05080237 (2) CITY OF CUPERTINO �a t f^Lr> a '� "�' a
BUILDING DIVISION PERMITCONTRACTOR INFORMATIpN �
BUILDING ADDRESS: JNSJ ROOFING INC PERMIT NOO 5080237
OWNER S NAME: PERMIT ISSUE DATE
5
NE: SANITARY NO. CONTROL NO.
4082796171
ARCHITECT/ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�o Z, LICENSED CONTRACTOR'S DECLARATION Job i`5 nOn
}j 1 hereby affum Net 1 am licensed under provisions of Chapter 9(commencing Fop
ith Section 70010)of Division 3 of we Business and Prefussiun Code,and my license is P� k 9 S � F ,,,�
mfoumroeitdcRcM.r_ja 7 nb REROOF-T�O SHAKES, IN TALL'• CbMP S NGLES
5@4 License CIp}s / Lk.Y .Y
t Dau tl—iS�—con r
9 ARCHRECTSD ON t
1 undotmanJ my gluts shall be mud u public Me
V
5✓��a
Licensed Professional
3 we Ia.exempt
DER on the Constantine,ATION
0 1 hereme affirm o n I em eacmpt fare Nc sionsaLicense Law co the , '"'m• v
S:O O following rtann.(Section 7(131.3,Business and Ro(ouinu Cade:Any city or county Butt ; f S :,,
$ which requires a Permit to connwct,slur,Minnow.demolish.or mpmr any structure, 2"a i,Sp i. �x.l
priafbincenaMpursu pursuant
0 the proviion,o the Compactor'bicense ga (Chapter
— . `
FFF< thatheislko With Section
00)ofDivionnfthcConushressaLicenseashouCode)Or Sq.Ft. Floor Area ' Valuation
3$ (commencing wishSettion700B)nfDivuian,of fto, BuslneuitdProfeNiCodo)ur $7250
3 Net he B euaopt IMe(rom nd Ne bu4(or Bu slkgetl eumpdm.My Moladon of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of APN Number Occupancy e
men mom Nan Bw hundred doll.($300). P Y TYP
❑1,a owner of the pmpmy,m my employms wIN wages u fttrmle mmp melon,
will do the work,and Neawctum is notimmided oro0ered forwe(Sec.764/,Business 3,6652042 . 00Required Inspections
and Fm(wsion Codote.1 The Committer,Lkw law doret appy w n e Manor of q P
property who buildsmimprows thereon,endwho doessuch work himsel(ur thorough his
own employers,provided that such Improvements are but intended aroff red for We.if.
however,the building or impmwment is mid within sae year ofcompletion,we Owner.
Wilder will haw flue burden of proving Nat he did not build Or improve for purpose of
ark.).
0 1.as;owner of Ns propeny,am exclusively contracting with Removed contractors in
eonmuet Ne project(Sec.7W,Business and Profeui.n Cade:)The Contractor's LI- _
tens Law don out apply m an owner of progeny who builds or ImProws werem,and,
who contours fw such projects with a contracmrt8 licensed pursuant in the Conuactoh
Lt., ..Law.
❑I am exempt under See .B h P C Its this reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
41 1 hereby afarm under penalty of perjury one of the following declantiom:
flow and will maintain aCeNfiwu of Comer an m,for Wosksf,Compen-
Ion,as provided for by Section 37M of the Labor Code,for mho performance,of the
work for which this permit Is issued.
❑1 haw and will maintain Wallace,Compemation Inamnm,as required by Section
37M of Ne Labor Code,for we performance of the work for which this permit is issued.
My Worked,Compensation low ante wrier and Policy number tee:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Th6 auction nerd nut becomplewd If the permit Is from hundred unit=(SIM)
or I.) ,
I cenify Not in the performance of the work for which this permit is iumd,I shall not
employ any permit in my mmmer b more 'uc M.2Vorken'Compeuation .
Laws of Csiifomta.Date
APPllwnt
NOTICE TO APPLICAND If.after making dits ComillEate of Elan mon.y.0 m
become mbjewt m the Workefa Compensation p on we Lat mit ecu
.JO forthwith comply with such provisions.,this permit she c ceme rewked.
rV! CONSTRUCTION LENDING AGENCY
[—m I hereby affirm that were is a construction lending agency for we performance of
fY,7
the weak fur which this permit is ismrA(SM 3097,CO,C.)
a I<ndces Name
]z Lender's Mdmu
C.p Q 1 wni(y that I haw read this application ant nam that the show in(mmation is
{f.^ cmrett I lagne to comply with all city and county onlinantts and mute law,relating to
QrU^ building construction,and hereby authorise representatives of this city mentnupon we
W above-mentrotmd ProPenY fm iupecdon purposes.
Lam (We)agree to nw,indemnify and keep harmless the City of Cupertino against
h Iiabithicsjudgmcnu,casu and comma;which may in any way accrue agsiutred City
fJ7 in comemome of the gritting of this permit.
�i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signuurc of ApplicitUConDam Of ROOF
HAZARDOUS MATERIALS DISCLOSURE Type
WIII Ne applicant or forum building occupant nom or MMk Istrarbuts
anmeual
ri
u dented by the Cupertino Municipal Code.Chapter 9.12.and site Health and Safety
Code.Sectionv332bil � All roofs shall be inspected prior to any roofing material being installed.
❑Ycs AT9.1
Will we applicitt.r future Wilding Occupant six equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hanrdnw air contaminants as defined by Ne Bay Ama Air Quality Management all new materials for inspection.
I
wicR
❑Yea XNu
Its w mad the hu�rdtmsmawdetamquiremsmm under Chapterd.95 of M Coffer.
Hcalw SeMyCmk,Sccdau 25503 5]3 am1255N.lundcrwAm watlfwe buildingcs not namlYhsve a units, at itimres oulbility m 1ify the uccuPnt of 00.ire sew uxtcmel' or vit fa Cerjocatc of Occupancy. SIg OfAIicant Date
All roof coverings to be Class "B"or better
ovMm M, o agen
hodyt Dow g
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
1-UPEkTINO
Building De artment
JOB ADDRESS: PERMTr#
(f SSI 'br. O 2-3
OWNER'S NAME: Dkz,*ca a PHONE#
GENERAL CONTRACTOR J&ISJ (Ur ' c . FAX #
I am not using any subcontracto :
Rigmbire Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
ectrical
Exchkation
Fenian
• Flooring: eting
Linoleum/ W�dbo
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet tal
Painting/ Wallpaper
Paving
Plasterin
Plumb' g
Rogffng
S4ptic Tank
Sheet Metal
Sheet Rock
Tile
er/Con actor S' ature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
UPEI�T�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.
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 " 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: PAA' k;k oHe�Cax,
Job Site Address: II SSI S4,J-# ^ S?✓;ns
Roofing Company Name: SJ c C
Applicant's Signa e: Date: V-2S--05
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
ao
CITY OF CUPERTINO
REROOF os-vfa 2 3,
CUPEVINO PERMIT APPLICATION FORM
APN# S66—
/'6— S2 — O Z Date: g—23—w a
Building Address:
Owner's Name: phatCdr Phone#:
Contractor: Phone #: License#:
JNSJ qog 2?9- 6(Z( _ 739?80
Contact: Phone#: Cupertino Business License#:
l�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ ilt-Up roof
❑ Asphalt Shingles &K Asphalt Shingles
R'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 ReaFUnderstandWill Com 1 With Cu ertino's Tear Off Polic :
Job Descripvaq' chf 1a1.( NWS C.O+Nf' Skth (<
ResidentialCommercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
-712 50"
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
3u � 32