05100053 C[TY OF CUPIvRT[NOCLINTREICTQRINk'ORMATION *(
BUILDING DIVISION PERMIT W,
BUILDING ADDRESS: S TOLENTINO ROOFING CO PERMIT NO. 05100053
10351 HENEY CREEK r>T.
PERMR LSSUE DATE
OWNER'S NAME: ,
ANDREW & ANITA SHU 7007 REALM DR in/i2/20nc;
NE: SANITARY NO. CONTROL NO.
(408) 578-4141
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
na, LICENSEDCONTRACIOWSDECLARATION
u+FmF I bereby affirm O,1 am licensed under provisions of Chapur 9(commencing Job Description
on
-i% with Scnion]q)U)ofpivixion3ofthcBuxinnsandr.cssi9psCodcaQmylicense is REROOF-T/O SHAKEES,MS, . IN
n<N
in full folie and effect. - S 2 Z7 �®
z Licensef0— �3 Lw.a LIGHT WEIGHT TILE
n t•o Dam ]— C-S DECLARATION
DECLARATION
Sy-< ! I undcmanJ my plans sM1all be useJ as public¢mNx -
NOV �g 5
'60 100
;oG Licensed encs Tonal
3 OWNER-BUILDER DECLARATION � cess
0 f I hmou. .(Sce that 1 1. exempt from dm Contras Co License Law for the O■M•y r-
Oo Which
moon.Permit
]1151.5,Busirmssand ve dcaen Code:Any city or county y t�
$I which rets sU.a permit m cursors alcor.improve demolish,or repair.sli any suourco.momm .:((:]]� .AAT��{
priorto its censed purse rtyuithe prevision of o,Contractor's
fined stammrnt S Ft.Floor Area 'dL$ d 8 'V Vaalua#M 8 7 0
—=< that he is licensed pursuant it) previsions of thc CDmmcmr's Li¢nse law(CM1epmrY q `J
YFG (commencing wiH Seaion]Ot]Ol of Division S of du Businenand%afession COde)ser
i $ Nat k u eaempt tMrtfrom and dm Inose for the allcgc0 exemption.Any violation of
S<ction]051S by eery applicant!orapermis subjccu Ne appiicantmecivil penally of APN Number Occupancy Type
or more thao 0m hundred dulls.($500). 34248029 . 00
1,as owner of the property,or my employees with wages u their sole compensation,
will do the work.and due summa u not inuended or offered for sale(Sec.](Aa.Business Required Inspections
and Pmfessn License idCode:The Cciamm ce,L ce law deer net apply to an owner of
property who builds or improves Hereon,and who does Man work himself or Hrough his
own employers.provided that such improvements art not intended or offered for sale.It,
however.He building or improvement is Sold within one year of completion,He owner.
Wilder will have Use,burden Df proving Out he did not build or improve for purpose of -
sale.).
❑1.as owner of the property,am uclusively contracting with licensed contractors to
construct He project(Sec.7814.Business and professions Cade:)The Contractor's Lt.
cerise law does not apply to an owner of propeny.who builds or improves Ihemon,and
who contracts for such predicts with a contraeror(s)licensed pursuant o He Contractor s
License law.
❑I am a..nM under Sec. ,B A P C for His mssan
Owner Data
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penalty of perjury one of He fallowing declaration:
I ham and will maintain a CenlOom of Common In self-inum for Winkes
n provided for by Section 5]00 of the labor,Code,for the performance of thc
W
for which His permit is issued.
❑1 have and will maintain Worker's Comns
peation Wurance,as rcyuimd by Section
5]00 of He labor Code,fm the performance of the word,for which His permit is issued.
My Workers scope tion Immomme artier and Policy number am:
Cartier. S' Policy No.: —
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section recd not W complcud Hire permit isfororm hunNW dollars(5100)
or lest.)
I certify Hat in the performance of the work for which this permit is issued,I shall not -
employ any person in any manner so ar w become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Eacmporm.you should
become subject in Use Wodch Compensation pmvisions of He labor Code,you muse
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
z '—' CONSTRUCTION LENDING AGENCY
I M1creby affirm that dare is a construed..lending.germy tar tee Performance of
ya 7 thc work(or which this permit It issued(Sec.5097.Co.C.)
ti] Q Lenders Name
=z Lender's Address
U 0 1 certify,Hat 1 hart mad His application and sou Hat thc above information is
f" correct.l agree to comply with all city and county ordiruntts and sou laws relating to
O U building construction.and hereby auth0risa mpresenutires of this city to enter upon the
r W shove-mentioned property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
H h
Liabilities.judgments.costs and expenses which may in any way accrue against said City
U z in eomequencc of He graming of this permit. Dale Vim/ G a
CANT U ER ST AN MPL WITH ALL NON-POINT Issued by:
w. SOUR EREG L S. /7
t'0-6� Re-roofs /-� -�✓�a 1 1
Si aur of ApplicanVCOntractor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
III the applicant or future building occupant mare or handle Invasions material
az defined by the Co anino Municipal Code.EWpur 9.12.and He Health and Safety
ode,Section 25552(a)?- All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will thc applicant or for..building..Pontuse cyuipment e1 devices which If a roof is installed without first obtaining an inspection,I agree to remove
it M am us air cmuminsets.dcfincd by the Bay Area Air Quality Management all new materials for inspe n.
trip?
D Yes
1havesad He Mmrz ousmawrialsmyuimmcnuunderClmpur6.95ofthcCalifm-
Ith&Sab"Y"dc.Section 255(1 2�n5XIun&�Odifthc Wilding L at CunC beaC a Mn - ItHCoccupantofthe
egai' emsmn msuL met Priercmpancy. atu e of Applicant Date
0^(L All roof coverings to be Class"B"or better
O net r auNutfre agent Dam
Community Development
10300 Torre Avenue
f1 Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
b-3,57 -EclC P E a yy boo s3
OWNER'S NAME: w —S PHONE # A Sb I
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
RI 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
Owner/Contractor Signature Date
Community Development Department
am Building Division
City of Cupertino
10300 Torre Avenue
CI OF Telephone: (408)777-3228
U P E RTIN 0 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.
7. NOTE: If you call for a plywood nail 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 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 statedpolicy on re-roofing.
Homeowner's Name: /i1-1�rVAf('-Cw /UL,L(
Job Site Address: J 1 /J� C/ �tc
Roofing Compan me: ` / V
Applicant's Signa tu e: L Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
ar�,,zwv CITY OF CUPERTINO
RE ROOF
CUPERTINO PERMIT APPLICATION FORM
APN # n Date:
Building Address: / 35
J l
Owner' Name: P
Co tract Phone #: License #:
X077
Co t t U Phone #: Cupertino Business License #:
Type of Roof Covering:
ExyC g: Proposed:
Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
`
< Wood Shakes ❑ Wood Shakes
`❑ Wood Shingles r /�� / ❑ Wood Shingles /
Other(Specify) lTlriE EY' 6 9�Other(Specify) (, , l It d °JtE
Nu ber of existing coverings '�b pL� ❑ Provide I.C.B.O. Re #
To be Removed Y-Q,{�tl� ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: (yt O CEJ S / � 1 AJ4
hex C s 2 wer F
Residential Commercial rn
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Pro. C ' D _ Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
/1 BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
7o , 0 �