09040062 CITY OF CUPERTINO ;
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
8035 PUMPKIN DR MBROWN CONSTRUC I
PERMIT ISSUE DATE
OWNER'S NAME:
-PRM DaD BARBA A O. CONTROL NO.
nT,"40NE:
(4 0 8) 2 6 0-12 6 0 BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECTPLUMB MECH
E
u O p TR
LICENSED CONACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z 5 with Section 7000)of Division 3 of the Business and Professions Code,and my license is RE—RF RJ SIV EXT 2 LY S H K& I N S T L A PRX 2 6 S Q CMP CLS A
n=H in full force and effe era— Z"
Z License Class
file.N
E Date Contractor k^ ro/tI N Gov sf RF & SH:!ATHN
~ ARCHITECTS DECLARATION
$I.-, t understand my plans shall be used as public records
to
�yU
C y Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
y p O following mason.(Section 7031.5,Business and Professions Code:Any city or county
e m which requires a permit to construct,alter,improve.demolish,or repair any structure Valuation
y y prior to ifs issuance•also requires the applicant for such permit to file a signed statement $ Ft.Floor Area
?e that he is licensed pursuant to the provisions of the Contractor s License Law(Chapter 9 q 4500
Yt=-$ (coin cncing with Section 7000)of Division 3 of the Business and Professions Code)or
y 5- that he is exempt therefrom and the basis for the alleged exemption.Any violation of ApN Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars(S500). 0
0
0 I,as owner of the property.or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Conuactoes License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees.provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contmtoes Li-
cense Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the contractor's
License Law. B P C for this reason
0 1 am exempt under Sec
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Workces Compen-
-tion,as provided for by Section 3700 of the Labor Code,for the performance of the
work fo hich this permit is issued.
have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued
My Works C m as tion Insurance rticr d Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WO ERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you mus
`Z, forthwith comply with such provisions or this permit shall be deemed revoked.
Z 0 CONSTRUCTION LENDING AGENCY
C/2 I hereby affirm that there is a coasuttction lending agency for the performance of
> the work for which this permit is issued(Sec.3097.Civ.C.)
W A Lender's Name
0 Lender's Address
z
V 0 I certify that 1 have read this application and state that the above information is
LL H COMCL I agree to comply with all city and county ordinances and state laws relating to
V building construction,and hemby authorize representatives of this city to enter upon the
0 W above-mentioncd property for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit. Date
�4 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued ty:
SOURCE REGU 1715•
q-13-0Re-roof;
Signature of Applicam/Conuactor Dare T Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building Occupant Store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? _ / All roofs shall be inspected prior to any roofing material being installed.
0Yes ° If a roo r is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
nit hazardous air contaminants by the Bay Area Air Quality Management all new materials for inspection.
lstrict?
0 Yes °
1 have mad the hazardous materials requirements 33 nd55 under understand
tha of the balding
or-
ria Health&Safety Code,Sections 25505.25533 and 25534.1 undcrstvhd thu if the building
does not currently have a tenant,that it is my responsibility to nodfy the occupant of the Date
requirements which must Inc rior to issuance of a certificate of Occupancy. $ignatU Ce Of Applicant
3-qAll roof coverings to be Class';•"or better `
Owner,or authorized agent
Date `
09oq
CITY OF CUPERTINO
RERoOF
In F PERMIT AP?PLICATION
CUPERTINO
Date'. C4 13 ' O
APN # �
Building Addre s:
3 r� Phone #
Owner's Name: g 2 Gj�j �--�-Z
1�,r�no�l��ll
S Phone #: L4
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Contractor:
/� Fax#:
C� Contractor License #:
Cupertino Business License #: O� 21� Z
Type of Roof Covering:
Proposed:
Existing: Built-Up roof
❑ Built-Up Roof ,Asphalt Shingles
❑ Asphalt Shingles u Wood Shakes
VWood Shakes o Wood Shingles
❑ Wood Shingles ❑ Other (Specify)
❑ Other (Specify) _ ❑ provide I.C.B.O. Report#
N m
7ber of existing coverings _ -- ❑ provide Mfgr. Installation Specs.
ITo be Removed
2 ley
lr
Job Description. e X
Commercial ❑
Residential Confirmed with Planning Dept. if
Tete relevant port of n of the there are any restrictions: ❑
Green Building: Please comp application ori f
Green Building Checklist & attach it to the app _ -
include in plan & the sheet index. __-_----------
apr licable,
Valuation: S pC v_ __--------- —_ —
Nrith Cupertino" `bear-Off Policy:
I Have Read, Understand
and Will Comply
Signature — Revised 6/16/08
CITY OF C-UPERTINO
REROOF
r'UPEkj1N0 FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg StzLndards B ALL PERMIT TYPES
Commissior Fee
1BSEISMICO Seismic Commercial B
1 REROOFRES Re-roof Residential B 1SFDWLR00F
1BCBSC Cal Bldg Stz�ndards B ALL PERMIT TYPES
Commission. Fee
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg St<<ndards B ALL PERMIT TYPES
Commissior. Fee
1BSEISMICRE Seismic Residential B
1 BUSLIC Business License B
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
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 2007 IBC Standards
and manufacturers specifications on re-roofing. All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the buildin€;inspector. A final inspection and
approval shall be obtained from the bu Iding 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 apprcval.
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 f rst obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be perfcrmed.
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 ')e scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/ " oer 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:Mated policy on re-roofing.
Homeowner's Name: ` 7 i2 Yyl b I0, <S
Job Site Address: g D -36 �Ln_ a n D(. Cype(' (�U t cA-
Roofing Company Name: H flitw' ' C"N ctfiCy-) t -
Applicant's Signature: — Date:
Greg Casteel
Building Official
Revised(17/30/08