04090072 (2) OF CUPERTINO �. * .., y -
BUILDING'DIVISION
CITY PERMIT CQ1`TRt1CTOR=TNFUXiMA'CTON�
BUILDING ADDRESS: PERMIT NO.04690072 4090072
Q-7-7 T.A RC)DA PR FINAL r OWNER'S NAME: PERMIT LSSOB OATS
21
DNE: SANITARY 0 OL 10.
ARCHITECDENGINEER: SWUM BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p
il jZp LICENSED CONTRACTOR'S DECLARATION lob Description
i�F1 hereby affirm that 1 em licensed under previsions of Chapter 9(commencing p
with Section 700D)ofDwhimin Sufdm Bmi d Professions Coate.and my license is
p�Oi inmRfam REROOF W/SHINGLES
z Lice CI Lic �,
?g' Dam c°m �`Ld�r CONTRACTOR: A MENDOZA ROOFING
ARCHITECTS R ION
1 understand my phos shell W used as pts Ile accnms
Licensed Pramssional
S OWNER-BUILDER DECLARATION
I hereby aRrm That I am ucmpt from the Cantmctor'a License Law for the
o o following action.(Section 703I.S,Business and Proteadans Code:Any city or county
X%9 which requires a permit to consumer.slot.improve,demulish,or repair any svuctum
ea' 2 prior to its issuance.also acquires the applicant forsuch permit to file a signed statement
`4 that he is licensed pursuant to the provisions of the Contractor's Liccnu Law(Chapter 9 Sq.Ft. Floor Area Valuato�300
y�s (commencing with Section 7000)of Division 3 of the Business and Pmfessians Code)or _
�.-
that he Is exempt them(rom and that basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant la a civil penally of APN Number Occupancy Type
not mart than five hundred dollars(S500).
❑1.as owner of the property,or my employees with wages as their sole compensation, 3693302 '55 . 00
will do the weak,end theawccaee is not in¢nticd or offered for sale 70/4.Business
.it Proportion,Cc&:The Concession's License Law dace,not apply in an owner of Required Inspections
property,who builds or improves thereon,and who does such work himself or through his
own employees,provided thmauch improvements tie not mounted uroffcred ferule.if,
however,the building or improvement is sold within one year Of completion,the ownea-
builder will have the burden of proving that he did not Wild as improve for purpose of
talc.).
❑1,as owner of the property,am eaclusively convecting with licensed ronhSmm to
mnslmct the project(Sec.7044.Business and Professions Code:)The Contomora Li.
came law does not apply in an owner of property who builds or improves Nemon,and
who contracts for such projects wit a conusctar(s)licensed pursuant in die Contractor's -
ease ave.
Iamecarrounder Sec. ,B&PCrorthismnson
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby arrive under penalty of perjury oro of Ne following declarations:
I have and will maintain a Car ifimm of Coment in self-insure for Worker's Compen-
salmn,as provided fm by Section 3700 of IM Labor Code,for the performance of the
week for which this permit is issued.
1 have and will maintain Worker]Compensation Insurance,as required by Section
37M of Ne Labor Code.far the pcdxemacc,of the work for which this permit is issueal.
y orker's Compensation Insurance camm and Policy number are:
'a Pali .:
CERTIFlCATE OF P.XEMPSIO OMWORKERS'
COMPENSATIO SURANCE
(This section need not W completed if the permit is for one hundred dallata(5100)
or leas.
1 certify thOl in the performance of the work for which this Permit is issued.I shall not
employanyy.,�man in any mortician as m become subject to the Workers'Compemadoti
Laws of CallfMs.Data
ApppRLyt
ren7CE TO APPLICANT:IL atom making this Certificate of Exemption,ood you should
become subject y it Worker's Coons or
is provisions m the Lehr Code,you must
�Q foMwiN comply with such provisions or Nis permit shell W deemed revoked.
'�ti CONSTRUCTION LENDING AGENCY
[-. 1 hereby alarm that then Its construction lending agenry far Ne performmce of
!Yi a theLe wok for which this permit is issued(Sec.3037.Civ.Cd
a Q Leader's Name
Addo
z LcndeYS Address '
J 1 comity that 1 have mad Nis application and sum that Ne sinew information is
IL,f" coma,1 agree to comply with all city and county mJinsnass and aWe laws relating to
0 C.) building contraction,and heacbyauthodu repreaentadvan.f this city to color upon dre
[7a above-mentioned property for impeetion purposes.
gL (We)agree to sew,indemnify and keep marleav de,City of Cupertino against
% liabilities,judgments.casts and expemm which may in any way same against said City I/
V 7 in consequence of the granting of this permit.
r1• APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N DINT Issued by:3 Date
REGULA NS.
Re-roofs
Si a afApp oar nor Dam
HAZARDOUS MATERIALS DISCL E Type of Roof
Will the appliceln or future building Occupant stare or handle heasrdeus material
u defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safely
Calc,SectionY25532(a)1 s, All roofs shall be inspected prior to any roofing material being installed.
Y. No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Imminence air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Minim?
❑Yes eNu
I have mad the lowsob usmamnals requirements under Cha ue,6.95 of the Calif.,
nix Health&Safely Code,Seedons 25505,25533 and 25534.1 undemand thmif dm Wilding .
does not Currently him a street,that II Is my maPOMNllly m"airy ALLY NL of NC
re cneswhichmubcmelimmuibmanccofaCcnifinemaf -pa Signature of Applicant Date
�4' All roof coverings to be Class"B"or better
Owner thodud ageW 0
l
Community Development
10300 Torre Avenue
Cupertino CA 95014
`_� 'f TM Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB A D ESS: PERMIT#
OWNER'S N PHO # /
GENERAL C RACT R: 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
9/1 O _
�r/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
OUPEkTINO
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 Nam' •
Job Site Address•\,/ 11Q� � 1
7 A eo 1) 4 �Y
Roofing Company Namp- " �//!//EAZ 0-,L,* ?C0QJf A2
AplicanYsSignature. Date:\ ��
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
L REROOF o
CUPEkTINO PERMIT APPLICATION FORM
APN# 3 � � � Date:
C Q
Building ddress:
00- CUP61z-fi-,fV0
Owner's Name: Phone#:
4
Contractor: Phbne
#: License#:
-� /o _ C_ . 3q . 7Sa/S9
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Ar Asphalt Shingles
Wood Shakes Z1 Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Irn ❑ 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: ElJ Description:
XbernaU ds s s e • (Ze 8 IVj iV ie1
Residential ®. Commercial ❑
Fire Zone: Yes ❑ No p— Confirmed with Planning D
there are any restric i s:
Cost of Project: Type of st ion: Occupancy gro
s -- A
—Y I
Qty
A tcable J 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