08060002 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORANFORMA JON
PERMIT NO.
eu11,o1Nq,yppR SAN FERNANDO AVE TBD — TO BE DETERMINED 08060002
OWNER'S NAME: PERMIT ISSUE DATE
CI'PY OF CUPERTINO BLACKBERRY 06/02/2008
NEn non SANITARY NO, CONTROL NO,
ARCHITECDENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
(� 0
u o O LICENSED CONTRACTORS DECLARATION Ib Description
rd U 1 haffirm
ereby that 1 am lieOesCTIP
naed under provisions of Chapter 9(commencing
nz16 withSecoonl0(1lparoiMnun�urumBudneaaanerrorea:;nrutnde.,namyueenxu TEAR OFF EXISTING ROOF, INSTALL NEW ASPHALT
n full fame and effm.
CBA, License Class Lica SHINGLES, AND NEW GUTTERS ( CITY JOB NO FEES)
a—p Date Comr,cw
7W ARCHITECTS DECLARATION
1 unMnuns shal
nd my plans be,used as public records
A.,
g u0 t; Liar ed Profee anal -
5 OWNER-BUILDER DECLARATION
on
F 1 hereby efforts that I am cam pt from the Commad's License Law for the
52o fallowing mance.(SeNon RD 1.5,Business and Professions Code:Any city or county
.E! which sequins a permit to anteroom.alter,impmvs,demolish,or repair any nbunum
_xi prior to its issuance.alsu requires the applinntfortuch permit to file a signed smartest
pp < Sq.Ft. Floor Area Valuation
bur be is Hamad pursuant to the pmviaimu of the Comments's lactone law(Chapter9
y�$ (cammcnd.,with SeCfi..7")dDivui..3.fue Business sod P.C.i..Codc)or $16141
— ghat he u eaempt therefrom and the baso for the alleged exemption.Any vi.lauan of
Section 701.5 by arty applicant for a permit subjects the applicant te a civil penalty ofNumber OCCU anC e
re tha
not mon five hundred dollar,($30y). 35710005 .t? P Y TYP
❑1.u cant of the propvry,a mY emplaycns with mgr u their note eompemahm,
add Ppthewmrit and the V.Consume,Lt ear oRe dotarsale(Sec.to as
sere Pm,whobu Code:Th Comrecmn Ligase Low don ed apply lf ri mWOCr is Required Inspections
.a emY who Wilds m imyrat such
h unproaesdormnul weds mdule nimselralhumugh his
own employers,provided Nn such improvements ase not can fon moReree for ale.W.
ba Id the Wilding mimprowemmtusoldwithinarc)ear or Wturmm for the Damn
builder wiR h iM burden of proving Nn he did not Wild or improve for purpose of
Gley
1.a awn of ea property,aro esduaivcly concocting with licensed commando W
construct ue Mica(See.]OCG,Business and Professions Code:)The ConmemrS U. .
cwe taw don mat apply m a Dane W propenY who Wilds or improves Merton.sod
Who contracts for such projects with a cOnbYWf(n)licensed pursuant to the Comacmrs
License law.
•'lam exem sunder eta ,B B P C for thus wan
Owner Date / 10P
WORKERS 0 PENSATIONDECIARATION < !
1 baebY alfum under emltY of perjury are of ha:folbwing declaatioru
I hsas aM will for by a Cion 37M of the Labor
Code,
due performance
of use
noon,r provided far mi Section 7'100 of the IaWr Cotle,for the performarra o!use
wart for which this permit is issued.
❑1 have and will maintain Worters Compensation Insurance,as doctored by Section
77M of the Inbar Code,for the performance or the work for which this permit is land '
My Worlds Compensation hawrance carrier and Policy number art:
Cartier. Polley No,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu mason mcd not WComplaal ifthe permit is forone hundred Wilson;($100) - -
errWd)
1 artily than in uc pcsfordsma of the work for which this permit is issued,l shall not
employ any person in my m ser bbemmem dmtheW 'Compewded
laws of Caiifumia Dacj% �
Applicant �W�
NOTICE TO APPLICANT:If,a0er gAeyd Nu Califrsmte of Exemption,you should
become subject m um Workers CPmpeGstimn pmtiions of the later Cede,you must
C)O forthwith comply with such provisions or this permit shat]W mv
doomed nhed.
zr h CONSTRUCTION LENDING AGENCY
F-r Ithereby,TBdm that them is a construction lending agency for the performance of
C4> the wont for which hos permit is issued(Sec.7097,Civ.C.)
a0 Landers Name t .
Z:)Z Lenders Anew
U o I certify that 1 hale read tis application and sate this the shows information is
comet I agree to comply with all city and county oNinanas add all laws mining to
.� building mrtswaIm.and hereby athadm rtpmanutiwss of thistidy to murupon the
Lg7 above-menfitmd property for inspection purposes
f+ LL (We)agree to arc,indemnify and trap handler the,City of Cupertino agairtst
r/) Iiabililm.jodgme.d.easu andeapenes which may in any my.ame.gainnt said City
V z in consequence of the granting of this pontoon.
APPLICANT U DERSfANDS AND WIL .CD PLY WITH ALL NON-POINT Issued by: Date Z `�
SOUR R GU TfONS. /� `�
Srgnaurc of Apphcen .Lel //Oats Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ON applicam or future building occupataom or handle haardons mamoal
as de0md by en Cupertim Municipal Code.Chapter 9.11.and the Health and Safety
Conn.0yes s71(a >I �� All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
m t hvaNnm air comLmimnts a defimd by ue Bay Area Air Quality Management all new materials for inspection.
Disuict,
❑Yen
Thaws malthe h,Sation 25505. mquhements under Chapmrb.95 ofem Califon
dies on"u Safcty Cees Sccoa that It.25573 and 2557 lyndeyend uaifue Wilding (' Z
ems rot curmnOY hose a duan4 that it u m din m mtifY the occupant of Nc O
ayuimptcnaw nth must Ee ma p' r uana ala Ccnificeu:of Sign cure of Applica Date
//f al 6 d'
Owner amumrvee nt D„p All roof coverings to be Class'J{.”or better
" CITY OF CUPERTINO
SCG°-
REROOF
•CUPEI�TINO PERMIT APPLICATION
to wz
APN # Date:
s'7 /p G�Sbv 6la/oCP
Building Address:
2 / 9 7 9 .S�,j F?n/q X070
Owner's Name: (3�A�lt deed Phone #:
Cit n1 C�PP� fiNu- F�R� LIOP- 777- 3.27z.
Contractor: Phone #: 4k, P_3 77 $77 7
po,je
Fax #:
Cupertino ppsmess Licen5.e#- Contractor License #:
77Y9 62
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles f Asphalt Shingles
X 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.
Job Description:
Residential El Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the there are any restrictions: ❑
application or if applicable, include in plan
set & the sheet index.
Valuation: 1A6/ P//
/
•I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
;- CITY OF CUPERTINO
.- - REROOF
OCUan OF
PERTINO FEE SCHEDULE
Number of Fee ID Fee Description . Fee Permit Type
Squares Group
1 REROOFCOM Re-roof Commercial B ICOMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
•
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
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 stated policy on re-roofing.
Homeowner's Name: u Y Cv 20/2 i/,fo
Job Site Address: 97c) S .� re 12 i,,19 Cl)Ro.2 fi ,a
Roofing Company Name: D�^1 2 1 j ry f _7Z i C
Applicant's Signature: Date: Z o�
• Greg Casteel
Building Official
Revised 11/2/04
Community Development Department
Building Division
City of Cupertino
• 10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408) 777-3333
Building Department
REROOF TEAR OFF POLICY
1. You must schedule an inspection for the tear off the day before
you wish the inspection to be made. The procedure is to call the
Building Division (408) 777-3228 between the hours of 7:30 a.m. and
3:30 p.m. to request a next-day inspection.
• 2. ' When the roof is torn off, the nails have been removed or driven in,
and all of the dry-rotted wood has been replaced, you must call the
City Building Division. An inspector will be there within one hour.
There are special hours for this service: from 7:30 a.m. to 10:30 a.m.
and 1:00p.m. to 3:30 p.m., Monday through Thursday and from
7:30 a.m. to 10:30 a.m. and 1:00 p.m. to 2:30 p.m. on Friday. (Note:
Building inspectors are on lunch break from 11:30 a.m. to 12:30 p.m.
and will not be called during that time. City Hall is closed between
12:00 and 1:00 p.m. daily.)'
3. If you call for a tear-off 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
Greg Casteel
Building Official
Revised 8/13/04