03100107 CITY OF CCIPERTIN0 .
I 'i�;
BUILDING. VISION PERMIT ,CONTRACTOR`•INFORMATION;-,
BUILDINQ ADDRESS: PERMIT NO.
MARTINEZ-OJEDA CONST. 03100107
,n-]7 F Ac 710171 ^_-r
(1WRER- NAME-V PERMIT ISSUE DAM
�gM 326 STAPLES AVE 7
N (408) 259-5171
E: SANITARY IRj ' CONTROL NO.
ARCHITECT/ENGINEER. BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0
LICENSED CONTRACTOR'S DECLARATION
m I hereby*(firm that I am licemed under provisions of Chapter 9(commencing Job Description
with Soon ] ))af Division 3 ofthe BUST and Professions Code,and my license is
;OZ Licenise Cl ""s`1 t: )r Lm.a /'2
Dale Comm V.-6�Ijf1- 'ta.141,'.4TEAR OFF SHAKES INSTALL PLYWOOD & LIGHTWEIGHT
g ARCHITECTS DEED ON
iW �rsundmypluuahall beuud sspuhhc manila TILE
Ile
u. Cleansed Professional n
�0OWNER-BUILDER DECLARATION It
S 1 hereby of fret that 1 am exempt from the Contractor's License Law for she
.02 O following mason (Sadao 703 m L.S.Business and ve.demolish.Code:Any city or county
5$
which requires•permit re ennswn,alter,impmw,demolish,in mpmg any atnmum s 1.
-ti pnomntts censed pursuant ho to the pmvsamicanf far sochpemmuo Bense Law(Fatemem the
that hcrsbccnud o mcpmvramnsaf she Contractor's License lsw(Chap¢r9 Sq.CFI,2Z'�
ea I 1 `1' Vauatld
j S (commencing pt th Section
rom and)of bans f rth the eged easand ption.Any Vi Code)uf 17�
(cn he is exempt therefrom and Ibe basis for the alleged exemption.Any vinlatlon a( _ ,]I 1 l] LLL���+�-���'---"' 1
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of AF r — Occupancy Type
nos more than five hundred dollars(M).
P Y YP
❑1,as owner ofshe propaoy,or my employees with wages as their sole compensation, 32656025 . 00
will do the work,and me stncwm is oat intended at offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License law does not apply b an owner of Required Inspections
property who builds or barrows thereon,and who does such work himselfor thmugh his
own employers,provided that nuehtmprowinams are not intended or o(reud for ssle.If. 305 - FRAME
however.the budding or improwmens is sold within one year of compleumn,the owner-
builder will haw the burden of pmving that he did not build or impmw for purpose of 3 0 7 - INSULATION
sale.).
0 I,as owner of the property,am exclusively contracting with licensed contractors to 601 - ROOF TEAR OFF
construct the project(Sec.]044,Business and Prafesvoa Code:)The Commons U. 602 - ROOF PLYWOOD NAIL
cons,law dins not pply m an owner of property who builds or improves Wagon.and
,' 603 - ROOF BATTENS
Who contracts for such projects with a conuacmr(a)licensed pun uanl li the Caatraclar!
��a`naeLaw' 604 - ROOF IN-PROGRESS
I an attempt under Sec. B k P C for this moan
(Owner 'law
WORKER'S COMPENSATION DECLAR..IION
1 hereby*Mint under penalty of perjury one of dos following chi...
Own,have and will momuin a CooiEcare of Consent m cal f.m.um for Winker.Crompton.
sa Pur iced for by Section 3700 of the Iaber Code,far the performance of the
work for which this permit is issue&
❑I haw and will maintain Workers Compensation Insurance.as required by Section
3700 of me Labor Code,for the Performance or the work for which this permit is Issued.
My Worker's Compensation Insurance carrier and Policy number au:
Cartier. Policy No-
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not becomplewd if she permit Is for one hundred dollars(SIM)
or Irm.)
I comfy that in the performance of to work far which this permit Is issued,I shall not
employany wnin anym terse in bec�ng)ybjecuotM WOrktrs'Cam(cnudon
Law.of Cal to 'act
Apples t 3t^i10-"
NOT] AP LICANT:IL after making this CcmOcawdT✓E.empa.n,you should
bee. Jcot to the Worker'.Compensation provisions of the Lahnr Code,you must
�O forthwith comply with such provisions or this permit a hall to deemed revoked.
y CONSTRUCTION LENDING AGENCY
I hereby affirm that gem I.a construction lending agency for the performance of
2$ the work(car which this permit is issued(Sao 3097,Cw C.)
g7 A Lender's Nam^
D z Lender's Address
Q 1 coolly that I have read this application and sure that me show mfommiun u
yF correct.l agree to comply with all city and county ordinances and sure laws hoisting to
�O building construction,and hereby authonu mphoumadves of this city to enter upon the
a above-mentioned property for inspection purposes
ti (We)agree to saw,indemnify ad keep harmless the City of Cupertino against
Z incoracquargmcnu,costs and of this may m any wry¢true against mid City
J z inconsequence of the granting of This permit. /
t--' APPL ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S EREGULATION _
�'�"'-r'�'�'0� /0--114 �7 Re-roofs C7
i attar rAppbcant/C.tr cut Data
HAZARDOUS MATERIALS DISCLOSU� Type of Roof
Wd1 the applicant or future budding occupant sow or handle haarEuos material
Ocfined by tbe Cupertino Municipal Code.Chapter 9,13,and the Health and Safety
Code.Section 25532(.)+ All roofs shall be inspected prior to any roofing material being installed.
It ❑Ycs
Will the applicant or forum budding=upon(use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
haurdnus air contaminants sa dcOncd by the Bay Area Air Quality Management all new materials for inspection.
o'?
❑Yes [ o
l have mad thehvaNr smeterialsmyvihomenu under Chapwr6.95 of dos Cad
nix HCaIN65efctyCodc.Scctiuu 253115.2553)and 25514.Iundcrsund thazifthc buildng /A w .s X17
Jars not curtcnlly have a tenant,that it is my expansibility m notify the anupant of ma (C ® /Yl t�,1/r- �l
eqm nu whmh must be reel prior f a CenOcate of Occupary. P
L�-Tignature Applicant Date
L w7agent �l/7 to �,-!J") All roof coverings to be Class �,B�,or better
r..aner car thorimd,gain paw
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
I
APN# y ,�j � Date:
j`�e ✓ co-- iy-- 03
Building Address:
2c911IS A
Owne1r,'s Name: Phone#:
(F�IA�'fa (ti
Contractor: Phone#: License#:
" Q-T"i t t C Z C_M (\.A Ccs N,sT 7-5-'q S"l `7 / 7 R
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
• Built-Up Roof ❑ Built-Up roof
• Asphalt Shingles ❑ Asphalt Shingles
,W_ Wood Shakes ❑ Wood Shakes
C3 Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)_aj Aid lA Fad VV -
Number of existing coverings ❑ Provide I.C.B.O.Report# '7117 S (o
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: ❑
Job Description:
_T_4t2014— 5"r—sr S x)sr-Arc- PwwooD U HT WL-
I�C 14TTII�
Residential P Commercial '❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if IJ
there are any restrictio ) IJ
Cost of Project: Type of Const Occupancy group: / I
Qty. if
Appl' able Fee ID Fee Description Fee Group
I BPERMFEE I Bldg Permit Fees BUILDING J
I/ ! BENERGY I Energy I BUILDING I
I BSEISMICRE I Seismic Fee Res BUILDING
BSEISMICOM I Seismic Commercial I BUILDING
BPLANCHK I Plan Check Fee I BUILDING
I BUSLIC I Business License I BUILDING
I I I I I
I I I I
Community Development Department
70a Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U PE ITT I NO 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: ( Y/f N)5 r f) Ill C kV li I�
Job Site Address: � 1 � /A A (-;r,
Roofing Company Name: V,,k 0 if t ill f5r_(� _. D S A tc-OVr
Applicant's Signature: J U4 A YA Date: 0-- —03
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper