04090012 (2) CITY OF CUPERTINO p "°�- ��' '^ "K �- _ ..
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION - - -. -
OUILDINGADDRESS: EL CAMINOyROOFING CO INC PERMITNo.04090012
OW_NER'S NAME: PERMIT ISSUE DATE
WENDY E M
,.ONE: SANITARY O. ONTROL NO.
(408) 292-7644
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
.00 LICENSED CONTRACTOR'S DECLARATION JobDescri ti ��
;.6by strum than 1 am imensed under provision of Chopur 9(commencing p
i withit 9000)m(Dlvision3ofthe Kusar�/ay�r a fcsaoncode.aodmylmente is
in mu ne/rr�L; Lm.11 77 Z' RERIIF W/CAPSHEET
zq�p Daun�Clns Conran I.
rya IunderstandmyplanshalllWusedDasECIA /ordds SEP 2�U4
JyU
3a� Lm Pref m BUIL®INS
5 OWNER-BUILDER DECLARATION
0 y I henry afrrm Thal I ore exempt from the Contmaors Limnu law for the
_
no following mann.(Section 703 LS,Business and Proressious Code:Any city tar county
$ which requires a permit In construct,alar.Improve,dcmmlish,or repair any structure
poor In its iauallte,also rectum the applicant for such Permit to( te
Ie a signed surmount
��< shat M is licensed pursuant ta the provisions of she Committal's lJanse Law(Chawl 9 Sq.Ft. Floor Area Valuation
e�$ (commencing with Section]000)of Division of she Business and Pro(rstionsCMe)or
y _ that he is exempt therefrom and Use bais for the alleged exemption.Any violation of 86000
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
.or mom Nan five hundred dollars(4500).
❑1,as owner of du property,in my employees with wage as their sole compensation.
will do she work,and dm swctum isnot intended or offered for sale(Sec.70s4,Busircss
and Pmfeasimm Code:The Commm
ors amore law don tams apply m.n..or Required Inspections
proPcOywhu builds orimprovu Iheomn.and who does suchwork himself orth augh his
Own employes,provided that such improwmants art not intended or offered forage.It.
however,the building or improvement is sold within one year of completion,the owner.
builder will haw the Wrdm of proving that W did not build or improve for purpmu of
sale.).
1,u owner of Be,property.am exclusively contracting with licensed mntracmrs to
consumer the projmt(See.70d4.Business and Professions Crede:)The Contractors Li-
cerise Law docs not apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with a contra tons)licensed pursuant o the Contractors
License law.
❑1 atm exempt under Sec. .B d,P C for this mason
Ow er Data
WORKER'S COMPENSATION DECLARATION
ION
hereby affirm under penalty of perjury one of Ne following decimations:
1 have and will maintain a Certificate of consent to self-insure for Wmrk/r'sCompan-
utimn,as Provided fm by Section 37W of the Iatwr Code.for the Performance of the
work far which this permit is issued.
❑1 have and will mainuin Worker's Compensation Insurance,as required by Section
3900 of the Latimer Code,for the performance of the work for which this penin is issued
My Work s C penalion Insumwa camicr and Policy number art:
Cauicr. N( Policy No.16LStOF'Z'
ChRTHRCATE COMPENSATION
I N FROM WORYsfiRS
COMPENSATION INSURANCE
(Tait section wed not be CompleudillW parmiti /hundred dollars(SIM)
or lcsx)
1 certify mm in to Pear....of the work for which this permit is roved,I shall nos
employ any pmron in any manner so as in become subject to that WorlmnS Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making his Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
.Jz forthwith comply with such provisions or this permit shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hemby affirm Nat them is a construction Binding agency lot the performance of
a the work for which this permit is isvmd(Site.3091,Cih,C.)
W Q Lender's Name
Lender's Addrns
U C) 1 comfy that 1 haw read this application and sou that the above informaliun is
W F CommL 1 agree t0 Comply with all city and county ordinances and state laws minting to
0 building cons action,and hereby momme n:muenmives or this City to Com upon the
mova-mentimacd property for inspection purposes.
(Wit)agree 10 sows indemnify and keep harmless Banw City of rue Cupertino against
N' in emi0es.judgmcnu.costa andof this es which may in any way accrue against said City
U Z APPLICANT UNDEgranu NDS Au permu OMPLY WITH ALL NON-POINT Issued by: Dat
SOURC NS
-� Re-roofs
07
plhc HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle by nonmaterial
m defined by IW Cupertino Mu ap i Code.Chapter 9.13,and sW Health and Safety
ode,Section 25533(x)? All roofs shall be inspected prior to any roofing material being installed.
Dyes P�Nm
Will the applicant or fuum building occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hammous air contaminants as defined by she Bay Arca Air Qualily Managcmenl all new materials for inspection.
District?
❑Yes ONO
I have read are harardousmalcrials requimmenu under ChaPur 6.95 ofte,Califor-
nia Health h Safety Cock,Sections 25505,25533 and25534.1 understand n Ih diftc Wildin
does not carmmly have u
a nm
a ,that it is my responsibility ility nodly the mcupam of N
m:quircmcn uv "
In ignatU fApplicant
o nermr nti,<das/nl D,ta All roof coverings to be Clas B"or titer
! Community Development
10300 Torre Avenue
! � Cupertino CA 95014
is
y Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO _
Building De artment
JOB ADDRESS:
PERMIT #
OWNER'S N �O PHONE #
GENERAL CONTRACTOR: f 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
F/ Roofingj�,
Septic Tank
Sheet Metal
Sheet Rock
Tile
/Contractor Signature ate
Community Development Department
Building Division
s7a' City of Cupertino
10300 Torre Avenue
OCITY OF Telephone: (408)777-3228
��I�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'sNan-P.�'
lob Site Address /Vy ��A'
Roofing Company Name
A plicant'ss Siig^n Da�
GregJteel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
CITY OF CUPERTINO a l
REROOF d �(
CUPEf�TINO PERMIT APPLICATION FORM
APN# 2,/ -2� J 7 Date; U,
Building Address-
10 vOwner's Pho
Con actoj: Ci// Phone#: License#: b l
�f7�r�/�iJ �17i- 7G� 7 ,77
Co act: Phone#: Cupertino Business License#:
1L
z-4 7,- 7G Y
Type of Roof Covering: .
Existing: Proposed:
P Built-Up Roof �c 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: G
Jo cn� _9n. C � / � �, H� fl NPh/ SGT ice /
Residentiali Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable 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