04120069 (2) CITY'OF COPERTINO �� ' — — —
BUILDING DIVISION PERMIT - r CONT"CTOR LNFORMATION - —`— - -
a.e.e <d.9'i o�aii
BUILDING ADDRESS: R E ROOFING & CONSTRUCTION VM�N`b4120069
845 LONNA LN
OWNER'S NAME: PERMTf ISSUE DATE — -
r
I JAMES BOUCREE 15230 CI.YDFT.T.P,*
ONE: SANITARY NO, CONTROL NO.
(408) 925-9995
ARCHTIECfIENGINEER:
BUILDING PERMIT INFO
• BLDG ELECT PLUMB MECH
-app LICENSED CONTRACTORS DECLARATION Job DBSCrIpllOil>/y _
C 1 S Y nm Nn I am lived under pros''ons of Chapw Y(commencing -
b with Stt n] )n( G3 the Busineof 'ms Code,andm liccn.¢ix
in Toss mm ,arta res y REROOF
j i Lic<nac /a -
=�p
Data ' Con
RCH CT's D
3 /
a v I�mermanJ my pla shat used as pts m O F a/ /� �•._1
oG Z
� Licensed Professional / �'C/:�IrJ -
5 OWNER-BUILDER DECLARATION /]0
+� I Wreby affirm Thal 1 am exempt form the Contractor's License Law for the
i p c following tensor.(Section]ID 1.5,Business and Professions Code:Any city or county
k$� which requires a permit In constmc,alk,improve:demolish,or nepair any structure V,/ t �Y F�
m-m prior 0 its issuance,alsumquims lWapplieant fromach permiOO Blcasigned statement
t?'< thatWisEccvcdpu�,nttalhepowisionsofthcCunumcmralJanseLaw(Chaptm9 Sq.FL Floor Area 1444 'pValuation
x V
arc t-� do.,M is
Stttiosreand mDiasisfron3 nftheoged cosanditumpt Professionsliode)of
i�$ Net he u exempt Nemfrom and Roe buss for the allegrA exemption.Any violation of � tk
Section]051.5by anyapplimntfora permitsubjects the applicanuoacivil penaltyofcrO0 Occupancy Type - - -not more than Ew hundred dollars(S500).
❑l.mownexof Nepmpcny,mmyemplocmwithwagmaat kmlccompenmlon, - -will do the work,and theswctum is not intended oraffered forsale(See.70m,Business ,
and Professions Cade:TW Contractors Lice-•-Law does not apply m in owner of - Required Inspections
property who buildserimpruw sthereon,andwho docxsuchwmk himselfortluough his
own employcu,provided that such impmwmmu are notinundei oro@red for We.If,
however.the building or improvement is sold within one year ofcompleuon.Ne owner. - _ -
builder will love the burden of proving that W did not Wild or improve for purpose of "'-
Wo.).
O.I,as owner of the property am extlmiwly conuaztin6 with licensed contractors to _ ..
construct the pjem(Sec.1044,Business and Fmfettlons Codeq The Conuacmr's Li -
ceme Law does noupply man owner of propeny,who Wilds of improves thereon,and.
who contracts for such projects with a conuacmr(s)licensed Pursuant in the Conuaetors
License Law.
Q I am exempt under Sm. .B k P C for Nis tenon
Owner Data -
WORKERS COMPENSATION DECLARATION_,..._
I hereby sfarm under Pemlty of pedury one of the following declaration:
I haw and will mainain a Cenifmam of Covu
eno elf-insure for Worker's Camper- -
yumn,as provided for by Section 3/00 of the Labor Code.for the Performance of the
wort for which thio Permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section - - ....
W a Cade,for the performance of the work for which this permit is issued.My/I
'uon Insura ea carrier and Policy nn�umbi�er arty�: �1�II//�� J(��
Carie. Policy No.:1I�� tGrll
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ThO cd no W complemd if Uspermit is far otic hundred dollars IS tall
nr 1e55.)
1 comfy Rot in the performance of the work for which this Permit is issued.I shall not
employ any person in any mannerso ax to become subject to lW Workeri Compensation
Laws of Cilifomia.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should
become subject to the worker's Compensation previsions of the Labor Code,you must
•JO forthwith comply with such provisions or this permit shall W deemed rewired.
CONSTRUCTION LENDING AGENCY
F+� Ihcmby aMI.Nat tWm is a conslmcunn lendingagency far that perfumun¢of
x�
to work for which Nu permit or issued late.M.Civ.C.)
IA 0 Lenders Name, -
11 Underi Address
U C) 1 ratify that 1 have read this application and same That the show information is
(y P^ conau 1 agree to comply with all city and county eminences and sum laws relating to
�U Wilding construction,and hereby authorise mpresenmiwa of this city to enter upon the
�[L1 abow-mentioned property for impaction purposes.
(We)agree to saw,indemnify and keep harmless tW City of Cupertino against
H y
liabilities,judgments,coats and expertses which may in any way accrue,against said City
U z mPPLI quence of e RSTANDS At
DND WILL COMPLY WITH AL NON-POINT - Issued by: Date
50 tl - I-f
_
r2 to p Re-roofs
Applicant/ Dam
GODS MATER SURE Type of Roof
Wdl y the Capers m,forme Wildi e.Chanumre7,and dle hearth and Safety
as od
de.ac io the Cupertino Munici Code.Chapter 9.17,and the Health and Safety
Cole.Section 15511(D]
❑Yes No All roofs shall be inspected prior to any roofing material being installed.
Will the apNie=rater future bmhli aapant eye ewipmenl tar,avec If a roof.s' stalled without first obtaining an inspection,I agree to remove
mit havardoi s air contaminants u ed by the Bay Arca Air Quali magcmcm w materials ins ection.
Distrix]
❑Yes No
Ihavereadetchaa mousmaterialsrequirementsunder Ch mr695ofthe Califon
ria s mc,Sec' JJ and 25534.1 undo dihmiflic Wilding
d of c it raw an Nat it is my punsibily,m rout ..P.,el the
re i s wlnc t Interior am a Centra.of Occ
( Z nature of-AFphean Date
ethmi.dagenl Dale 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 De artment
JOB ADDRESS: C'L� i N� Lo PERMIT/` 0061 0 I`DQ
OWNER'S NAME: l 15o u CR w, I� PHONE 2`5iJ�� t— L414
`
GENERAL CONTRACTOR: 1,6 RuvF Iw 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 — *L jr* WI l t 1 l
Septic Tank
Sheet Metal
Sheet Rock
Tile
12 vu
/Contract r Signature Date
Community Development Department
Building Division
City of Cupertino
E f✓ 10300 Torre Avenue
4ppCI[TY OF p Telephone: (408)777-3228 .
U f E IST I N® 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. :M(7
3) Final inspectiori-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.
7. NOTE: If you call.for a plywood nail inspection and the job_is not ready,
you will be charged a re-inspection fee of$176.18.,The re-inspection fee must
be paid befoie aif6thei inspection''can be scheduled.
IMPORTANT::'
1. Flat roofs must.have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An 1.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: �0ucRa� -•--
:.li�l , v •'ate I ,... i'.1� __ (; ..
Job Site Address:
Roofing Company-Name:
Applicant's Signator : _ Date: 2_kd �.
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO 9
2
REROOF DZP� �u 6 l
CITY OF
CUPERTINo _- = PERMIT APPLICATION FORM
APN # Date:
S r oz i2_6l��
Building Address: /
60NA- LA- jc
. Owner's Name: /IM �b �LKa Phone #: 2-q
y -1
Contractor: D I N Phone #: ( c, _ License #:
0 � t
Contact: I�ll� l � Phone#: �M M Cupertino BOusiness License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 13�, 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: T%MtTyV_ , u�-. woM cst 5 t I N6'rKL't- N��J
12° CbY 30 # Nk r-tLr 5U Y�. ASPNA2i CoNIP
Residential Commercial ❑ ,z -
Fire Zone: .".Yes ❑=3 •No .❑_- :'_'_5;.,., • Confirmed with PI g Det. if
there are any res ctio Li .. %
Cost of Project: I z OO� Type of Const cti : \ Occupancy up:
Qty
A tc e Fee lD Fee Description Fee Group
T 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
`yz . 3K