05080170 (2) CITY OF CUPERTINO7av, s<ar r,+
BUILDING DIVISION PERMIT &,CONTRACTOR INFORM�.TIO1V :
BUILDINOADDRESS: DONE RIGHT INC PERMIT NO.05080170
0295 VICKSBU
OWNER'S NAME: PERMIT ISSUE DATE
CARL & JUDITH FLOCK 1129 LONG FE 08/19/2005
NE: SANITARY NO. CONTROL NO.
(408) 377-8777
ARCHI'IL'CT/ENGINEEN: BUILDING PERMIT INFO
B DO ELECT PLUMB rn
MECH
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oo LICENSED CONTRACTOR'S DECLARATION lob Description
1 hominy".that 1 am licensed under provisions orchapter 9(commencing P
iMSaw ]Of1U) r o Me BmiessandPimil. .aw"a"Iceucis
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in full RE OOF-T/9 SHAKES, INSTARif,WOOD 50 YR. ELK
2 y0 Z License Lic.N (((�), p
Dam
Ganllacmr ry Q
QCK ARCHITECTS DECD Y,T
I understand my plans shall W used u public records �•iF..,
g La Licensed Professional
y OWNER-BUIIAER DECLARATION
Contractors
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0 0 1 hereby a(Scc that I an attempt form Ute ionn,C :Any c law for Me v IT
0 o following moon.permit
171171.5,Business and ,do oII Code:Any cm or county
which mqulrm a Permit re Construct,we a7leL Improve,demolish.ri e 4 sig ed atneent J t'
lost he Wiensedpaaumgaime we applicant Me aanPermit m0lelo Ladauumcot _
r�p o (comminmm�wthSmilnlmmepmvivioonofthe0uiner'snianscssonCharm,9ode)or Sq.Ft. Floor Area �y s - ,aValuation
ss (commeneing with Section 7000)of OivisionJof theBuainnse and Profrsinm Code)or w.v,a. :r x$12614
lt, dw he is exempt Memfmm and Ne buss for the alleged exemption.My violation of Y
Sanson 7071.5 by any application for a permit subjects Me applicant to a civil penally of APN Number Occdpancy Type
not mom than five hundred dolhcs(3500).
❑I,aowner of dm propeny,ormy eoployaa wlM nguathehsole campewlion,
will do the work,and Me Nwnum Is notinunded oroReral formic(Sec.704,Business 36907815 80
and Professions Cade The C mmines License law does not apply a an Owner of Required Inspections
pmpeny who Wilds oriammvea Merron,endwho doessuch work I imself orwrough his
own employees.provided Matsuch impmvements are notinunded oroReml formic.If.
however,the building or improvement is sold within aro year of completion,Me owner. '
builder will have the burden of proving Mn he did vel build or improve for Purpom of
talc.).
❑1,as owner of Me property,am exclusively contracting with licensed commoors m
constmcl the prejecl(Sec.7044,Business and Professions Codi The Contractors LF
cense Taw Meas not apply to an owner of property who Wilde or improve thereon.and.
who contracts for such projects with a contrator(s)licensed pursuym in the Contractors -- - .
License law.
.. ❑lam aempl undo See. - ,B@PCfor this won . -
owner Dam n.,............. . _ _ _
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury on of the following ded.d.ns:
1 have and will maintain a CW orate of Consent to self-insure for Workers Compcn- -
sation,u provided for by Sanson 7700 of we Labor Code.for Me Performance of Me
work for which M
Is permit is mused.
❑1 have and will maintain Workers Compensation Insurance.a mquimd by Section
31l 0 of Me labor Code.for Me Performance of the work for which this permit's issued.
My Worker' P lady sun artier and Policynnu/mbbe
Carrier. No.: WORKERS'C CATS EXEMPTION I FROM W ORKERS'
COMPENSATION INSURANCE
Mus section need not be compleud If the permit is foronchundred dolls(3100)
or lase.)
1 artily that in the Performance of the work for which this permit is Wood,I shall not
employ any person in any manner an a to become subject to the Workers Compenatlon
Laws of California.Dau
Appllant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
became Subject to the Workers Compensation provisions of to latae Code,you mum
,J 0 M
forthwith comply with such provisions or this Permit all W domed mvaked.
Z'•"
CONSTRUCTION LENDING AGENCY
[•+� I herby opium MU then is a Construction lending agency for to performmar of
the work for which this permit is issued(Sec.7097,Civ.C.)
Q Lender's Name
Z) z Leaders Maw
V Q 1«Nly that I haw read this application and sou that the move information is -
11.!! Comm I agme to comply with all city and county,oNlossa_s and sum Was relating to
Q tr.'J building construction,and hereby authorise mpruenutivem of this city to enur upno Me �.[_J--\ tg/./,/gam//
{!7 shove-mentionedms, ms(and epectian pugaseA /`'^�1LV
(We)aVea t0 Hw,Indemnify Nd keep locations Me City of Cupertino agaiml
in C;nln,judgmcnu,cos III S upcuawtich may In try way attmc against mid City
U rjr ACOnICA of MCg A Of MINDr'WIL (•.
AP ICA UND ANDS AND WILL COMPLY WITH ALL ON- NT Issued by: Date
SOURC ONS.
Re-roofs
S' fAppliaMConncmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Me appllcent tae future Wilding occupant mom or handle hamadous material
at dcBnsd by the Cupertino Municipal Cade.Chapter 9.1 y,and the Health and Safety
otic,Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
❑Yas 01> '
VAR the applicant or future building accupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
0 hwardous air contaminants a denncd by Me Bay Area Air Quality Management WSinNture
jma * Is for inspection.
grim?
Dyes Ne
I haw reW theh nuNmauridsreyuimmanu under ChaPur6.95ofMeCalifm-
niceHcalMd<S tyC ,Seetimts23505.755J7 end 75374.1 undo dMmi(Ihc Wilding
urea I a am Mu it ts my rape Willy u n fy de occupant of Me
myul muubcmaPrior tuiss ca( C a�.�CC CY of Applicant Date
ncr or aulhorixed agent U Data All roof coverings to be Class"B"or better
I
Community Development
10300 Torre Avenue
&CF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS:
1,
19 6. // PERMIT�D
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR 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 C
Septic Tank
Sheet Metal
Sheet Rock
TileAl
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
UPEkTINO 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
dndinanufacturers 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 before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of /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: �l /
Roofing Company Name:
Applicant's Signature: 0�
Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
Gft
CITY OF CUPERTINO Ste, °O
REROOF
Iwo
CUPERTINO PERMIT APPLICATION FORM
APN# � Date:
Building Address: 1,0 C� q C
Owner's Name: ® Phone#9
Contractor: n Phone -J T76 7 77 License
Contact: J o #: / / G / Cupertino Business License#:
NrIJ -6 .�}' 0_ e
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑/Asphalt Shingles }Y 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.
Aj�l Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: O � � t
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: / Type of Construction: Occupancy group:
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
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