04070117 CITY OF CUPERTINO74.7— -% '�-nI,7 k-
BUILDING DIVISION PERMIT fl�CONUbWTOWINFORMATION:
BUILDING ADDRESS: WOODS ROOFING PERMIT NOO 4 O 70117
20212 GRF.RNLRAE 1)P
• NER'S NAME: PERMIT ISSUE DATE
OW
CHUCK OLS SANITARY O. OL NO.
ONE:
ARCHITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
top LICENSED CONTRACTOR'S DECLARATION Job Description RMA
,s�t1 f�
U p 1 Mrcby affirm that I am licensed under prowis s of Chapmr 9(commencing p 911�`$AL.`a_
tGl with Section7wd,of Division Sof the Businessland Prof siu C da.and my license is
mo, �mnl���eleas^tier's? a�3� � 9 REROOF W/GERARD STEEL TILE AUG 2 2004
of aq Damexan
ARCH
LO
Y I understand my plans shell used u public me rd/
Zi'u
G LiccmeJ PnlfPssienal BUILDING
5 OWNER exempt RDECLARATION
I hereby affirm um I am exempt form the feaneamm'd :Any C ty O for tbe
a o following moron.(Smdon)1131.5.Business and w,deamu Cole:Any easy Of aunty
$ which rcyuircs a permit m mnslmCL dor,impmw,demolish or repair any ssanww
priermi6 issuemc.ahu mquims lM applicam fonoch pcnniuo file aaigncJ summent S Ft.Floor Area Valuation
2? thatW'tsliecmedp...mtoNcprovisionsoftheComracmr'sLiceacLaw(Chapter9 9•
yFs
recommencing with Section7Mfff Division 3ef dm Business and Profrsshas Coun)-1
.. Wt be u exempt shemfrom and the basis for One alleged exemption.Any violation of
Section 7031.5 by any applicant fora perch subjects the applicant 19•civil penally of 3 25&BIlI9tf cr0 0 Occupancy Type
not mom than five hundred dollars(5500).
❑Lasowner,and W^pmsy, re is eaployxs withwagesasnee semi wmpeanana,
wdl dd thework, Neaw Consulates Li Wide Law cal dorso apply to 44.inO nanea - Re uired Ins ections
add erty whiom Code:The Contremon. nd who Law such
not apply tom owner of - 9 p
property who Wilds mimprowach improve who aresauchworkh pro if offered
his
ownemployees,provided pr suchimprovementsart oro ouroclar o0krcd for mom.
however.the Wilding or improwaantIssold hatwithin one idofimprovforn.Neowner-
Wilder will have Ibe burden of proving IMI Ire did not dtild or improv for purpex of
sale.).
❑I,as owner of the properly.am exclusively contracting with licensed ceneacmrs m
construct the pmjccd(Sec.7W.Business and Professions Cruel The Conemtur's Li'
censeLaw docs not apply man owner'of pmpeny who Wilds or improves unclear.and,
who commets for each projects;with aconto cmr(s)licensed pursuant in the Comracmis
License law.
❑I am exempt under See .B At PC for this won
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby aRrw under penally of perjury one of the following numismatic":
1 haw and will maintain eCmifiole of Consent to self-insum for Worker'sCompcn-
satission,as provided for by Section 3100 of de Labor Code,for the performance of the
work for which this permit is ued. .
1 have and will mainmin Worker's Cempencitc.Insurance,as required by Seesion
of the Labor Code,for'Ne performance of the won for which this permit is ittued.
My Wenefs�rCom nsetionylnwnntt earlier and Policy nquw4he/r]re_:0,
u
Carrier: S• t^'I_ Polity Ne.:OkYO 3�_
CERTIFICATE OF FXEMPfIoN FROM WORKERS'
COMPENSATION INSURANCE
('Otis section need nut becompleed if the permit is fortune hundred dollars(SIM)
or less.)
1 modify that in IW pciformeae of be work for which his permit is issued,I shall nut
employ anyperson in any manner in as to become subject in she Workers'Compermtien
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Ccnificam or Exemption,you should
become object m the Workers Compensation provisions of the Labor Cade,you must
,J Z fundwith comply with such provisions or this permit Mi be deemed revoked.
Z O S
COND UCnON LENDING AGENCY
[.. I hemhy a1Rrm Nat them is a comeuction lending agency rot IW performers a of
!Yi 7 Ne work fur which Wx permit is issued(Sec.3091,Civ.C.)
U]A Lcince,Nme \-
O, Legal Addw
V 21 eersameufy that 1 have mad Nis application and se that the aW u
w information
F Correct.I at=to Comply with all CITY and county ordinances and stag laws minding to
�YJ building(We)agree to,m ,rode nify aauthond
keep
har miwsof Nis city to color upon the
[D movomeramed property for inspection purposes.
gy (We)agree to saw,indemnifyandkith may
Ness wCisyof against
ions tsagainst
h Iiabilitiu,judgmcnLL costs andenpcmes which may in any way attroe against said City I
U Z inconsequen fthegmnn got rats Date
APPLICA N D WIL MPLIF WITH ALL NON-POINT Issued by:
so C 7Re-roofs
Signature of ApplicuNConeacmr Dam Type of Roof
HAZARDOUS MATERIALS DISCLOSURE yp
Will the applicant tar future building occupant store or handle herardmus mamnal
as&fined by the Cupertino Municipal Code,Chapmr 9.13,and Ne Health cad Safety
InutictL"
We.Sm on 35533(.1' All roofs shall be inspected prior to any roofing material being installed.
cYes (]dln-�
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future Wilding occupant tawrea Air Qu of Mara which
mit hmramnus air mnmminants as defined by Nc Bay Area Air Quality Management all new materials for inspection.
istrict?
Cl Yes 6+��
I have mad the hararduus materials requirements under Charier 6.95 of the Califon /'f) T
SafnyCodc,Smo.255f15.I5533and3553a.IuakmaM Nuifem Wilding {"Tms not curnndave i m t Nm' 's my respomthilily m notily Nc ac pan of the slquirements �nss�a^t tranm aceti(jamefocmp Y Signature ofApplica t Date
°�04 All roof coverings to be Class"B"or better
Owner ,whormdagem Dam
Jul 16 04 06: 53a James Lampe 408-267-9999 p. 1
COr=uaityDevclqxjcw .
17crt Tone A
vg cue
plperano CA 95014
4OF j: (
TcLq � 406)777-1 )7
408)777-3 Z28
CUPEkTINO ;;
Building De artment
JOB ADDRFSS: PERMIT#
07OI �
OWNERS NAME: J PHO.YE#
'° GENERAL COIV 1RACtOR 4 A � A5 �a!–lr✓E FAX#
r 1 am not using any slbcontractory: > k 7 'S o
Signature Da
Please check a le subcontractors and com Iete the fo1lowin information;
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE
Cabinets do work
Cement FinSshing
Electrical
Excavation;. —
_ Fencing, I;. --"�—
Flooring.CAipeting
Linoleum/JWood
• Glass/Glazing
Heating
Insulation
Landscapin
Lathing ! –
Masorery
Ornarnentali Sheet Metal
Painting,/ V1 allpaper
Paving
Plastering
r_ Plumbing
f��g
Tank
Sheet Metal
Sheet Rock
Tile
? /COQ ac Signature
• 3f$
ZO 3JOd ANI S311I110KST1 ZSZE9E5016 OP:Zr POOL/S11[
Community Development Department
f Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E kT I N O 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.
Homeowner's Name: CA,�
Job Site Address: �U r3Z
Roofing Company Name: Zt, (9 trcP r —
A plicant s Signature: "2 a� Date: 7 3o O#
11
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFCITY OF
v 7 7
CUPERTINO PERMIT APPLICATION FORM
APN# r Date: ZQ/v y
Building Addre�o 9-3 z�
Owner's Nam �o�iyi.�-�c,�.. Phone#:
Contractor: P one#: License#:
L) t717d ' s 09GyU v$v3 3Z5� 3 /
Contact: Phone#: Cupertino Business License#:
qat SOS -5// 5 a-0 8-/C7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) X Other(Specify) 6.OtAa,. 5=tjP•Le�
Number of existing coverings I X Provide I.C.B.O.Report# 0—Q 5'4 �6
0 To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Underst nd and Will Comply With Cu ertino's Tear Off Policy: 1�31
Job Description: T—/0
georow,
Residential Commercial ❑
Fire Zo Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: LJ
C st of Project: Type of C tion: Occupancy group:
2/ UUO . �}y
Qty. I
Applicable 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
63