04040157 CITY OF CO13ERTIN0
BUILDING DIVISION PERMIT y 'ONTRACT!OR INFORMATION .
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BUILDING ADDRESS: WESTERN ROOFING COMPANY PERMITNo04040157
1OR21 F. ESTATFR DR
OWNER'S NAME: PERMIT ISSUE DATE
ldhk RITA LEE 2174 DIANA2004
ONE, SANITARY NO. CONTROL NO.
(408) 258-7749
ARCHMCTfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECf{
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LICENSED CONTRACTOR'SDECLARATION tj �m1
LtoF 1 hereby arum mal I am Ilcened under adPoonn mfl Cod er n rpylom cog Job Description $a Y4'1�1'/!
S LII with llfare 700Np of Divinion3of me Ousincxs and Profcssinns coat,and myliccnsa is
;t2_<e, in mutnreeandeffect. t �� REROOF MAY 1�' 2004
License Class C 3 ! Lic.p ,
c F w Dal[ Commerce
[n ARCHITECTS DECLARATION'
Y a R 1 understand my plans shall her clod as public records
t u.A s- Licensed Professional
BUILDING
D5 OWNER-BUILDER DECLARATION
6I 1 hereby affirm that 1 and exempt from the Contractors License Law for the
n O follnwing mason.(Sermon 7031.5,Business and Professions Code:Any city nr county
K m fi which requires a permit or construct,alter,improve,demolish,or repair any structure
z frictions issuance,also requires the applicant for such Permit mr file reigned statement
E:=c that he is licensed puessantmmep no,innacnhe Cmancow,License law(Charter 9 Sq. Ft. Floor Area Valuation
yF (eamme ming with Section Wall of Division Sar the Br,m..and Pnafexsioms Cape)or
i that he is excerpt thcmfmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a pno nit subjects the applicant to a civil penalty of 3 WZ124 biri r0 0 Occupancy Type
not more than fin hundred dollars(SSW).
P Y YP
❑I,as owner of the property,or my employees with wages as their.mle compensation,
will dm she work.and the structure is not intended or offered for sale(Sec.70,14,Business
and Professions Cade:The Convenor's License Law docs not apply to an owner of Required Inspections
property who builds or improves two on,and who dues such work himself or through his
n employ.,pruvidetl mat such improvements are not intended or offered far sale.If,
however,me building or impmvemenl is.told within one year or completion,the owner-
builder will have the burden of proving that he did net build or improve for propos of
salt).
❑1,as owner of me podiatry,am exclusively contracting with licensed contractors to
omment the project(Sec.7(N4,Business and Professions Code:)no Contractor's Li
case Law does not apply to an owner of property who builds or improves Ihemon,and
who comment for such projects with a Contractors)licensed pursuant o me Contractors
License Law.
I am exempt under Sec. ,H&P C for this reason
137W
wner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pe jury one of the following declarations: _
1 have and will maimein a Cenificrm of Consent self insure for Worker's Cumlmm
ion,u provided for by Section 37W of me Labor Code,for the pnfammnce of the
rk for which this pemtit is issued.
1 have and will maintain Worker's Compensation Insurance,az required by Section
of me Labor Calc,for the Performance mf the work for which min permit is issued.
y Worker'aCompensation Insumna carter andPolicy n/uyrh/erJam��rtier: i '7^I�i Policy No.1J�CE TIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seenion need not he romplmcd Bonn varmil is far anc hundred dollars(3100)
loss.)
I minify that in IM1e v rni marom of the work for which this Permit is issued.1 shall mol
employ any Person io any manner so as to become Subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,alto making this Ceni lice¢of Exemption,you should
become subject to the Worker's Compensation provisions or the labor Code,you must
forthwith comply with such provisions or this Permit shall M deemed revoked.
OCONSTRUCTION LEN DING AG ENCY
[-+ I hereby aro nor that there is a construction lending agency Ior the peelannounce of
C > me work for which this permit is issued(Sec.3097,Ci¢C)
V] Lcndcrs Name
G Lender's Address
az
U O 1 certify that l have read this application and sort that the above information is
I,, F correct.1 agree to comply with all city and county ordinances and sum laws relating to
0 U building construction.and hereby sommi'to reprembradveS of this city to enter upon the
I b I'I mentioned affronts,
property for inspection purposes.
H y
WC)agree to save,indemnify and keep harmless the City of Cupertino against
h liabilllicsf ludgsardecosmand cs this Permit, they in any way ac<roc against said City
C) z m cense nee of the onaribeR
TAN Of this permit.
APPLI AN 7 UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR EREy1,U,LATIONS. p
r 1,-9, ,eA 41,�."�.:�Y 2�-(�(� Re-roofs
`- Signature of Appbca1 ntranor
HA ARDOUS ATERIALS DISCLOSURE Type of Roof
Will meepGuter or futures al Cgoccupantstoicm handle baalth and
as defined by the 32(s)l nn Municipal Code.Chapter 9.12,and the Health and Safely
10oneCode, 0tion zss33(an All roofs shall be inspected prior to an roofing material beim
❑res ONO p p � y g g installed.
Will thea applicant or mare building oceu and use a If a roof is installed without first obtainingan inspection, I agree to remove
pp 6 P a Air Qu or dMana which P g
til barartlnus air contaminants as dcOneJ by the Bay Arca Air Quality Management all new materials for inspection.
i'llics,
❑Yes E]No Ir
Ihavcrcedmehcanlnusmam,)5,255birs uircmcm5under dChapter
r,s=GaLifmc hoddin6
r
si s"V��c
Senant, lat it is my oand35534,1to molmndmatcupsum of ti ca rmnam,torr n i5 my rreµslmnaibnay u,sadly me r.:eupm+l nr me
quicr pno,In issu eofa Ccmfi"m of occupancy._ _ Signature of Appli ant Datem Dile All roof coverings to be Class "B" or better
Community Development
10300 Torre Avenue
k
-to Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building Department
JOB ADDRES PERMIT # (� 0( p S7
/ 0 23 E - ESI 1C R- ioo
OWNER'S NANW. PHON94 p — 7
GENERAL CONTRACTOR: FAX # 1Yo -'-9-79-
1
I am not using any subcontractors: 6 2
S gn a Date
Please check applicable subcontractors and complete the followinginformation:
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
r Con act r Signature Date
• i
/r Community Development Department
Building Division
f7 01 . City of Cupertino
' 10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF 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 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: P-1 / /t— LEE
Job Site Address: 10 g 23 C • S ( ��L I /fi n 1 1(lJ�7
Roofing Company Name:
A plicant's Signature: U, Ot^/\ Date: D —Z 3 —OV
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF J �S
CUPERTINO PERMIT APPLICATION FORM
APN# 7 / 2- Z O / Date: O
Buildin Address: f
In 2 EC2469TIN
Owner's Name: PhoneC 12
Contractor: Phone#: License#:
Lv�i2lZtti}�.m 08'2 _ G2S`S3
Contact: Phone#: Cupertino Business License#:
1/c9 —6Gi-66
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles El Asphalt Shingles
}� Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) mo-h t fit 4C ft
Number of existing coverings�_ ❑ Provide I.C.B.O. Report#
dr'�To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: laA_2 b r oCIP 42� kC 1_t. i �7}l(
Residential Commercial ❑
Fire Zone: Yes-O'No 2- Confirmed with P anning-Deept, if
there are an estrictions: u i
Cost of Pr ' Type of Constructio Occupanc group: b Z
l 1 -IZc9 O
if
] able Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING