05020032 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONT"CITO INFORMA IQN
BUILDING ADDRESS: J & 'J ROOFING PERMIT Nf05020032
OWNER'S NAME: PERMIT L4UB DAM
I ONE: SANITARY NO. CONTROL NO.
ARCHnRCDENGINEER: BUILDING PERMIT INFO
RLDO ELECT PLUMB MICH
p t�
jdF
LICENSED CONfRACmR'SDECLARATION JobDescri tion
I Mmby uflitm that 1 w IiCoMed under and
Proona of s Coda. 9(commencing P
with Suction m criafDWidan 3 of the Buainw end Profesviwu Code.and toss license is
fl� mmn Chnut erc a ueR 7[pL�//2 REROOF W/COMP.
z LiemY Cow e`- 't9 /�r�
B Dam Comm emr
�f ARCHMIC17S DECLARATION
y I Understand my plana shall be used as public records
U
Licensed ProfcuioMl
5 OWNER-BUILDER DECLARATION
I hereby affirm Son Net I am attempt from the Casa s Car License Law for the
O O following maaoa(Saito 703 Construct.
Business and PmfMaioM Cade:Any city at county
$r
which roqulm•permit re cnpewck alter,improve,ticermit t fi repair any nonce, Ron
,4r that
tnu its ficem d reason,also requiresae the
provisions of forrvch Actor's icaranfile a gad summCot
ggggFFQ NaIIMYIIR withScmNCofDiom3oftCOnVYmsandPrClJw(Cbapmr9 Sq.Ft.Floor Area Valuation
ds that he
exempt
SecUon70W)of Diasiiafrof theBed exemption,
Any n.vilatM)of
slut he r MemM therefrom and or aper for the objects
alleged esemant to Any violation of
EesaM than five any red doll far a permit rvbkcu Ne applicant m a Nvil penwy of 3 6d�d�ii'®2rftt0 0 Occupancy
era tome Kali tiro bundrtd dollars(5508). P Y Type
❑1,u mmr of dw pmperty,m my employcu with wages u their Yle cmmpeondon.
wllldo th..rk,and meawnum LL ml Intended wC@red fm We(Sa.701a,Budtmu
and Prefeadon,Code:The Contractors License Law dma rot apply to an owner of (y Required Inspections .
property who buildsor improves theran,and whodoessueh work himadforthrough his
oweemploytes,provided that such lmproxements art notlnleMed reoffered fm We If. /
however,Ne buBdleStr Improvement Itsold within am year of Completion.Ne answer. `
builder will haw the human of proving out he did Mt build or Winnow for Impasse of /
sale.).
❑1,as Caner of the property. M
em clusively communing with licensed Contractors to
construct the project(Sec.70",Business ad Professions Code:)The Canlnctorl U.
Como law data not apply to an owner of property who suit&Cor Ingram thereto,and,
who Contneta for such prejecu with u eontrsetor(H licensed pursuant to the Contractors
License Law. _
❑Ish"emVmodim See ,B&PCfwthrrtamm
Owner Dem
WORKERS COMPENSATION DECLARATION
I hereby affirm under peMlty of perjury arc of the fallowing declarations:
I haw and will maintain•Canifieste of Comm,toself-Ipeume rw WorkersCompan-
ion,pe provided for by Section 7700 of the labor Code,for the performance of Use
1M031'00
rk for which this permit is issued.
1 haw and will maintain Workers Comperuaaan IMunnce,u mquired by Section
nation,
of Labor Code,for the performance of the work for which this permit Is Issued,
y Workcrs Compewtion Insurance carrier and Policy number are:
rrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(7Tr mien heed not h tcompleted if the permit is forom hundtedmIlares(SIM)
or leas.)
1 certify that in the performance of the work for which this permit r IuueC,1 shall not
Applicant perYninan tnWrCf eo asm Meomc subject to the work CCompe"Ilm
lawa of California J
Applicant
NOTICE PP CANT:If.after making this Certificate of Exemption,you should -
become a j the Worker's Compensation pmvrloM of the labor Code,you mum
.,O forthwith Comply with such provisions or this permit shall be dammed meted.
q y CONSTRUCTION LENDING AGENCY
F Iheroby of emWlthert Is.ce.finn lending agency fro the part..of
lx> the work fur which this permit It issued(Sce.3097,Ci,C.)
UU n~. Lendcr'I Name
Ll z Lenders Atltlmst
Q certify NInNr
et 1 haw d Application on and sum the ave Information r '
0 Wilda.I groe to Comply wit all city and crudely pam ardlnatkea and ataU bas r upon
W
W abow-mcmmmctioaatm hembyYNorisrpose& uGw of Nis city in enter upon the
shove-(we) ncdare property for Inspectindemnify
an pugwsea J
gy
(we)gm. to save,indemnify and hap hay i m Irk y se of Cupertino against (y
I/f in
DNd expenseswhichmay In my wayaCCNe agaln[t Yldfaly v`
O 7 in consequence of the germing of this permit.
F7 APPLICANT U04DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
BOU N5.
pfd.� .2-3-s- Re-roofs
�Ign art Cof1lippilcamlCoommor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building wcupantsmat or handle huamoua material
u defined by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Coda,Steam 25331(07 All roofs shall be inspected nor to an roofin material beim
C3 yo, p P y g g installed.
Will the applicant or futum building occupant Me equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it ha%Aroma air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District] �
❑Yes pNt
I haw mW Ihehaurdtcsmamrials requirements underChaparei.95 ofdm Califor- _
err Health&SafctyCode.Secdmu75305,75533 and 25531.I undemmm thatifte Wilding
dues not cunt sly haws tenant,that II it my mpoMibility M naal'y arc mctpMt of
re Ulm.
hichmuu 'orm issuance or a cmiftcam o(Occupancy. 'g sere of App scant Date
or amharixcd agent - DamS All roof coverings to be Class"B"or better
4
Community Development
10300 Torre Avenue
Cupertino CA 95014
' Telephone(408)777-3228
aClOF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
iyG/ s GGz�r OSo 2 0 0 3'Z
OWNER'S NAME: DA , „4 5YIW,¢ PHONE #
GENERAL CONTRACTOR: J6,-3 FAX#
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
66 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 S �o o �i�r 9� /hst2 ✓N z ol��r
Septic Tank
Sheet Metal
Sheet Rock
Tile
a-3-S
Owler ontractor Signature Date
Community Development Department
Building Division
City of Cupertino
_ 10300 Torre Avenue
" Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
tUPEkTINO
Building Department
Subject Re-r"oofing policy for the City of Cupertino
1. y 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 Irom the City,_the following steps are
required: - a•.: •1+
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,
•' rr will iequire the i enioval of all new material down`to th'e sheathing,
so £properCity,inspection.can be'performed. ,: : .T% c;,
T % NOTE: If you call,for a plywood;nail inspection;and the job is not ready,
you will be charged a.re-inspection fee of$17618 The re-inspection fee must '
' b6•paid before another*inspe'cti6n-can be`§chedWed:
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: " 'Qf1UiQ' M `�ME'GLA 5' ii12(Z
_ _..
Job Site Address: Ig(ol
Roofing Company Name: 1f �J �do Fri/y
Applicant's Signature: Date: 22_3_S
Greg Casteel '
Building Official
Revised 11/2/04 .
Pdnfed on Recycled Paper -- ,
CITY OF CUPERTINO
REROOF oS" oa ,3 03 Z.
CUPEkTiNO - PERMIT APPLICATION FORM
APN# /L ,�3 D�� Date:
Building Address:
Owner's Naive.-L-. . — -. Phone#:
-- ,O{It�p �- me SfFVA2i z
Contractor:I Phone#: License #:
�J J o�rr�v
410?-73S—:z3/
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: -' Proposed:
❑ „ Built-Up Roof ❑ Built-Up roof
❑ 9sphalt Shingles Gd�Asphalt Shingles
®/Wood Shakes ❑ Wood Shakes
❑ Wood Shingles — ❑ Wood Shingles
❑ Other(Specify) - ❑ Other(Specify) .
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ . Tobe Removed- ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and,Will.Comply With Cu ertino's Tear Off Policy.,
Job Description:
7"6A o �, ;,SYS ES// cvooil 36/(, SQVRr,� sFFry S
T c .Residential ;,;:::Commercia . ❑;_�:rg -f...: .
,._:- -Fire Zone: Yes ❑hz_No ❑ - ~-r= 'a Confirmed with Planning
LJ
De t.if
there are anrestriction
:. Cost of Project: pgoa, oa Type of Construction: U Occupancy group: .
Qty. if
A licable. . 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
�,7z S��