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' CITY OF CUPERTINO
CONTRACTQR=IlYFORMATION
BUILDING DIVISION PERMIT............
I
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BUILDING ADDRESS:
JOHN HENRY ROOFING
PERMIT NO. 05100044
-10671 LA RODA DR
ER'S NAME:
PERMIT L55UE DATE
SHAUYING KUO
iGNE:
12780 CLAYTON RD
11 2005
SANITARY NO. CONTROL NO.
(408)241-1334
ARCHITECUENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
p
with Section 7") of Division 3 of Ne Business rid Professions Code, and my license is
On lull first and et. —S
F-
REROOF-ISNTALL STON pSQ}ES�,
Liven I . Lica C
Dem Cunuacmr
L��Ilgv�p�d`J�,
ARCHITECTS DECLA T1 I
I understand my plans shall he used as public records
NOV 44 2005
Licensed Professional
OWNER -BUILDER DECLARATION
c
1 hereby that I am Exempt from Nc Contractor's Li«nsc Law for the
maso . (Sect C's
whichre mason. (anti t ]1131.5, Business and vet de ons Code: Any city Of county
which squires a Permit m construct, alar, improve, demolish, m repair any structure
N $', ip'�w �� $6160
CIOIIIM
h 1 signed t
prior us its issuance. also mqo the the applicant for such Permit m Glc
p an
F[. Floor Area 1>�yValuatlOn
Inashe is License Ch.por
wit pSection tulha pm visions of NcConushicasnProfessions
Sq. �8
Coda) or
(commencing with Section ]000) of Division 3 of me Business and Professions Cale) of
mecing
' Nat he u exempt Ncm,Gom and the baso for Nc alleged exemption. Any violation of
3 AN A§_F U U Occupancy Type
Section 7031.5 by any applicant for a Permit subjects the applicant ro a civil penalty of
not mom than five hundred dollars (5500). ,
1, as owner orae progeny, or my employees with wags as their sole compensation,
Required Inspections '
will do the work and the swxure is not intended or offered palliate (Sec. 7044, Business
Rod Professions Cade: The Conuecmr's License Law does nal apply to an owner of
property who builds or improves Verson, and whodm such work himself or through his
own employees, provided Na such improvements are not Reacted morcoul forsate. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving Nat he did not build or improve for purpose of
sale.).
❑ I, as owner of me property, am exclusively contracting with licensed Contractors to
construct the project (Sec. 7044, Business and Profusions Code:) The Contractor's Li-
_
cue Law toes not apply in an owner of pmNny.who Wilds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to Ne Contractor's
'
Lice nae Law.
C]1 am exempt under Sec. . B & P C for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Ne fallowing deelaration e
Ihave and will maintain a Certificate of Consent to self -insure fur Workers Compca.
ion, u provided for by Section 3]00 of the labor Code, for me performance of the
rk for which Nis permit is issued.
137M
1 have and will maintain Workers Compensation Insurance, as required by Section
of Lie Labor Cote. for me pmformance of Ne work for which Nis permit is issued.
y WorkersCompensatiioonInsurance carrier and Policy number am:
rtier:�/q
CCC ER�TIFICATEOFEMPT10NPolicy ROMWORKERS'/
COMPENSATION INSURANCE
(Thu station ncad not be completed lithe permit is brute hundred dollars ($Nf,
or lcsa)
1 canary that in me x,rfo m muc or Ne work for which this Permit is issued, 1 shall not
employ any person in any manner so as N become subject to the WorkersCompensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of Ne Labor Code, you must
frMwith comply with such provisions or this permit shall be deemed nvokcd.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there isi lending agency for Ne performance of
' the work for which this permit is issuer (Sm. J09], Civ. C.)
cd(Sm.3
Landcr's Name
,
Lender's Address
j I certify that 1 have mad this application and sur m that the above information is
correct.' coect. I agree to comply with all city and county ordinances and sma, laws slating to
building construction, and hereby authrme represcat iwr or Nis city to enter upon the
1 above-mentioned property for inspection purposes.
(we) agree to save, indemnify and keep mummers me City of Cupcnino against
j liabilities,judgments, costs and caprices which may in any way accrue against said City
in consequence or me gunti ng of this Permit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 1,9-11—e p,
SO REGULA
Re -roofs
Type of Roof
arum, or ApPma t/ onuacto - Date
HAZARDOUS MATERIALS DISCLOSURE
Will me applicant or future building «cupant store or handle havardous material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Hcalth and Safety
Grote. reopen 25532(a)?
OYci �lr
r
All roofs shall be inspected prior to any roofing material being installed.
1
a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant alit equipment or devices whichIf
mit haiartous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Dili ix?
❑Yes �rqu
I have read the ha ardnus materials requirements under Chapter 6.95 of me Caliror
/1
ria Health& Safety Code, Scomis 25505,25533 and 25534.1 understand Naz ifthe building
dors not currently haw moan', that ll Is my fCapnmsl hdity m firmly me «cupaen Of OR
ants whichmel prior i rracemremeor Om aneyy
gnature of Applicant Date
roof coverings to be Class "B" or better
ncr or authrrircd agent Date
iI J
CIN DF
�UPEkTINO
1'
r
Owner/�
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
PERMIT #
S/D�O�f l
R' N
PHONE #
GENERAL CONTRACTOR:
FAX #
f
I am not using any subcontractors:
Signature Date
Please check applicable subcon ctors and complete the following information:
/lam -// - 62:g -
bate
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
/lam -// - 62:g -
bate
Community Development Department
Building Division
ti City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
U P E kT I N® 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 LC.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/g. Z/" '7�30 9V
Homeowner's Name: U
Job Site Address: ll, -)K —;;—;, l _/ '-1 �,,.-�/�„ j�1
Roofing Company Name:
Applicant's Signature
"Dater-l�—
Greg Casteel
Building Official
Revised 71/2/04
Printed on Recycled Paper
CIN OF
CUPEkTINO
CITY OF CUPERTINO o �.
REROOF
PERMIT APPLICATION FORM
APN #
:
BUILDING
Date: I
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
Building Address:
1.
BSEISMICOM
Seismic Commercial
Owner's Name:
BPLANCHK
Plan Check Fee
Phone :
BUSLIC
Business License
BUILDING
D
Co tractor:
Phone #:
License #:
Contact:
Phone #:
Cupertino Business License #:
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)
❑ 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 With Cu
ertino's Tear Off Policy: ❑
Job Descripti
Residential Z
. Commercial ❑
Fire Zone: Yes ❑ No 0
Confirmed with Planning Det. if
there are any restrictions: LJ
Costo P oject:
Type of Co struction: Occupancy group:
�Pr,0
+°
Qty. if
Applicable
Fee ID
Fee Description
Fee Groun
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