04050052 CITYOFCUPERTINO .twT%°"">;"c�d`"` ''� xa „»r .
BUILDING DIVISION PERMIT CONTR?.CTORINFORMAVON:
a ILDINGADDRESS: TNT ROOFING CO PERMITT4050052
PERMIT ISSUE DAM
OWNER'S NAME:
4
SANITARY NO. CONTROL NO.
ONE:
(408) 277-0800
BU
ARCHITECTIENGINEER: ECT PERMITINFO
BLDG ELECT PLUMB MECH
LOC LICENSED CONTRACTOR'S DECLARATION Job Description
dI Mosby affirm thin I am Themed under provisions of Chapin 9(rommencing
^� with Senior] )of Divisio Softho Bassi Professions Code,andmythenm is
mu derr n� ly� Sty �S REROOF
z License Con�t Date r `
Y6
ARCHITECT SYs TION
1 un st
Y d my plans aNll M used nand.u c recnNs
i uD Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from tins Contractor's License Law for the
p O following mason.(Section 703 1.5.Business and Profusions Cade:Any city or county
s}$ which requires a permit to Construct,alnte Improve.dccendi h,or¢pair any sa nwro S6145
'ruZ< prim to its iuuanm,alsu m,tine ted applicant rmsuch Permit o file uigmedsutmem Valuation
ppssC that he is licensed pursuanuo on previsions of N
e Convector's Lkeme law fchapter 9 Sq.Ft. Floor Area
rZF$ (commencing with Section 7008)of Division 3 of the Busioevand Profusion,Code)or
that he is exempt therefrom and do,basis for the alleged exemption.Any violation of
Section 70316 by any applicant for permit subjects the applicant m a civil penalty of 3 6AEN 9"be0 0 Occupancy Type
not more than five hundred dollars($5W).
❑Las owner of tins propmy,ar mY employcca with wgaas Heir sole eompenwlon,
will dote worLishmn end thestructure,Con is roti License Law
do s nt apply in an Business Required Inspec
and Professions and
The Contractor's License Law dose not apply ban owner sof
s q P
property who build,or improves thereon.and who does[oCh wink himself or throush his
own employees.provided thmsueh imprewmenta arc notinlended aroQered fmhile.If.
however,use building or improvement is sold within arc year arco nithoo n.Ne owner- /
builder will Mw the burden of proving that M did not build or improve for purpose of
❑I,as owner of the property,,Business s and confessions with licensed contractors m
construct the es Cut apply
to in meri and Profusions Code)The Cs there rs Li- D
cerise Inns dao nm apply jt u owner of property who builds rs improv Corton,and
who convects for such prokcts with a conuscbr(q licensed pursuant to the Canumto8
License law.
lam exempt under Sec. ,B&P C for this mason
OwnerDans
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Iseult,of perjury one of the following declanuons:
1 have and will maintain aCeNficate of Consent in sel6insum for WarkeYsCompen-
hition,as provided for by Section 3700 of the Labor Cock,for the performance of thc
work for which this permit is issued.
0 1 have and will maintain Worleh mr
Compensation lemas ce, required by Section
37M of the labor Code,for ted performance of the work or which Nu permit u issued.
fd\y W,orkeh C/om/pe�n,eu�irsumt¢ Polity N.. G�
CilAer. rGOF
��/ CERTIFlC COMPENSATION
MON FROM WORKERS'
COMPFNSATION INSURANCE '
(7Th section aced not M completed lfthe,permit is forms,hundrecidollars OHM)
or kss)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner an ss to become subject to the Workers'Compensallon
Laws of Callfomis.Dab
Applicant
NOTICE TO APPLICANT:It,after making this Certificate of E6'mPtinn.you should
hemme subject in dic Wohv's Compensation provisions of On.labor Code.you must
,JZ forthwith comply with such provisions or this permit shall W deemed invoked.
Z CONSTRUCTION LENDING AGENCY
(-. I hereby affirm Nat there is a comuucdnn lending agency for the performmco of
fY.i the work for which this permit Is issued son 3099,Civ.C.)
W Q Landers Name
1.r7 z Lenders Address
U O 1 certify that I have mad this application and sub that the above Information is
it.F correct.I agree On comply with all city and county ordinances and sunt laws misting to
OU building construction,and hereby authorim mprasemadwa of this city b enter upon On
W movcmemiorcd pmpeny for inspection purpoxex.
Ly,G (We)agree to hive,indemnify and keep toothless the City or Cupertino against
M V3 liabilities,judgments.costs and expenses which may in any way section against said City
U in t^ his rmit.
APPLICANeRNor due grunfing of tAND
TUNDERSTANDS WILL COMPLY WITH Af,t,NON-POINT Issued by: Date
SOUR G NS. �Y
S � LT Re-roofs
.SiAdsftua o(ApplicanVComramor Dau ,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle Inumlous material
as defined by the Cupertino Munieipa -cele.Chapter 9.12.and the Health and Safety
IdCos
onk.Section 25532(¢)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
mit ha'rartlnus air conuminenu as dc0n 'ted Bay Area Air Quality Management all new materials for inspection.
Yes
Ihave mad the havurdousmknals requirements underChapur 6,95 orthc Califor-iaHcnithik SafnyCode,Sections 25505,15533 and 25534.1 undentted thaUfthc building not summit haw a tenant,that it is my responsibility b nt 'fy the Occupmt of the re riarbihiamttaraceni0a\ Dejrwy SignatureofApplicant Date
Owner antrma .<d¢tarot Date o All roof coverings to be Class"B" or better
Community Development
e 10300 Torre Avenue
j y Cupertino CA 95014
' Telephone(408)777-3228
CITY OF Fax(408)777-3333
#UPEkTINO
Buildin De artment
JOB ADDRES Ppmn #
re3 �� ,v �r of oo s z
OWNER'S N ' 9rvn/ i PHONE # � z 77'-o 8 e'o
GENERAL CONTRACTOR: FAX # db 2-7 7— Cry C'?
I am not using any subcontractors:
Signature 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 evv,F- �` C)
Septic Tank
Sheet Metal
Sheet Rock
Tile
S J�
O /Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
CUPEI�TIN®
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: S/I �/�f /�l ex
Job Site Address: lO 3t° / /�'��/ y_�
Roofing Company Name: L �UU /
A plicanCs Signature: Date: Ste/C o�x
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO S' Z
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 36 S�Z O Z� Date: 5- U�
Building Address:10281
<'
Owner's Name- ,{ r Phone#t
F7�- SS��
Contract o : Phone#: License#:
T�cp Fra z7 ooa0 Sous
CAI,: e_ ` /� f Phone#z 7� O Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ ilt-Up Roof ❑ B t-Up roof
B' Asphalt Shingles 0, 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: 0�
Job Description: / k
e Orre C .Vj 30 JrPiiv
Residential Q/ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confsme rth Planning Dept. if
there ar any restrt 'ons:
Cost of P ojec Type t ction: Occup cy gro
Qty. i
ApptAcabVa Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY —EneEgy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING