04020003 CITY OF CUPER'1'INO 0NMr, ACTORINTORMATION.
BUILDING DIVISION PERMIT
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BUILDING ADDRESS: SANFORD ELECT 1E11ITN004020003
, 10-104 roT.RY AV
OWNER'S NAME: PERMIT ISSUE DATE
MAY WU2'12
ONE: SANITARY N0. CONTROL NO.
(408) 996-9797
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT' PLUMB MECH
1� 0 0
woo 0 LICENSED CONTRACTOR'S DECLARATION Job Desc }g,�
C 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing a\II�p❑ 2�
n<u with Section itM)nf Division 3ofihe BeeireV agal Professions Cock,and my license is WI n'�J LU6
_>m in full to-'np effect.
,�JK license e174 ('-w.- 1i ue.a 3 REROOF
a-o D 2�� �1fi- _Ctmotow. - FEB 1 7 2004
', 14 ��_ ARCHITECT"S DRATION
y d< 1 understand my plans shall he uud a We memo,
IEU
qZ a.r^ License)Professional OWNER-BUILDER DECLARATION BUILDING 3
9 y 1 hereby affirm that 1 am exempt from the Comranors License law for the
0 o (allowing moon.(Section]ID 1.5,Business and Profession,CWc:Any city or county
K$ which requires a permit to Construct,alter,improve,demolish,or repair any.nmetum
V=y
prior o its issuance,also rwnims the sppGcam Bir such pmmit to Bl c..i,mi,tI t momil
pZ< That he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
`z i- (commencing with Section 7M)of Division 3 of the Business and Professions Code)or
a. $ that he is exempt IhcmGom and be basis for Ne alleged exemption.Any violation of
Section 703 L5 by any appliant for a permit subjects the appliCMLto a civil Penally of 31A01UQu'4cf00 Occupancy Type
not more Nan five hundred dollars(5s00). P Y YP
1,u owner or the pmperty,or my employees with wages as their sole compcnxetion,
will do the work,and the swcwm is not intended or offered for sale(Sec.](H4,Business
and Professions CWc:Tim Convenor's License Law does not apply to an nw.,pr Required Inspections
propeny who builds or impravu Ihcfcon,and who docs such work himself or through his
Own employes.provided Nal such improvements arc not intended predicted formix.It.
however,Ne building or improvement is mid within one year of completion.the owner-
Wilder will have the burden of proving Nal he did not Wild or improve for purpose of
sale.).
1,ei Owner of Ne property,am exclusively contracting with licensed contractors to
answer the project(Sea]lies,Business and Professions CWc:)The Contractors U.
me law docs not apply in an Owner of property who Wilds or improves;theeon,and
who contracts for such pmjecu with a eonuactor(s)licensed pursuant to she COmmenses
License law.
CD am exempt under Sec. .B h P C for Nis mann
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one or the following decimations:
I ban and will maintain a Certrrcate of consent to self insert for WOrkCfs Compere
cation,u provided for by Scaipn 7]00 of Ne la W r Gke,far Ne performance,of the
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
37W of Nc labor Code.for the performance of she work for which this permit is issued.
My Worker' wwremotion lasommax,eirme,and Policy numbcf art:
C r X14 7VA0 Poli,No2113
CERTIFICATE OF EXEMPTION FROM OR .
COMPENSATION INSURANCE
(Thu section neW nm W completed if the permit is fora.hundred dollars(SIO(B
or less.)
1 minify that in Ne peefnrmanee Of she work Our which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Wdrkeri Compensation
Laws Of California.Do¢
Applicant
NOTICE TO APPLICANT:if.after making this Cenifieate of Exemption,you should
become subject to the Worker's Compensation provisions of Ne laWr Code.you must
., Z forthwith Comply with such provisions Or Nis permit shall he deemed revoked.
z O CONSTRUCTION LENDING AGENCY
�-. I hereby affirm that Here is a construction lending agency for the Perfufmance of
P4 Ne work for which this permit is issued(Site.JIH],Civ.CJ
U] Q Lender's Name
=,z Lender's Address
V Q I certify that 1 bare read this application and state That the above information is
U, correct.1 agree to comply with all city and county ordinances and stem laws relating m
0 V building construction,and hereby aethorve representatives of this city to enter upon the
aabove-mcminned property for inspcetion pmpmes.
(Wit)agree to save,indemnify and keep harmless Ne City of Cupertino against
W Iiabilides,judgmenH.costs and expenses which may in any way accrue against said City
U in eomigicnce of the granting of Nis permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO REGULATION
`tel z- Re-roofs
go urcofApplmaHAZA.DOfo
USMATERIALSDISCLOSURE Date Type of Roof
Will the applicant ear future building Occupant store or handle havudous mother
as defined by the Cupertino Municipal Cock.Chapter 9.12.and the Health and Safety
eWe.Scednn 25532(a)?
❑Yea M All roofs shall be inspected prior to any roofing material being installed.
Will thea scant or future building t use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
PP 6 by the B
fill M1azarUnus air contaminants u defined by IM1c Bay Arca Air Quality Management all new materials for inspection.
isms?
0 Ycs ON.
(have mol NC WraNrws materials myuimmen¢under Chapter 6.95 of the Calding
nixs notcu Safety Code,Scctiom 25s05.2myresId2s5Js.l undcrsmthcoif Nit Wilding /A —i//— f///K g(//(�`e-t
Jtcs nal curtcndy have a Tenant,Nat itis my respunxihility to nobly IM oeeuPant of Ne I
regV' cnIs which must mel prior to issuance a cenificate of Occupancy. ri
d-149 I)-4-
_
Si re of Applicant Date
erprapmpacdagent Dale All roof coverings to be Class "B" or better
Community Development Department
AR Building Division
,�6l City of Cupertino
10300 Torre Avenue
4 pCl[ll OF AI Telephone: (408)777-3228
U f L,_,•,I I�I® 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.
Homeowners Name: 1V4 1/ 7 t)1.1
Job Site Address: 3,o 4 �7 ^
Roofing Company Name: JAN F1//q r)
A plicant's Signature: @ Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO u o�
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
Building Address:
o
Owner's Name: Phone #:
M UX96
Contractor: Phone#: License#:
XAAJ 'Oe b 408 6L?79 7 1 44 -33og
Contact: Phone #: Cupertino Business License#:
RAIVI1 LION 40$-966-9? 9) > vagv
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ . Built-Up roof
® Asphalt Shingles e;f Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Y ❑ Provide I.C.B.O.Report#
H To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residential ® Commdjcial Ej
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: LJ
Cost of Project:. v p ` Type of Construction: Occupancy group:
Qty. if
AppliQle Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY EneKSy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING