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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
RUFF'S ENTERPRISES
PERMITN004120086
1077 MILKY WY
OWNER'S NAME:
PERMIT LSUE DATE
BETTY BOLANDER
3643 EASTRUDGE DR.
12/14/2004
ONE:
SANITARY NO. CONTROL NO.
(408)528-6227
ARCHITECT(ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB - MECH
0 I�
c LICENSED CONTRACTOR'S DECLARATION
Job Description
�t'tfcytby affirm Nel i am IiLcvcd under prion of Chapter 9 mommenring
P
wNScyr66610(X17 O(Oivision3 of NCBusnamonlure Com,aMmylicommis
- -
nlbt(oreeanderr ✓ c
Lkense Class Lis. g 1 1
REROOF W/COMP.
Dam1?— f 4.-014 Centrbnor��'Y E N _ '
ARCHITECTS DECLARATION
�rmm y planashallbouscdsspunlicmn l—ru—g ay planawRbeuscdsspunficmca Z—ru—a �.
L' nsc Pro nal
���G��
ON
DECLARATION
I hereby OuH I am exempt front Contractors License law Ire she
Nat 11. exempt Idem the Conlnal
reason. Sect
Co
t YfD LS, t. altess and tweeprodemolish.
whfollich requires aPermit e ols h. or minor mity or countyLure
which requires . rtpaig der almcmn
re em1ANC1, aLLm, Ilrgmise dcermit
tf ' //��1
pCrmn
• -• 0
t file ement
printtoits pursuant nto the LIC ilio o (for nonextorlmiec a Law Chstaapter9
wshcisling wis pmvivismofof
�
Sq. FL Floor Area -�..,�Vahi'atidn
sction 7 ) of Me Business and PnfAn,ACade)or
(em Me Buxnr'sndProaaons Code) or
somit Srsli.
Net aund)M basis for Any violation of
r exempt wrefmm aha Ne aper
he is the carman
it to
Semon 10]1.3 by erry applicant for a permit subjects Ne applicant to a civil penalty of$
io subjectsMe
not mon Nan Gro hundred dollars ($5()(h.t
(J)
e
FOCCUp anCy Type
ay
moa ulns'vhalt mm motion.
❑ I,uownm of the Y poycesw Bes pe
isoffered
ti/y 1.
MetimiparmcmI
ss
and Lica e L w it for of apply to in owner
and Pr Ne moons and Ne swcnrt is Corrosion's Law can haat apply n in owner of
of
cam: The Canhemon,
o : i , l i s
- Required IHSp0Gt10DSr J I. -
who had who
property rimprot=hiMon,andwhomessuenwueknimtelfm
p
!/ \r _
owever. ye ora 1f.
cmploho .prod Nm suchimprosemmtamoot intendedmaBeeed foe Ir.
Wipnvidrri
pu owner-
own
or improvement is hath within one year of mpromf
builder the ave
J
the
builder will neve w burden of proving Nn m did not Wild m impratt for puryam of
r
—
❑ I, as owner of she motion,, am exclusively, convecting with licensed contractors to
,
construct Ne pmjmt (See. 10X4, Business and Professions Code:) The Como cnri Li -
mouse Law LOCI net apply ta an owner of pnpcny who Wnids or improves doRon, and
who contracts fin such projects with a contraimr(s) licensed pursuant in Me Convmtols
License law. -
❑IsmexemplunderSec. .B&P C for this mann
.
Owner Dam
WORKERS COMPENSATION DECLARATION
I thereby awsro under peeahy of mijur, one ofw fallowing doelaeauon:
.
I bawand will maintain aCe rf .mof Consentmself-insumfer Wof .Co.,,-
setion, as provided for by Secure 3100 of Ne labor Code, for the perforewro a of the
_
work for which this permit is issued.
.
❑ 1 have and will meimain Worker's Compenseuon hum an as required by Section
_
3/00 of the labor Code, for the performance of the work f w h Nis permit is issued.
My W kcta Compensation Insumtoc camiumd Pol'eynu ram
S{at,Fe F,AL.dQ !8'35
CElmFlCATEOFFXEMPn NFROM WORKERS'
COMPENSATION INSURANCE
mosseetion seed not Wcomplemd iftne permit rforome humhouldollm (SIM)
or less.)
I certify that in the performance of rte work for which this permit is issued, I shall not
-
employ any person in any mannerm as n become subject to de, Wortrri Compennuon
_
- - -
lawsef California Date
- — —
Applicant
_
-
NOTICE TO APPLICANT: IC after making this Certificate of Exemption. you should
beeome subject 10 the Worter's Compensation provisions of line labor Com, you most
forthwith comply with such provision or this permit shall be rumored ranked.
CONSTRUCTION LENDING AGENCY
-
IWrebyaRsm that Nem iaa copewction lending agency lm Ne perform muf
Me .,it for which this permit is issued (See 31191, Ca, C.)
ICMCIs Name
Lender's Add.,
I ante wt 1 have nae this application and stab Nal the above im mlasiun r
1 agree n comply with all city and county ordinances and smm laws relating
buildscorrect-
building rationed ion: and enthrone malivcs of this city n color upon the
e
former
iemnify anpurposes.
purposes
shout -mentioned to
(Wju agree n cost, indemnify and keep hay w City Cupertino againstCty
incoisequene or Mecos¢ando(Mis Psin m iso
mit. may in my my accrue ageism City
Aconsequence of w RSTAgranting of Nis permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WI -POINT
Issued by:
S 0.CE REGU A NS.
91/
aaO/2-fV" d V,
Re -roofs
Type of Roof
Ignmurc ppli anucam nr Date
HAZARDOUS MATERIALS DISCLOSURE
Will Me applicant or future Wilding mmolor l some or MMIC hmudous material
u defined by the Cupertino Municipal Code. Chapter 9.12, and Ne Health and Safety
ore. Sect.2ss32(a)1
❑Yu I;�afo
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or dcvmm; which
If a roof is installed without first obtaining an inspection, I agree to remove
mil hanocous air contaminants u defined by Me Bay Area Air Quality Management
Dimicta
all new materials for inspection.
P
❑Yes YNu
I have nail the ha ardnusmmriar noM mmcnta under Chapter 6.95 of the Califor-
'
nesHcol" SafelyCedle, Somo M505,25533 spot 25534. I understood! Ihatiflh Wilding
dues our c oil have a tenmc Na it r my mspomibiloy o nos occupant of the
mquimmnmwme7J�p,'',Ix^mclfrior�n iaeaan�`o ream ora may.
Signature of Applicant Dale
ae0 /�'-ircw/�ari 12- ey--J<
All roof coverings to be Class "B" or better
o ,til riadagent' Dam
CITY OF
�UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
BuildinLr Deuartment
JOB ADDRESS: PERMIT #.
ion M.4- W A 4 oy Id -00
OWNER'S NAME: 8 L-1 i f o L-A N 9 F- (L PHONE # a -(o as -7
GENERAL CONTRACTOR u r -F nJ e 9- e R-0� FAX # -7a,-9 S
I am not using any subcontracto
Signature Date
Please check applicable subcontractors and complete the following information
Wt�:+� q .
Date
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
N2Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Wt�:+� q .
Date
Community Development Department
Building Division
" City of Cupertino
I
10300 Torre Avenue
CITY Telephone: (408) 777-3228
Fax: (408) 777-3333
U P E IST I N O
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.
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 stated policy on re -roofing.
Homeowner's Name:
Job Site Address:
Roofing Company Name: P—U ELS 7r - A Q [2-(,y L S
Applicant's Signature: ,tu/&Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
J
CITY Or
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # � � � f U Q
� �—
Date: 1
Building Address:
Energy
BUILDING
BSEISMICRE
Owner's Name:
BUILDING
Phone #:
&Ei i Y 0
DC2
-7-1 - -7
Contractor: F S £ >J E rem s f. S Phone #:
License #:
EA P-� 1�J
say -G _
—7 5 , a -i 9
Contact:
Phone #:
Cupertino Business License #:
4f 111V�_
Sic
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
Asphalt Shingles Lo p
V, Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing covering—
❑ 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 Description:
!,,,-L- eckr o
ey7*oVV\. Slti� e o- - ��tsA_z!( Q 4i3 e,r
Residential
Commercial ❑
Fire Zone: -,.Yes ❑ No ❑
_ - Confi with PlanningWit. if
ther e any restrictions: 15
Cost of Project:
o C tion: Oc up y groom
-I S < J -T-0
if
nl ab)
Fee M -
FaP rlPcrnntinn
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
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