04070012 j CITY OF CUPESION cU TTx�.C"I'(iR TNS ixMAVON
IV
BUILDING DIVISION PERMIT „ � _,,. „�,, k .. .<..,
BGILDINC ADDrtess: SECURITY ROOFING INC PERMIT NOD4O7OO12
20883 STEVEN
OWNER'S NAME: FERMITISSUEDATE
VOLCKMAN & ASSOCIATES 406 EL
NE: SANITARY NO. CONTROL NO.
(650) 595-1213
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG- ELECT PLUMB MECH
0
LICENSED CON TRACTOR'S DECLARATION J�$crl tion
❑ 1 thereby affirm that III
d under provisions mf Chapter 9(commencing P
ZW wi Swo ]M) fDiviaiusi Profcuian.CoJe,end mylicense il' ,
_<<U inn and f 1. REROOF
p�Z Lt"'J" "
is
n t- Dere cmr
AED TION
�i 1 understand m plaed u e records
;py Licensed Pmfcssional
OWNER-BUILDER DECLARATION
aI hereby..a. affirm that 11. exempt from the Gonion Co e:Lice..Ac Law for the
i p O which. rasa..permit
t II131.5,Business and improve,
d.proll Cale:Any city or county
x which requires a a.lmit to enrm Lh L alter,impmvo,h punch u fie pair any suuctum
that onn
hes issiuuam'palsuntto the prevision of ftaswMe Co permit Licame gaw(Chapt em
< that mencingWJpSachem70 )ofDivision(thehe minima
Sq.Ft.Floor Area
Valuation
H S (cat he is(Commencing Section IDn d M basis
3 of the al eged exempt Professon.Any
Code)of
that he Is exempt therefrom and the bssu far the alleged exemption.Any violation o[
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 2QjFAer00 Occupancy Type
not more Nan Ove hundred dollars($500).
Q 1,as owner of the property,or my employing with wages as their sole camps...Itoa,
will do the weak...it the thucturs it not intended M.Rarad Sur a.].Sec.71314,Business Required Ins eCtIODS
and Professions Code:The Commerce's Use=Law dans not apply to an owner of 9 P
propenywho builds orimproves therconand who doessuch work himselfor through his _
own employees,provided that such improvemodware maintained untainted hassle.If.
however,Ne building or improvement is sold within one year of completion,the oweer-
builder will have Ne burden of proving Nat he did net build or improve for purpose of
sale.).
0 1.at owner of Ne property,am excluively contracting wit licensed contractors to
Conswet the projem(Sec.70",Business and Professions Code:)The Conmetar's Li-
cense Law docs not apply to an owner of property who build.or improves thereon,and.
who contracts far such pmjecss with a contacuras)licensed pursuant to the Councilor's
License Law.
❑I am exempt under Ett. .B&P C for ads reagen
owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby arm under penalty of perjury can of the following declarations:
1 have and will maintain aCenfOcam of Consent to self-insure for Worker'sCompen-
sation,an provided for by Section 3700 of Me labor Code,for to performance of Ne
work for which this permit is issued.
❑I have and will maintain Worker's Campmonflaa Joan...as required by Section
3700 of Ne Labor Cmdp for the lied-ma ce mf the work forwhich this pcmtit is issued.
My r scompensuoRaunnce lot and Policy numberam:
er, No.:
C"RTIFICATE OF E7 NFROM WORKERS'
COMPENS TION INSURANCE
(Thissectlon need not hecomplemd if the permit is forma,hundred doilata(SIM)
nr list.)
I certify that in the performance of Ne work for which this permit is issued,)shall not
employ any person in any manner so in to become subject to the Worknes Compamallon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CeniBcam of Exemption,you should
become Subject m the Worker's Compensation provisions of the labor Cade,YOU must
.,O fuMwith comply with such pravlsions or this pormit shall be deemed invoked.
.ZiCONSTRUCTION LENDING AGENCY
[—i I hereby affirm Net there in.emauumlaa lendingagency for the perfurmanm of
lYi r�
to work for which this permit is issued(Sec.3097,Civ.C.)
a Q
Lan
Jcfs Name
z Lender's Address
U I mNfy Nat 1 have mad this applicrawn attd sum that am above w om airm is
coned 1 agree to comply with all city and county ordinances and suite laws minting to
V building construction,and hereby authortm representatives of this city in enter upon the
0. shove-mentioned property for inspection orpoem.
(We)agree to an.indemnify and keep harmless the City of Cuparlimm against
„y Ce) liabilities judgment.Cash ad aspirates which may in any way seem.against said City
6) ',L in caoac'mnce ofN grsmfngof thispermit.
s"'
Al UN STAN S ND WIL MPLY WITH ALL DINT Issued by: Date
SOUR E U NS,
/�
st Re-roofs
are TApplicam/Contmcmr Care
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munpipal Code,Chapter 9.11,and the Health no Safety
odd,Section 25532(a)? /��(lp'a` All roofs shall be inspected prior to any roofing material being installed.
Dyes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
10w*
it Inanition,at,conuimi...a u Jcfiaed by the Bay Arca Air Quality Management all new materials for inspection.
strict? 5
❑Yes
lharcreadthehuar usmatcdalsmquimmenuundcr ,Chaprer6.95ofthe Califon
aHalth&Soft Code,Section 25505,255 am12111 "it dilstif talJing
t I.Mr. h a tenant,Net it ism pansihility to notify IM upmt of the
rats wb u met oro iaa mf.codreraco cy. Signature of Applicant Date 1.
oramhori'rcJagent a All roof coverings to be Class nB��or better 9
j CITY OF CUPESION cU TTx�.C"I'(iR TNS ixMAVON
IV
BUILDING DIVISION PERMIT „ � _,,. „�,, k .. .<..,
BGILDINC ADDrtess: SECURITY ROOFING INC PERMIT NOD4O7OO12
20883 STEVEN
OWNER'S NAME: FERMITISSUEDATE
VOLCKMAN & ASSOCIATES 406 EL
NE: SANITARY NO. CONTROL NO.
(650) 595-1213
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG- ELECT PLUMB MECH
0
LICENSED CON TRACTOR'S DECLARATION J�$crl tion
❑ 1 thereby affirm that III
d under provisions mf Chapter 9(commencing P
ZW wi Swo ]M) fDiviaiusi Profcuian.CoJe,end mylicense il' ,
_<<U inn and f 1. REROOF
p�Z Lt"'J" "
is
n t- Dere cmr
AED TION
�i 1 understand m plaed u e records
;py Licensed Pmfcssional
OWNER-BUILDER DECLARATION
aI hereby..a. affirm that 11. exempt from the Gonion Co e:Lice..Ac Law for the
i p O which. rasa..permit
t II131.5,Business and improve,
d.proll Cale:Any city or county
x which requires a a.lmit to enrm Lh L alter,impmvo,h punch u fie pair any suuctum
that onn
hes issiuuam'palsuntto the prevision of ftaswMe Co permit Licame gaw(Chapt em
< that mencingWJpSachem70 )ofDivision(thehe minima
Sq.Ft.Floor Area
Valuation
H S (cat he is(Commencing Section IDn d M basis
3 of the al eged exempt Professon.Any
Code)of
that he Is exempt therefrom and the bssu far the alleged exemption.Any violation o[
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 2QjFAer00 Occupancy Type
not more Nan Ove hundred dollars($500).
Q 1,as owner of the property,or my employing with wages as their sole camps...Itoa,
will do the weak...it the thucturs it not intended M.Rarad Sur a.].Sec.71314,Business Required Ins eCtIODS
and Professions Code:The Commerce's Use=Law dans not apply to an owner of 9 P
propenywho builds orimproves therconand who doessuch work himselfor through his _
own employees,provided that such improvemodware maintained untainted hassle.If.
however,Ne building or improvement is sold within one year of completion,the oweer-
builder will have Ne burden of proving Nat he did net build or improve for purpose of
sale.).
0 1.at owner of Ne property,am excluively contracting wit licensed contractors to
Conswet the projem(Sec.70",Business and Professions Code:)The Conmetar's Li-
cense Law docs not apply to an owner of property who build.or improves thereon,and.
who contracts far such pmjecss with a contacuras)licensed pursuant to the Councilor's
License Law.
❑I am exempt under Ett. .B&P C for ads reagen
owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby arm under penalty of perjury can of the following declarations:
1 have and will maintain aCenfOcam of Consent to self-insure for Worker'sCompen-
sation,an provided for by Section 3700 of Me labor Code,for to performance of Ne
work for which this permit is issued.
❑I have and will maintain Worker's Campmonflaa Joan...as required by Section
3700 of Ne Labor Cmdp for the lied-ma ce mf the work forwhich this pcmtit is issued.
My r scompensuoRaunnce lot and Policy numberam:
er, No.:
C"RTIFICATE OF E7 NFROM WORKERS'
COMPENS TION INSURANCE
(Thissectlon need not hecomplemd if the permit is forma,hundred doilata(SIM)
nr list.)
I certify that in the performance of Ne work for which this permit is issued,)shall not
employ any person in any manner so in to become subject to the Worknes Compamallon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CeniBcam of Exemption,you should
become Subject m the Worker's Compensation provisions of the labor Cade,YOU must
.,O fuMwith comply with such pravlsions or this pormit shall be deemed invoked.
.ZiCONSTRUCTION LENDING AGENCY
[—i I hereby affirm Net there in.emauumlaa lendingagency for the perfurmanm of
lYi r�
to work for which this permit is issued(Sec.3097,Civ.C.)
a Q
Lan
Jcfs Name
z Lender's Address
U I mNfy Nat 1 have mad this applicrawn attd sum that am above w om airm is
coned 1 agree to comply with all city and county ordinances and suite laws minting to
V building construction,and hereby authortm representatives of this city in enter upon the
0. shove-mentioned property for inspection orpoem.
(We)agree to an.indemnify and keep harmless the City of Cuparlimm against
„y Ce) liabilities judgment.Cash ad aspirates which may in any way seem.against said City
6) ',L in caoac'mnce ofN grsmfngof thispermit.
s"'
Al UN STAN S ND WIL MPLY WITH ALL DINT Issued by: Date
SOUR E U NS,
/�
st Re-roofs
are TApplicam/Contmcmr Care
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munpipal Code,Chapter 9.11,and the Health no Safety
odd,Section 25532(a)? /��(lp'a` All roofs shall be inspected prior to any roofing material being installed.
Dyes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
10w*
it Inanition,at,conuimi...a u Jcfiaed by the Bay Arca Air Quality Management all new materials for inspection.
strict? 5
❑Yes
lharcreadthehuar usmatcdalsmquimmenuundcr ,Chaprer6.95ofthe Califon
aHalth&Soft Code,Section 25505,255 am12111 "it dilstif talJing
t I.Mr. h a tenant,Net it ism pansihility to notify IM upmt of the
rats wb u met oro iaa mf.codreraco cy. Signature of Applicant Date 1.
oramhori'rcJagent a All roof coverings to be Class nB��or better 9
Community Development Department
u Building Division
fl i - City of Cupertino
10300 Torre Avenue'
Telephone: (408)777-3228
CITY OF
OUPEkTINO
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: 2o6?P-21
Roofing Company Name: < AA
t
A.12plicants Signature: Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
f � CITY OF CUPERTINO !�
( REROOF
CITY OF
CUPERTINO PERMIT APPLICATION FORM_
APN # Date:
Building Address: $ 1
I
Owne 's ame: hone
Co trac r: Phone #: License #'
Q 7
C ct: P one#: Cupertino business cense#:
• Gw Atx - Jay
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles Asphalt Shingles
Wood Shakes T 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
Fire Zone: Yes ❑ NONConfirmed with Planning De t. if
there are any restrictions:
Cost of Project: g�o lL- Type of Construction: Occupancy group:
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
� 33 �
12-
Community Development Department
u Building Division
fl i - City of Cupertino
10300 Torre Avenue'
Telephone: (408)777-3228
CITY OF
OUPEkTINO
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: 2o6?P-21
Roofing Company Name: < AA
t
A.12plicants Signature: Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
f � CITY OF CUPERTINO !�
( REROOF
CITY OF
CUPERTINO PERMIT APPLICATION FORM_
APN # Date:
Building Address: $ 1
I
Owne 's ame: hone
Co trac r: Phone #: License #'
Q 7
C ct: P one#: Cupertino business cense#:
• Gw Atx - Jay
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles Asphalt Shingles
Wood Shakes T 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
Fire Zone: Yes ❑ NONConfirmed with Planning De t. if
there are any restrictions:
Cost of Project: g�o lL- Type of Construction: Occupancy group:
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
� 33 �
12-