05090205 (2) CITY OF CUPERTINO *'• -' '� ` -n h`
BUILDING DIVISION PERMIT s,CONTRACeTOR�INFORMATION
BUILDING ADDRESS: LOS GATOS ROOFING PERMIT NO.05090205
7558 NEWCASTLE D
OWNER'S NAME: PERMITISSUEDATE
JACKS KEARNS 888 FAULSTICH CT 09/29/2005
7ARCHITECT/EbiGINEER:
NE: SANITARY NO. CONTROL NO.
(408) 298-9399
BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I Wuby affirm Nat I am littnsed under provisions of Chanter 9(commencing Job Description
Sauon7IXN)of Division 3ofdm BusircssaM Profcssiuns Code.and myliccnuu QCT, 9 .`\ n+ ,,anderrec ble7a7 q REROOF--REMOVE 2 LAYER ,INSTALL DMARK
nCl Lia.x d . �P q_ror Comrumr La.f 6-4 dvi TL SHINGLES i'1
W
ECTS DECLARATION
ay K I understand my plans shall he used o public mentis
�G G Licensed Professional
i. T 2005
w3 OWNER-BUILDER DECLARATION
i E I hereby affirm that I am exempt from tic Contractor's License Law for the ❑ +y _xxx,,,��- /��
Z a O fallowing moon.(Section 7031.5,Business and Professions Code:Any city or county
<m which mqums a permit to comeri alter,improw,demolish,in repair any Smso m
prior to its issmnce,also requires the applicant for such Permit to file a signed summmt „.. tare
£ < that heislice mudpumanttothe provisions ofthe Common's License Law(Chapter 9 Sq.Ft.Floor Area ValuatiOS264
yam$ (commencing with Section 7000)of Division 3 of the Business and Profcssioru Cour)or
Numnu
at he is exempt 0crtfrose and the boo for the alleged cn.Any violatuan of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom Nanrwnanemaaml,rs(ssoo). 36617016 . 00 p y YP
❑Lo owrcr ofiW propume or Is empleym with emdf r ntic(ee campewness
will dorework,end Ne he Cionnnotintendedor o@rtosHe,a(Sec.7im w.,,oa
and Professions code:The Con hereema ndwho law uses not apply lf rt owner or Required Inspections
property who bullus ri Improves;chicon,endwho doessuch work himselfor offered
Ito
own employers,p building
or i that such improvements are net intsMW aro@rev for owner-
Wilder
the Wildingorimprovementissoldwithin orc ild or completion.the owe of
saleL will low rhe burden or proving Wr W aid ver Wild or improve Int purpose or
sale.).
❑1,ea owner or the pmpcny,am exclusively convecting with licensed contractors b
construct the project(Sec.7044,Boinces and Professions Code:)The Commucarf U.
cove Law does not pply re an owner of Property who Wilds Or improves Boston,and,
who contracts for such projects with a contracmr(s)licensed pursuant be Be Convector's
License Law.
El lamuemptunder See .B&PCfarthlerouon
Owner Date
WORKERS COMPENSATION DECLARATION
I hhmby affirm under Xualty of perjury one of the following dielantione
1 have and will maintain aCenifieate of Consent to self-imine,for WorkcesComport,
satim,as provided for by Section 3700 or the Labor Code,for the performanm of the
work for which Nis permit is issued.
❑1 have and will maintain Worker's Compensation Insuranm,u mquimd by Section
37W of the Labor Code,for the,perform eine of Ne work for which Nis porm,is issued.
My Nummi s Compensation biE.
umntt carrier and Policy n�ufZ %mber
rtiaam-
Caer. Policy No.: / -Z a Ojo
C FICATEO EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
OTU secunn good nothcccmplcled If the permit is for onchundred dollars(SIM)
or los.)
I certify Nat in the perfnrmmec of Ne work for which this Permit is issued.I shall not
employ any person in any manner so as or become subject on the Workcri Compensation
Laws of Califamia.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cendmide of Exemption,you should
become subject m Ne Worker's Compensation provisions of to Labor Code.you most
.J Z forthwith comply with such Frnviuens or Nu permit Nall be Ounce revoked.
z CONSTRUCTION LENDING AGENCY
(-+ I hominy alarm then ft.sea eonstructon kndingagcnry fm deperformanm or
!Yi
the work for which Nu permit is issued(Sec.3041,Ci,C.)
W Lender's Name
=Z Lander'3 Add. -
V 0 I cenify Nu 1 have read Nis application and sunt Nat the move ore mauun u
It, Corea.1 agree to comply with all city and county ominmces and stale laws relating to
O V building construction,and hereby authorim mpresenlnives^fNis city to unser upon the
W sow-menuogod propertyms.,mi for inspection which.st
(We)a9.m taw,indemnify and trop harmless Use City of Cupcnino aSat.,
Z in coucruenc oftheeostsendofpenus which may in any way ucmc against said City
V Z in consegrcnec of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG20NS.
se^a drtLZolxpnfiesnatpmwSEF-v Doe / Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will use applicant or form building occupant from or handle hoardous material
az defined by tic Cupertino Municipal Code,Chapter 9.11,and IW Health and Safety
ale.Section z5
❑Yu 532(e)T Nu� All roofs shall be inspected prior to any roofing material being installed.
.
Wll Ne applicant or future Wilding occur If a roof is installed without first obtainingan inspection,I agree to remove
PP g pant tau equipment Qu or devices which
telt hazDistrict? us air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
DisviciT
❑Yes �Nu
I have mol the huaNms mawrials requirements under Chapter 6.95 ofum filifor.
nu RUIN&Sarcry Code.Sections 25505.25533 and 25534.1uMersund Naz if f Wilding
does not cummly have a lumen,Net it u my mmonsibility to notify Ne soup.,of Ne
mquiremcntawhre ust be met prior he Issuance of a cemficam ofOccaPa^cy. Signature of Applicant Date
Owner or auNorirad aent Ogre g
�� All roof coverings to be Class"B”or better
g
iCommunity Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
qUPEkTINO 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:
Job Site Address: / SS O/ L�r/�GL 0/—
Roofing Company Name: CTCt� D cN/Yt.
A phcant's Signature: Date: y/(J
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # �_� / / Date:
Building Address: /55 6 /e
Owner's Name: Phone#: 7lJ 2 Sj--S7 Sd
Contr ctor: Phone k License#: p�D hO n
Cont t Phone#- Cupertino B iness License#:
a o� i o 93/x/
Type o Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Uproof
Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) �z Other(Specify) Q$
N ber of existing covering— ❑ Provide I.C.B.O. eport#
�To be RemovedIQ �s'
Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: k 2 /G '0_7_E-
14
Residential Commercial F147
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Pro'e t: Type o Constru tion: Occupancy group-
326 Al— oa S117l e
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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