04060128 .t
CITY OF CUPERTINO -
k ONTRACTORMOIWATIO1 a _ -- .-
BUILDING DIVISION PERMIT , „ , „ ;
Bun DING ADDRESS: SECURITY TROOFING AIR SYSTEPFSIMITN004060128
20833 STEVENS CREEK BLVD
OWNER'S NAME: PERMIT ISSUE DATE
J VOLCKMAN & ASSOCIATES, I C . 677 KINGS ROW 06/15/2004
NE: SANITARY NO. CONTROL NO.
(408) 971-1777
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0
o p LICENSED CONTRACT'OR'S DECLARATION
tcby in Nal 1 am lisxnacd under pmv eiona of Chapw,9(commencing Job Description -
`� with5�}t6 ]als)of Division]of the Buaincv end Professions Codc.end my l' is I�p
mrtKocaadeffect. rasa�FFF REROOF
S H Llan" 0.41
`�
�Fp Dam Cantromr ,/
ARCFN7ECTS DECL TIO JUN
�i 1 understan my plans shell W used as a mcnrds N 2�[ 2004
3c
Licensed Professional 9999 yp
a'D OWNER-BUILDER DECLARATION 19fix
a1 knehy atirm that I am exempt from the Contractor's License Lew for the aU� ��
p0 following mason.(Section 7031.5,Rashness and Professions Cade:Any city or county
'nsf! which requires a permit m construct,alcor,improve,demolish.or repair any someone 16 8
HZi prior to its issuance,also requires the applicant for such Permit to file a signed Statement
E�D that he is licensed pursuant a Ne provisions of the Common's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
s (commencing with Section 700g))of Division 3 of the Business and Profusions Critic)or
.. Nat he u exempt thcmfrom and the hour for the alleged exemption.Any violation of
SeNon 7031.5 by any applicant for a permit subjects the applicant w a civil penalty of er Occupancy Type
not more than Ove hundred della.($500).
❑I,o owner of Ne property,ormyemployca with wagesso theirsolecomperat
will do the work,and the monsu a isnotiatm ded oroffered forsale(Sec.7044,Business
and Professions Code:The Connectors License law docs not apply in an owner of Required Inspections
property who builds or improves Hereon,and who does such work himsel f or through his
own employees,provided that such improvements an,not intended"offered forsale.If.
however.the building or improvement is sold within one year of completion,the owner
builder will have jr,burden of proving that he did not Wild or Improve for purpose of
Rate.).
1,as owner of the property,am exclusively convecting with Hemsed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Con racmr'a Li.
cove law does not apply to an owner of property who Wilda or improve Neuron,and
who contracts for such projects with a cenlramor(s) 'ceded pursuant Ir the Comlor
nce .
LicenRa Law.
❑lam exemp under u. ,B d:P C far this moon
t
Dam
WOR CER'S CO 1PE14SATIOf DECLARATION
1 heroby affirm under penalty of perjury one of the following declaration:
1 have and will maintain aCenificem reorient to selGinsum for Worker's Compen-
sation,as provided for by Section 3700 of the labor Code.for than,Performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Wu.nce,as required by Section
3700of claWr Code,far Ne FcarfabrOlim of the work for which this permit is issued.
My n C»wpe lion =V0,'cr and Policy number am:
mer / Poli o.: >
CERTIFICATE OFEXEM OM WORKERS'
COMPENSATI URANCE
(This acedon need not W completed fine Permit is f"omptandred dallars($100)
or less.)
1 certify that in to perfxonance of the work for which this morh is issued,I Shall not
employ any Noun in my manner an as at become subject to be Workct%Compenadon
Laws of Celffornia Data
Applicant
NOTICE TO APPLICANT:If,after making this Cert of Exemption,you should
become subject in Ne Worker's Compmnsatian provisions of the tabor Crile,you mot
.J O forthwith eem
comply with such provisions or this Permit shall W emitted revoked.
„Z,i r~�n CONSTRUCTION LENDING AGENCY
[r I hereby affirm that them fs a construction lendingageney for the performance of
C> be work for which his permit is issued(Sec.3097,Civ,C.)
W Q lenders Name
z Lenders Address
O Q I certify this 1 have mad this application and sum then the above information is
(• commit.I agree to comply with all city and county ordinances and sum laws relating to
0U building conatmattir.and hereby aurhrries repreamuttives of this city to trim,upon the
W me--aniumned Property for ini'mir n Purposes.
G (We)agree to Rave,indemnify and keep harmless the City of Cupemno!phi
r.a
IA liabilities,judgments,costs and expenses which may in any way accmc against mid City
U Z inconsequenceof a rating of this permit.
w" APP (CANT U E TANDS AND WILL COMPLY WITH AL{,N -PO1Kf Issued by: Date
S E EGU N rl`O
Re-roofs
Sign reef Applin ont.cmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building acupentstom or handle hazardous mi conal
as defined by the Cupertino Municipal Cone,Chapter 9.12,and the Health and Safety
ode. er 25532(a)?Orte - All roofs shall be inspected prior to any roofing material being installed.
Will the applicantor furore building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
milt hazardous air contaminants u defined by the Bay Arca Air Quality Management all new mater Is for inspection.
District? '
-ka ,
❑Yes lr_�Vo
I have mad me hasxdtaa'.mamis requirements under Chapter 6.95 of NC Califon,
noHealth BSafety Codc,Secdan25505,25533 and 25534.1 understand then if the Wilding
J not anen0y a amnenl that it is my roepaniNlitywnotily lW acupmt of the
m ire an � T
m atW ❑pnorwissumcmofaCertiBca ofou upan� Signature o Applicant Dat9faMe
cr tar au ,ed agent w All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: (� PERMIT #O l
O R'S AME: Q �1 PHONE # l
GENERAL CONTRACTOR: l
I am not using any subcontractors: �( l
Signature Date
Please check applicable subcontractors and complete the following 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
Tile
Owner/Contractor Signature Date
Community Development Department
• Building Division
City of Cupertino
N f 10300 Torre Avenue
• Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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 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.
Homeowner's Na�nie: p" ��
Job Site Addr85 /_ C� 19�S Uk LLY1
Roofing Company Name: 3
A plicant's Signat Date: l�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO Z
J .� REROOF d
CUP` riNO PERMIT APPLICATION FORM
APN # 3 2-/ _? � Date:
Building Address:
,(D
Owners Name: rhone#:
Contractor: cense :
ntact: Cupertino Business License #:
Type of Roof Covering:
VC) C(C
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 Description:
Residential ❑ Commercial
1 t in
Fire Zone: Yes El No ❑ Confirmed with P a m g De t. if
there are an restrictions: IJ
Cost of project: Tyne of Construction: Occupancy group:
y.•if
I' abl Fee ID Fee Description Fee Group
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
s��