04030053 I CITY OF CUPERTINO +- `'~,
BUILDING DIVISION PERMIT ¢CONTRACTORNFORMATION
OUI
LONG ADDRESS: LOVELACE CONST. PERMIT ND04030O53
OWNER'S NAME: PERMIT ISSUE DATE
PIC
UNE: SANITARY NO. CONTROL NO.
(408) 255-4923
ARCH=fFINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
o o LICENSED CONTRACTOR'S DECLARATION lob Description
1 hereby affirm that I Am Licensed under previsions of Ch.pwr 9(commencing .
with Seatim 7rt of Division 3 of Jm Busbecia. tt Professions Code.and my license is o�p
�^ N in full fora en effect t O F s--i
jpz Ltcense REROOF Yu APl l--l�[b.. LDJ
Z~ Dam I undcrere6�tmY p1anR¢MI M�JDV C c ATL J0
SEP 152004
Z'u
3O� I
Licensed Prolimed...
3 OWNER-BUILDER DECLARATION pn
1 hereby Affirm Nat I am nxcmpt form Ne Conwcto's License law for she �.' 1111��1
—00 following moon.(Section l(131.5,Business and Professions Code:Any city or county lJ
$ which requires A remit to construct,Alter.improve,demolish,or repair Any¢mmure
Zi poor to its issuance.also mquims the applicant for such Permit or file a signed statement
<
that hcuLicensed pursuant tothe provisions OfINContrecmr'sLiccnmLaw(Chapta9 Sq. Ft. Floor Area Valua[on
as (commencing with Seetion]gp)o(Division Sof one Business and Pmfcusions Code)or
A. into he is exempt theri and the baso for the alleged exemption.Any violation of
Section 7031.5 by airy applicant fm a permit Wipers the applicant w A civil penalty of 3 41a j44ft2L;r0 O Occupancy Type
not more Nan five hundred dollars(1530).
❑1,As owner of the pmpeny,or my employees with wages As Weir We compensation,
will do the work and the smarms is notion need or offered fonvle(Sec.1014.Business
and Limfcuions Code:The Comuactoes case tu
use Law dot apply 10 An owner of Required Inspections
property who Wildsorimpmvesthcre^n.and.1meh sAuch workhimsclforthrough his
Own employ=.provided thmsuch improvements tie not intended oroffered for We.If,
however,the building or improvemem is sold within one year of completion,Lie owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
We.).
❑1,as owner of Jc property,Am exclusively contracting with he osed anvacmra u
immomwt the projen(Sec.10m,Business and Prafessm ns Code:)The Contractors Li-
eenec taw does not apply in an owner of property who Wilds or improves thereon.and
who contracts for such projects with a comractor(s)licensed pursuant m the ConuacmYs
Limman law.
1 Am exempt under Sec. .B&P C for this mason
Owner One
WORKERS COMPENSATION DECLARATION
1 hereby Affirm under penalty of perjury one of the following declarations:
1 have and will maintain•Cer ificam of Consent 10 self-insure for Worker's Compen-
ution,u provided for by Section 3100 of the labor Code,for Lee performance of the
work for which this permit is issund.
1 have and will maintain Workers Compensation Insurance.As mended by Section
}100 cruse Leber Code,for the performance of the work for which this permit is issued.
My WorkersyC�ypensa6on ace cafsim antl Polity nu QN:
Cartier._/I!/"> Policy No.: _
CERTIFICATEOFUEMP TONTqt M RKERS'
COMPENSATION INSUfc
�/('rho acctiw recd not W eempleted if the Permit is forma hundred dollars($10o)
or loss.)
1 certify Nat in the performance of the work for which this Permit is issued,1 shall not
employ any person in any manner On As to become subject o the Wofkeri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making Wu Ccnificam of Exemption,you should
become subjcn in the Workers Compensation provisions of the labor Code,you must
.,,Z foMwith comply with such provisimis or Wis Permit shell W dammed myoked.
Z0 CONSIRUC1710N LENDING AGENCY
j-. 1bewby Mo.WuAm.is A conswNot lendingagency,in,the perfomran.of
x> du work for which this permit is issued(Sec.3091,Civ.C.)
W� A Lenders Name
Z Lenders Address
V O I cenify that 1 have read this application and state that the aW ve information is
ILL F' correct 1 agree to comply with all city and county ordinances and sum laws misting to
0 U Wilding construction.and hereby anhoow mp2rznutives ofthis city to enter upon the
W shove-menuuned ree to saw.
forinspectionImp,ha
(We)agree to use.indcmmfy and keep harmless time City of Cupertino.gaunt
F'h liabilities.judgmenu,covu and expenses which may in any way accrue against said City
V Z in conugocano of thc granting of this permio.
.. APPLI�CC�CC99999A1NNN4TTTTTT UNDERSTANDS D WI COMPLY WITH ALL NON-POINT Issued by: Date
SO �IONS. W� �+��
-G r Re-roofs
S' mazes of Appi VCo no
au
H RDOUS MATERIALS DISCLOSURE Type of Roof
Will the pplicant or future building occupant stow or handle hasoous material
As defined by the Cupertino Municipal Code.Chapter 9.11,and Joe Health and Safety
nae.Section 25531(0? All roofs shall be inspected prior to any roofing material being installed.
E3 Yes Eplor
Will the applicant or future Wilding=open(um equipment ordedcea which If a roof is installed without first obtaining an inspection,I agree to remove
mit havardnus air contaminants As defined by the Bay Amo Air Quality Management all new materials for inspection.
7doca
❑Yes1 have mad due WAardous materials requirements under Chapter 6.95 of the Califor-
alicalth&Safcoy Code,Sections 25515,25533 and 25534.1 understand this iftW Wilding
ran cone arc a ta tNat iou ihility unotify tM occupant of Joe
quifemen hm.st mpd9r ora 'ficawof tL Signature of Applicant Date
reef or¢nthmowd age Daw D All roof coverings to be Class"B" or better
d Community Development
10300 Torre Avenue
I' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
'UPEkTINO
Building Department
JOB ADDRESS: PERMIT# 61
O / 3 Cry 6 ° 3
OWNER'S NAME: PHONE
GENERAL CONTRACTOR: p AX #
I am not using any subcontractors: Cq
Si a e Date
Please check applicable subcontractors and complete the following information:
60 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
AN Tile
Own / tractor Signature Date
�r Community Development Department
Building Division
"r�r City of Cupertino
�ff... 10300 Torre Avenue
CITY Telephone: (408) 777-3228
Fax: (408) 777-3333
4UPEkTINO
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 buffding 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:
lob Site Address: __ _/"Q
Roofing Company Name: r�
A plicanYs/Signature: ✓{ Date: 3 - t� `oQT
\A/451ND�X1
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
t� REROOF z(03CITY OF
a_S
CUPERTINO PERMIT APPLICATION FORM
APN # ?�Z _/ 062 Date:
Building Address:
Owner's Name: Phone#:
Contractor: Phone#: License#:
Contact: �y Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ uilt-Up Roof El B ilt-Up roof
t Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply Wit Cu ertino's Tear Off Policy: ❑
Job Description:
Residential Commercial ❑ �/�
Fire Zone: Yes ❑ No ❑ Confirmed with Pla g Dent. if
there are any rest ti ns:
Cost o jr36t Z5� Type of Const ctio ; Occupancy gro p:
Qty-
AppQty-
App t o e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING