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 cenifv that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dale
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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
a the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
0Lender's Address
U C) 1 certify that I have read this application and state that the above information is
IL" caned I agree to comply with all city and county ordinances and stale laws relating to
0 V building construction,and hereby authorise representatives of this city to enter upon the
U above-mcndo.cd property for inspection purposes
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
m�,r to 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 UNDER TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REffLAT S.
q-tt_o f Re-roofs
Signature of licant/Conuactor Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Wi 1 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
Cade,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑yes No
Will a roof is installed without first obtaining an inspection,I agree to remove
ll the applicant or future building occupant use equipment or devices which
-.nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection.
District?
❑Yes. No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building Lr
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
mquiremcnisIch must be met prior to issuance of a Certificate of Occupancy. S IgnatuIc ofpl icant Date
-O
Owner ora orized agent ^D te All roof coverings to be Class',tr"or better
/' ) DI
CITY OF C.UPERTINO -I 0 L I
RE-ROOF
CUPEIZTINO PERMIT APPLICATION
APN # 3 1 ]�U Date:
Building Address: r ��
Owner's Name: NMA r y p 7-0 �J Phone #: _2 - U Z S
ZS
HOA: Yes ❑ No ❑ If yes, provide letter from HOA
Contractor: Phone#: y 7— ,5-0fz0 -tJ1tj5 V
10 C
9v
Fax #:
Cupertino Business License #: Contractor License #:
s9 Sd'
Type of F.00f Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: t,✓ 7 D wt S ,k s i,, 03 B .3 O y4
Residential 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 index.
Valuation:
I Have Read, Understand and Will Comply wits. Cupertino's Tear-Off Policy:
4Signatur
Revised 02/05/09
CITY OF C'UPERTINO
REF;OOF
CITY OF
UPEkTiNO FEE SC=HEDULE
Number of Fee ID Fee Descr:ption Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg S-:andards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Ccmmercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissicn Fee
J 1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Multi-Family B IMFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commissicn 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 agree to comply with 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
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 nz it 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 nai.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 lig "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be orn the job site at the time on inspection.
I understand and will comply with the abode stated policy on re-roofing.
Homeowner's Name: MA,, �� ►�1 o g71 d
Job Site Address: / 01 0 4, �'-► /, -
Roofing Company Name:
Applicant's Signature: -Date: L7 '
Greg Casteel
Building Official
Revi ied 07/30/08