04100033 �• TY OF CUPERTINO ._ ; ' - �" '�
1-7
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BUILDING DIVISION ` PERMIT W3•FV�w:/ � ^"^�"""` �l"/ -�< x '.'v.-v��.�'. _
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•'. BUILDING ADDRESS: PE "" _
TOM MCAURTHER CONSTRUCION 04100033
10350 MILLER _
OWNER'S NAME: PERMIT ISSUE DATE
GREEN & TURNIE CO.
ZONE:
SANITARY N0. CONTROL NO.
(408) 509-1671
ARCHITELTENGINEER: - BUILDING PERMIT INFO - -
BLDG
o ELECT 0 I
PLUMB MECH
ee 0 0
a0Z' LICENSED CONTRACTOR'S DECLARATION ''11,,,,I{{I..,,��'' BSS ff��nnnn
I foreb .fibre Chet l am lironud under visions of Chapter 9(commencing F I O r► ® --
withSecuen 000)of Division Sof tho Bnsin d Profe.suns Code.and my license is '`V®�C/�p9r►L
d
rto` mfulIf derr 1�7N�6 REROOF W/COMP.
j✓�z Licen lawn
L' DekConlraemr aaan a c'j2-
3e q�q A CHITECFS DE�,k •...,y.N _
Y a I understand my plans shall M need as poini2lCl.,us OrT
Jy
c Licensed Prefcssi...I
OWNER-BUILDER DECLARATION BUILDING
r.a f 1 hereby maso .('firm that 11. exempt from the Connector's Co License Law for the ---
r.
-
p O which
re meson.(Section ID3 construct,5,Businos and w.de inns h.or Any city tar county
$E which its iss s a permit rat quiresOnsire.improve,demolish,m repair ed strusever,Women,
iy that hor e its�ensed soak.requites Oneapplicantfor such Contractor's
LieeseLawAstakmem
e
that roman licensed puruont tothe of Divinnsnf the Co usines's LklmY law(Chapter 9 Sq.Ft. FI007 Area Valuation -
$ (cat be is romancing tScNaore and of Division 3 th the alleged
exs a pt Professon.Any
Cade)of
- that he u exempt tftemfrom and the bon far the olegctl exemption.Any violation of -
Section 7031.5by myapplicant for 4permit subjects the applicant anacivil penalty of 3'ABONhinber00 Occupancy Type
nm mart Nan Eve hundred dollars($500). _
❑1,as owner of the property,or my empluyces with wages as their sole compensation,
will do the work and the structure is not intended or offered fur sale(Sec.7040.Business
and Pretensions Codi:(fie Contractor'.License Law does not apply to an owner of - - Required Inspections
propenywha buildsorimpmvuthercon.and whodoessuch work himulfurthrough his
ownemployees,provided Nat such improvements artnot intended oro@red tarsale.If,
however,the building or impressment is sold within one you of completion,the owner.
builder will have the human of proving that he did not build or improve(m purpose of
sale.).
❑I,as owner of the propeny,am exclusively contracting with licensed contractors to
concoct the project(Sec.7044,Business and Professions Code:)Tfie Contractor's Li.
cense law does not apply man owner of properly who builds or improves th.reon,and -
who contracts for such projects wit aconu.ctor(s)licensed pursuant to on Contractors _
Gsou law,
lam exem/plyndbe S,e/c./ ,B&P C for this moon
Owner f /a"/�' '1j✓a Dsk B^OG—
WORKER'SCOMPENSATIONDECLARATION - -
I hereby afllrm under penalty of peduty one of the following duluazlons: . _... -
Ihave and will maintain aCeNfmase of Consent mulf-come,for Worker's Compen-
sation,o provided for by Section 3700 of the Labor Code,for One performance of Ne
work for which this permit is issued.
E31 have and will maintain Worker'.Compensation Insurance,ss required by Section -
3700 of Nabor Cade,for Ne
e Lperformance of the work for which this permit is issued.
My Workers Compensation loan..eerier and Policy num her am:
Carrier,
CERTIFICATE OFEXEM O OM WORKERS'
COMPENSATION URANCE -
(This auction need not be completed if the permit is for one hundred dolboa($100)
or less.)
1 cenify Not in thdperkmnanee of the work for which Nis permit is issued,I shall not
emp(oyamy a in any manner so o to become subject inthe Worlaus Compensation -- '
Laws of C if .Date ._
Applicant ...
CE TO APPLICANT:If.after making this ConiOaxk ld
of Exemption,you shou
owe subject he the Worker's Comp osition provisions of the Labor Code,you must
Q Z oMwith comply with such provisions or this permit shall M decimal revoked.
'Z'O CONSTRUCTION LENDING AGENCY
[r I hereby arum that there is a conswctinn lending agency for One performance of
r(.7 the work fur which this permit is issued(Sec.3097,ON.C.) -
0.Q LondeesAddmss
Name v
.7 Z Lenders Address
V Q 1 cenify that 1 have read this application and sum that the shots information is -
jy cared I agree to comply with all city and county ordinances and slate lawn westing m
Qbuilding conion,t and hereby authorise representatives of this city m enter upon One
0 U above-memioned property for inspection purposes.
(We)agree to cove,indemnify and kith harmless the City of,agmina ag
id City /
Uh iiconsiaxnineorthegoosand ex this peemiichmey in any way eccmc against said City
V incomsequcncc of the granting of this permit. _
PUCKA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: - -- Date
SOUSE EGUL ONS.v4I - -
�6 ' Re-roofs
fbiahareafAlpiplicarwConuactorDow
HAZARDOUS MATERIALS DISCOSURE Type of Roof
Will kc applicant or(umre building occupaotstore or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
ode.SectiYeon 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑ s u
Will the applicant or(ware banding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. -- -
ixuict? — /
❑Yes RK.
I have road the hamodnus materials requirements under Chapter 6.95 of the Califor-
his Health&Safety Code,Sections 25505,25533 and 25534,I understand than ifOc building \ /�
does not c.onamly hos tenn due it is my mop ormbilitym notify the occupant of the
reyui us which must met poormissuance has Certificate off�upancy. 5'1 re of Applicant Date -
Qwafr or —4 oriznJegcnl Dow I All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
1y
Cupertino CA 95014
.. Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPERTINO
Building De artment
JOB ADDRESS: PE IT#
y �, �� I _ 0G(106q033
OWNER'S NAXArC, PHONES /_ S F<
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Sl 'ure Date
Please check applicable subcontractors and complete the followin information:
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
it- Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
1 .
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E'L 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:
Job Site Address: 5o 'end&,c QJ
Roofing Company Narn4A
A plicant's Signature.�N Date:
\�ll�L�l1Dt�
t Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper -
CITY OF CUPERTINO . 2_3
anat-35 REROOF
ISCUIPEkT
NO PERMIT APPLICATION FORM
APN# Date:
J( 6 < '- 0/ -
Building
Building Address:
// �u
Owner's Name: Phone#:
a-,1- 7 0 —o 76 6
Contractors �c Phone#: License#:
Ge�e 09- 67 %a76
Contact: Phone#: Cupertino Business License#:
u d i- Sass
e of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Qs Asphalt Shingles
r;9( Wood Shakes. ❑ Wood Shakes
l� ❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) i5,; _&9. '&I=
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 Descripf — -
. :- o
Residential Commercial- ❑_- n
Fire Zone: Yes ❑ No ❑ Confirmed with mg Dept. if
there are restrictio s: LJ
Cos fP# t: Typen cfo Occupan ou
Qty
A is le Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
2 23 24'
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