05070068 (2) CITY OF CUPERTINO 'a"
BUILDING DIVISION PERMIT CONTRAGTORANFORMATION .
BUILDING ADDRESS: GUARANTEED ROOFING CO. PERMIT NIb 5070068
10143 MILLER AV V
OWNER'S NAME: PERMIT ISSUE DATE
THOMAS HARLON E TRUSTEE 2190 STONE AVE
HE SANITARY NO. CONTROL NO.
(408) 482-4183
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� t� 0
uOE, LICENSED CONTRACTOR'S DECLARATION
€ I hemby,affirm that I am Bmroed under provisions of chapter 9(commencing Job Description
with Sccbm7O)0)af Division Softhc Businessand Profcssi CodemW my li<cnaa��is
o` In fall I.aodefr t +y
Lwcnu REMOVE EXISTING & REPLAC S P STEM
w
. 0 p Dau f— Contractor
e ARCHITECTS DECLARATION
Y I undcrsund my plans shall he used as public records �J
Say Licensed Ptef.wonal �O 2005
5 OWNER-BUTLDER DECLARATION
F I hemhy M.than I am exempt from the Contrzcwrs License Law for the
i p O follOwing mason.(Section 7031.5,Business and Professions Code:Any city or county
m which me.d.s pcwait w c.w ala,improve.demolish.Or.,On any craxtum
rZe prior In its issuance.also requires the applicant for such Permit o file a signed statement III DIN,
i€e that he is licensed pursuant to IN provisions of the Contractor's l.imnscLaw(Chapter 9 Sq. Ft. Floor Area Valuation
m � (commencing with Section 7000)of Division 3 of the Business and professions Code)at
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section TBJ 1.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 CIO 0 O
not mom than five hundred dollars(M). Occupancy y Type
❑I,as steno of th property or my employer wit wages u BUG sole compensation.
will da the work end Ne swcwre farm intended m offered forsaie(Sec.7044.Businessand Profess ons Code:The Conde encs License Law tines�t apply min cess or Required Inspections
property who Wilds or improvesHereon,and whodoessuch work himxlfor through his
own employers.provided Nat such improvements are not intended uraBere i for sale.if,
however,the Wilding or improvement is sold widest one year of completion.IN owner-
builder will have that Widen of proving Nat he did not Wild or improve for purpose of
ale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the pmject(Sec.704x.Business and Professions Code:)The Democrat's Li-
ecre a Law does not apply in in ewoer of property who Wilda or improM3 NCRon.and,
who contracts for such pmlecu with a contruwr(s)licensed pursuant On the Contractors
License law.
❑I am cm.to under Sec BA PC for this moon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury ON of the following dalaations:
I ham and will maintain a CeiuRau of Consent in self-insure for Workers Cwnpem
action,as provided for by Santa.3100 of the IaWr Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3100 of Ne labor Cade,for IN performance of the work for which this permit is issued.
My Workee C p titian lnumry airier and Polity number art:
Cartier. 7 Pat No.: _
CE,RTIFICATE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crhu=IN need tut W completed Bthe permit is forone hundred dollars(SIM)
Or less.)
1 mnify that in Oc performance or the work for which this permit is issued.1 shall not
employ any person in any mannersn as in become subject to We Workerf Compcnsadon
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate Of Exemption,you abould
become subject ae Ne Worker's Compensation provisions of IN Labor Code,you most
,J,z foMwi N comply with such provisions or this permit shall W deemed revoked.
ZO
CONSTRUCTION LENDING AGENCY
[—iIhereby.M.Nn ft.is a coowctinn kp
ndingthe cocy for perfuimm
ec Of
C> du..,it for which this permit is issued(Sat.3091,Civ.C.)
1 Lenders Name
0 Landers Address
U Q I cenifY that 1 have read this application and suis that the above information is
11.F cOmXL 1 agree to comply with all city and county ordinknaa and sum laws relating m
O V building consnnion,and hembyAuthodm representatives of this city w enter open the
mud
cdon
shove-ms jadgrwma.cmi for
and.. .3 purposes.
F n. (WO)agree m save,indemnify and keep hared.IN City of Cupertino against
h
in
of dim
ex pensesmit. may in anyway accrvc against aid City
(„) z in consequence of the branting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ,!��
S RCE REGUL TIONS. '7
Signature of AppLcanU nwcmr �/ Re-roofs /�Jy6
H ARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will IN applicant or future building accupant store or handle huudous maunal
o defined by"IMS
e Cupertino Municipal Code,Chapter 9.11,and Ne Hca1N and Safety
cWe.sEl ection zss3z(a)1 Ya dws� All roofs shall be inspected prior to any roofing material being installed.
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
iI ha'rardous air conuminanu u decd by Nc Bay Area Air Quality Management all new materials for inspection.
District' L/
❑Yes No
I have mad the haaardous materials requirements under Chapter 6.95 of the Califon-
iliaHmlNhWctyGode.Smtiauz5505.2533]and]553d.l unde%mw Nmifdte Wilding
does macurrently ham a tenant dust it is my mspooibility m emily the occupant ar Ne
mcm,�q�cru which mug W den prior w issuance oh Ccnifiate of Occupanty.
h1 yl—g ') Signature of Applicant Date
Owner or authonmd agent Date All roof coverings to be Class "B"or better
CITY OF CUPERTINO
I• 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36907002.00
DATE ISSUED. . . . . . . : 07/12/2005
RECEIPT 4. . . . . . . . . : 30331
REFERENCE ID # . . . : 05070068
SITE ADDRESS . . . . . : 10143 MILLER AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : THOMAS HARLON E TRUSTEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : MORGAN HILL CA, 95037-9203
RECEIVED FROM . . . . : MARTY NUNES
CONTRACTOR . . . . . . . : MARTY NUNES LIC # 26081
COMPANY . . . . . . . . . . : GUARANTEED ROOFING CO.
ADDRESS . . . . . . . . . . : 2190 STONE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408)482-4183
PEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 2,000.00 83.16 0.00 63.16 0.00
BSEISMICRE VALUATION 1,800.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 83.66 0.00 83.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 83.66 MC
TOTAL RECEIPT 83.66
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
IOUPE(�TINO
Building De artment
JOB A IDDRESS: P
ERMIT #
t -7")
OWNER'S NAME: L o Yvt q S PHONE # 4 o PL� 8 Z 4 r
tE&%T-�L CONTRACTOR G FAX # 7
li /Cr / Yt
I am not using any subcontractors: Y�
Sig6ture 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
er/Contractor Signature Date
i Community Development Department
Building Division
r City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF
TUPEFax:,�T'NO (408)777-3333
•K\'' 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.
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 before another 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 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: O N-- - _ ,
t
Job Site Address: D 1 �L / TP ( � LQA �P/;.p
Roofing Company Name: Fil 2 t'
Applicant's Signature: Date: /�)f
• Greg Casteel bb
Building Official
Revised 11/2/04
Printed on Recycled Paper
050 a�oc3
CITY OF CUPERTINO
REROOF
•CUPEI�TINO PERMIT APPLICATION FORM
APN# &Q9
_ O":�_ 000 v
J Date: _
Building Address: V�/o�
Owner's Name: Phone#:
'll - d � 2
Co tractor: Ph on #: License #:
14 ee , do ri 2 — � 3 `7
9
Contact: Phone : Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof P,'Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
N mber of existing coverings L] 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: e /
'YNOV c� ?�t '�I Yl p Th ^t Y v+
Residential ❑ Co mercia V
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
st of Pr je t:� Type of Construction: Occupancy group:
C,_ , L
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees =BUILDINGBENERGY Ener BSEISMICRE Seismic Fee ResBSEISMICOM Seismic CommercialBPLANCHK Plan Check FeeBUSLIC Business License
0