04060207 CITY OF CUPERTINOx5 ,+*' •x�fizr,..
BUILDING DIVISION PERMIT �aCUNTRACTOR N ORMATIOI
BUILDING ADDRESS: ROOF GUARD ROOFING CO PERMIT N004060207
OWNER'S NAME: PERMIT ISSUE DATE
Ag ihGERANIM
IFNE: SANITARY O. CONTROL NO.
408
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO EO PLO ME�CH
�oo LICENSED CONTRACTORS DECLARATION 'i Iob.Descriptionl
tZy 1 hemby am that i am licensed under provisions of Chepmr 9(commencing `
A<`yj with Section 70Ta)of Division 3 of the Budfmslomode.an
Cd mylkense is
REROOF
I�+Ai in lull mm a ctt ^JfO l
7�Z License Cl Lic.M \�/ I�
?'g' Date
ARCNII'E use D TION
3 late lid my Pkm alWl be usedupu is reCords /{� `IIIWWWIII
S Licensed Professional
S Oat lam exempt
DECLARATION
Comun
I hereby a1Rm on I em cxcmpl drum Nro Communes LiAny C Law for Nc
oo followingroes&. (anion 7(131.4Bmimss andve(esaiom Code:Any city structure
Z E which requires a issuance,at.re cnmwc4 elms improve,demolish,t o e a sig ed atmctum
m pdormissensedprsarequires lM aili.,ol for atmh Permit file Laedstsmmem
��i jenhc I.licensed pursuant 7 Nc of Divisio n(Nc Conu¢wfalianmiaw(CMPter9 Sq.Ft.Floor Area Valuation
dust W ncimgwith ominate and of but.for
odthe
egBusiness
ompt PmfMyn I Code)m or
� that he k evmpl tlortfrom and the buk fm than alleged ewnpdOn.My violation of
Seedon 7031.5 by any applicant for a pewit subjects Ne applicant to a civil penalty of 3 Wbr- Qiftero 0 Occupancy Type
not mart Nan five hundred dolkts(5500).
D 1,an Owner of Ne property.in my employees with weges as,Heir sole compensation.
will On the work and Neemuclurt is out intended moRereci for sale(Sm.7066.Busineu
anRequired Inspections
d profeaioss Code:The ComrecmM1 Litems toeq P IAw dead not apply an owner o!
property who builds or i m proves Neremn.andw ho does such work himself or through his
CAM employees,provided that such impro ementsart notinterNed mOBemd hostile.If.
however.the building or Improvement is sold within on you of completion,the owner.
builder will love dre burden of proving Nat he did not build or impmns for purpose of
aekJ.
O 1,as Owner of this property am exclusively c"bmting with licensed comsaccers in
construct the project(Sec.7044.Business and Prefndona Cade:)The Conuecmta Lt.
come law too;not apply to an owner of property who builds or improve,rhemmn,and,
who contracts far such projects with aconusemds)licensed puamnt in the Conummrs
License Law.
❑I am exempt under Sec .B h P C for thk mann
owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby alErm"der penalty of perjury one of the fallowing declarNo":
I hove end will mountain aCenifieste of Consent m selpinsum far WarkeraCompen-
mdan.sa provided Be by Seedon 3700 of the Labor Curie,for dm performanoe of the
were for which this permit is issuc4
❑1lom and will maintain Workers Compewtion Insurance,u required by Section
3700 of On he a Ne peRomanco of Ne work for Wlych this pewit is lured.
My carrie�r and/Pylicy nu r
cr. �pOlfry Na.: '
CE CATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Is and need not beemnplcmdIrtk pemll IafmronehundmAdoBan(5100)
or leu.)
1 certify that in the Performance of the work for which this Permit is isnN,l shall nm
employ any person in My manner m u In become mbjecl to the Workeri Compensation
laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making Nis Cci inmto or Emmption,you should
became abject to the War cess Compensation provisions of the Labor Code,You muse
.J O rOMwith comply with such Provisions or Nis pn
aic shall M deemed revoked.
'zy CONSIRUCTION LENDING AGENCY
[+ IMmby affirm Nn Nem is a consumed"lending agency for Ne Performance of
C> the work for which this permit Is issued(Sec.3077.Co.C.)
W�Q Lender's Nmc
]Z Lemim.Address
V 1 certify that 1 have read this application and sum that Ne above information is
LL,F CawcL 1 agree M comply with all city and County ordimnees and sok laws missing In
C U building construction,and hereby aummine mpotarenmives of this city to enter upon Nc
W show-memtiomnd property for inspection Purpose,
(We)agree in ave,indemnify and keep homeless the City of Cupertino agdnn
,,j Ikbilides,judgments.costs and expenses which may in anyway accrue gamuaid City aZ7 Z
V7 in consequence of the Smming Of this fw^nil, /
G APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
CE REGULATIONS.
Z Re-roofs
Signature of AppiicandCOntramor -- Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or durum building occupmtamre or handle hauNam material
u dented by dte Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code.Section 25532(s)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ym pato
win the applicant or future building Occupant=equipment lir awice,which If a roof is installed without first obtaining an inspection,I agree to remove
mit ha'aNmu,air c"tsmimanu u tie d by the Bay Area Air Quality Management all new materials for inspection.
District?
0Yea u
I have mad the haaardmssmaterials requirements under Chapter 495 of the Califor-
nia
esnoth&Sntlyhodc,Winds,dust
it 2S333and25334.I in notify
dn ocupo If On,Wilding �� �` `f f- , '1 Lit, 0
Joel net currently hose,recant Nn 0 u 55 3 and2 i5 i4.1 u1 notify Can Occupant of Na _y�� — —\] lQ C \
requirements which mesa be met prior m issuance of a Cerdncam of Occupancy. d ignature of Applicant Date
-,1 Fr -IOEI t`Igpt'j 0 ti All roof coverings to be Class"B"or better ,
er 01
amhodmd agent Date
Community Development
10300 Torre Avenue
IWO
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADD S: PERA41T#
S Tv SLE bL4oto 020--
OWNER'S plh PHO q S'1
GENERAL CONTRACT FAX #
I am not using any subcontractors:
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
-1)
/Contractor Signature Date
Community Development Department
Building Division
] / City of Cupertino
�. 10300 Torre Avenue
i
CITY OF Telephone: (408)777-3228
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: V yoI C: L_
Job Site Address: 'T-k) l_)lb
Roofing Company Name: 1201*—
A
Al2 plicanYs Signature7: W U s . _ y'�ate: b� •�� I• oK
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
I
CITY OF CUPERTINO
REROOF b o� a Z 7
CUPER INO PERMIT APPLICATION FORM
APN#37535C)S(o Dater a y o
Building Address:
10833 urrLe
Owner's Name: Phone#:
Contractor: Phone#: License#:
�o F Un V_n q3- X151 q (0 50 to FS 2
Contact: Phone#: Cupertino Business License#:
JO T1 �
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
'e'Asphalt Shingles O-�sphalt 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: 9_�
Job Description: Q.Urnvvprp �j�p >✓X�ST1N (� E?>"j" tqS jktJj�§
Qerpua,c w cis 1 t N
Residential 0 Commercial ❑
Fire Zone: Yes ❑ No ❑ Con,fiAed with Plann ng De t. if
thefe az restricti s: LLII
Cost of Project: Type of Construction: ccup cytgroup
Qty.
Appl,
jea 4 Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
1 BENERGY Energy BUILDING
/j BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
0 2�