03100106 CITY OF CUPERTINO •.p, .,.:,;a.. 4a, -,..y,. .;, .
Is UILDINCUIVISION PERMIT CONTItr+iGTQR'INFORMATIONi `s
BUILDING ADDRESS MARTINEZ-OJEDA CONST. PERMIT NO 03100106
on-Ync TnT1lTT n_m_
InWNER'S NAME: 326 STAPLES AVE PERMIT ISSUE DATE
,,,b1 RN T4nTTPRTQ ATTn ,TAATRT V J_ Q'/7 Q03
E: (408) 259-5171 SANITARY NO. CONTROL NO.
ARCHITEL VENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION Job Description
i aUa I hereby affirm that I am licensed under proviuune of Chapter 9(commencing P
i< vndhsfnreeau�l) fcDiv/ia,a)n Jo rut Buatness,�quprufcumm Cade.andraylicensci.
to K. Data Class IQc� r �_°14^ aXbD TEAR OFF SHAKES/INSTALL PLYWOOD &lor LIGHTWEIGHT TILE
'd ARCHITECTS D• ION
i Ian nandrayn.m.almllhcuuJUp. eZmds
ii as
f, Licensed Pndemonal
5 OWNER-BUILDER DECLARATION
S 1 hereby alfom that 1 am exempt from the Contractor's License Lew for the
:0 O following mason.(Section]11]1.5,Business and profession Code:Any city or county
j$ which requires a Permit in construct,alter,improve,dcmnlish.or repair any suucmm
z>r^ prior us its marrec.also requires the applicant for such permit to file a signed statement
s"22< that he is licensed pursuant m the provision of the Contionv i License Law(Chapter 9 sq.Ft. Floor Area Valu� 000
3F0 (commencing with Section 7")Of Division J of the Basin.and Professions Cook)or
that he is exempt therefrom and the basis for Lou,alleged exemption,Any violation of
Semen 903 1.5 by any applicant for a Permitsubj.,u the applicant to acivil penalty at 3 31 glgktper0 0 Occupancy Type
not mart Nan fin hundred dollars(S500).
0 h as owner of the property,or my employees with wages as their sale compcnution,
will do the work end the structure u not intended or offered far sale(Sec.7004,Bush•^..
and Pmfe ssion Code:no COnammes Ucenm Law does not apply to an owner of Required Inspections
property who builds or improves thereon.and whadoes such work hsmselfor though his 305 — FRAME
own employees.provided Oat uch improvements rte not intended aroffered for sale lL 307 — INSULATION
however,the building or improvement a sold within One year of mmpleuan,the Owner-
builder .will have the burden of proving Out he did not build at improve for purpose of 601 - ROOF TEAR OFF
nlc.).
0 1,as owner of the property,am exclusively contracting with licensed combination;to 602 — ROOF PLYWOOD NAIL
conswn the project(Sec.7004.Business and Professions Cade:)The Cooracros's Lt- 603 — ROOF BATTENS
term law dots not apply to an owner of property who builds or improves thereon,and
who conlocu for such pmiecu with a contractor(s)licensed pursuant to the Contracmp 604 — ROOF IN-PROGRESS
License Law.
(�•l am exempt under Sea _ _ B A P C for this mason
m
WORKER'S COMPENSATION DECLAR.::ION
1 hereby allirm under penalty o(perjury on of the following dxlaraoonst i
1
or
aw and will maintain a Cenificam of Consent to self-uuum for Worker'sCompen-
work f r provided for by Seniors J9a0 of she labor Code.for the peAormarrce of Nc
.,,an,r which this or by Section 3
0 1 haw and will maintain Workers Compeouuon Insurance.u required by Section "yati.
37W of the Labor Code,for the performance of the work for which Nis permit is Issued.
My Workers Compensation Insurance carrier and Policy number am:
Ca r. Polity No:If
CERTIFICATE OF EKEMP [ON RKERS'
COMPENSATION INS U ANCE d
(Thissecuon need not becompleted Bthe perish is intone hundred dollars($100)
or less.)
I cerary Net in the rformance of Ne work for which Ox permit a issued.I shall not
employ any per a any manner anum horn c subject to lbe Workcrl Compensation
La ws of Cah Det^
Applicant
NONCE� A PLICA artcr making this Ccririe or'Exemption,you should
bec?lgubject to the Worker'a Compensation provisions of the labor Code,you must
Ofortll((wid comply with such prnvisinn Or Nn peamd shall he acemrA revoked.
�'vy CONSTRUCTION LENDING AGENCY
I thereby affirm that dorm 4.comoummm xndmg agency Isar the ve,famm.m.of
Lv Fes•, the work for which Nn pemit is issued(Sec.3W7.Ch,C.)
s1 Q Leadcr's Namc
z Undcr'a Ad,i ^
0 1 cenify Nu I have road Nis application and sum that the above information is
y correct 1 agree to comply With all city and county ordinances and some laws misting to
building construction,and hereby auNorim ropmxnuows of Nn City to saner upon one
ahovcmeminned popc st for a inspection whiphms. ��
(We)agree to save,indemnify and keep harmless the City of Cupertino against
ti
in of the groaning cepcnmsmitah may many way ucnm against mid City
J 7 APPLI consequence of UNDERSTANDS of this D WILL APPLIC NT UNDERSTANOg AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOD R OULAGON
c% M rl�J'o�r ��n X111 f.h`r Re-roofs a
51 amre o pplmn Contract Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building ocaupantatme or handle ha%dous manlist
as defined by the Captions Municipal Code.Chapter 9.13.and Or Health and Safety
0Cotx,Semm.35532(a)+ All roofs shall be inspected prior to any roofing material being installed.
0 Yea R-/t{��'
Will the applicant or M buildingonupant use equipment or Ovixs which If a roof is installed without first obtaining an inspection,I agree to remove
1rict?boardous air cionsomints as defined by the Bay Area Air Qualsay Management all new materials for inspection.
0 Yes 1 u
In
an rcaJ thehvaNnu mamrinla rcyviremcnu under Chapter695 of Nc Califon /%/A////S, ,//JA /
nice HCOINB:Safety Cade.Sxuon 35NI5.255JJ eml235J4.lundcntantl Nati(thcn of a C/ of/ �r�/(�'J �f �0�I f�—r� 7
dos not rte By hoc a minnh Nat n u my responsibility m notify the cup of Ne
mqm k, inch
maatl ty%t�rsq� - nfacerdreamor�up. U' 5ignatur of Applicant Date
u rvadagem '�{�� Date All roof coverings to be Class i'B"or better
CITY OF CUPERTINO 0 3 I D&
I& REROOF
cl CUPEf�TINO PERMIT APPLICATION FORM
APN# Y � f (5 Date:
Building Address:
207175 A rA 0 Vr ClT. 1
Owner's u Name: Phone #:
t�
Contractor: r Phone#: License#:
,411A1✓rl Nr'z — 0) LC�A � br , z '� S� 71
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
JR Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) p V R�Ll i
Number of existing coverings ❑ Provide I.C.B.O.Report# ?,Le 5
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: ❑
Job Description:
_7£ia0— Ofd >ltdl=F5 �L4wo-oA ArrD btjjt\ CtNT"il Z1u5(A µtW
Residential P Commercial/ ❑
Fire Zone: Yes ❑ No ❑ F Confirmed with P1 n -Dept. if
°:��� there are any actions: Er
Cost of Project: Type of Constructi�9t Occupant group:
11600 � ✓Le 1 -6 6V-
l% !
Qty. if
Ap icable Fee ID Fee Description Fee Group
I / / BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
I BSEISMICRE Seismic Fee Res BUILDING
I I BSEISMICOM I Seismic Commercial BUILDING
BPLANCHK I Plan Check Fee I BUILDING I
BUSLIC I Business License I BUILDING I
I I I I
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E ITT I N O 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: 0(9(1-)iP£N' e )`4<!��J
r
Job Site Address: %t� 7 F (� )A
Roofing Company Name:4,6PMC_G?A plicant'sSignature: Date: J(.)—/ —613
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper