03070169 7 CITY OF CUPERTINO •' t-:•mew, ,c,.imF'v-=A'p-:.,"' -•'..;<""n-n: ,4i
BUILDING DIVISION PERMIT '"GONTRACTORINFORMATION:'
BUILDING ADDRESS: PERMIT NOO 3 070169
s OWNER'S NAME: RID 12 PERMIT ISSUE DATE
ntrur. munTVIAq T. ANTI TBTTPT T. n>�/;)0.43.
ONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+�oD LICENSED CONTRACTOR'S DECLARATION Job Description
I herchy afnrm Thal I am licensed under provisions of Chapter 9(commencing
i with Section 0110 of Di 'ion3 of NC Busi nd Professions Cede.sod mylicenac is ra�n
fullforcea L39 .# ,, REROOF G°Q�
p np Z Llcen I C" LIL.g
'ggF¢p Date ARCHIIECI'SDttor RAno CONTRACTOR: NEW AGE ROOFING
ppEC� I understand my plans shall heusc puMicrecmd. FlU/III& 2o
30 Licensed Professional �'I O�
OWNER-BUILDER DECLARATION
I I hereby affirm Net I em exempt from the Coutnooh Licenac Law for iM ��'�®�
D D following reason.(Section 7031.5.Business and Professions Code'Any city or county p gG
$� which requires a permit or construct,alter,improve,demolish,or mpsir any ammonia g V
prior m its issuance.also requires the applicant for such permit to file a signed statement
q�qm3m< that he ta licensed pursuant n the provisions or the Commcmri License Law(Chapter 9 Sq. Ft. Floor Area Valu$t19(9875
y+FD (commencing wi in Section 7(W)of Division 3 of the Business and Professions Code)or 4
$ Nn he Is exempt therefrom and tK buss for the dlcgc l exemption.Any violation of rA ys'�,7v,.v,as
Section 7031.5 by aia applicant for a permit sub)ecta the applicant m a civil penalty of i' 3 5167)lYtl 170 O Occupancy Type
not too n Nan five hundred dollars(5500).
[-]1,in owner of the property,or my employees with wages as their sale compensation,
will do the work and the Necnsn is act Intended or ofC.d(octal.(Sec.71114,Business
and Professions Cade.The Coronaries cave Law then runt apply 10 as owner of Required Inspections
propenywhobu ilds mimpraveatheseom,•ndwhodhessuchwoskhimselforthroughha 305 - FRAME
ownemployms,provided that such improvementa tae mam¢nded oroRW for sale.If, 307 — INSULATION
however,Me holding or improvement is sold within one year or completion,the owner.
builder will have the burden of proving that he did not build or improve fur purpose of 601 - ROOF TEAR OFF
ale.). 602 - ROOF PLYWOOD NAIL
t ❑1,as owner of the property,am eaelosively contracting with licensed eontracmrt to
comuucnhe project(Sec.7044.Business and Professions CWC:)The Contractors U. 603 — ROOF BATTENS
cmum law does not apply to an owner of property who Wilds or improves former,and 604 - ROOF IN-PROGRESS
who contracts for such projects with acantractar(s)licensed pursuant in Me Conlfael0es
License Law,
❑I am acmpl under Sce. .B&P C far this meson
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of Me following declarations:
011ax andwillmaintain aCenjframofConsenttoself-insumfm Wor r'&Compcn-
wmk far for by Sccsc 3700 of the labor Code,fm the performance of the
work for which Nu pennd i[issued
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W or the labor Code.for the performance of the work for which this permit Is Issued.
My Work,' ation urana ma and Policy number am:
Carr �q pe�G
VIWi CERTIFICATE OFEXFMPMN FROM WORKERS'
COMPENSATION INSURANCE
(Thin section need not M completed If the permit is(memo hundred dollars(tiro)
Ica.)
I unify that in the performance of the work for which Nn permit Is issued.I shall not
employ any permit in any manner an as to become subject a the Workeri Compensation
Laws of California Date
APplicar'
NOTICE TO APPLICANT:If.after making this Cenificate of Exemption,you should
become subject to Me Worker's Compensation provisions of the Iabm Code,you must
.,O forthwith comply with such provisions m Nis jicrmo shall M tmmrd revoked.
'�ti CONSTRUCTION LENDING AGENCY -
't•+ Iherchy aRvm that there is a construclon lending agency In %he Performance of C
P: the work far which this permit is issued(Sec.3097,Cm C.) CJ
{[2 Q Leader's Name _
aZ fender's Addm•-
U 0 1 certify that I have read this application and tote that the above off.ans.arm is
D.f•' correct.l agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorin reprinensatiwe of NU City 10 color upon the
[f] alwve-mentioned property for inspection purposes.
(We)agree m save,indemnify and keep harmless the City or Cupemno against
fLj) liabilities,judgments,casts and expense[which may to any way soave against said City
U in consequence ord, ring oithispermlt
APPLICANT UN TA�AND WILL COMPLY WITH ALL 'SON-POINT Issued by: Da[
SOURCE ONS. rC✓//yet / V3
Re-roofs
c of AppLCaHAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or future building occupant aore or handle haartaus material
in defined by the Calendar,Mun' ipal Code.Chapter 9.12,and the Health and Safety
Cade.Section 25532(,)' All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will the applicant or future building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil haardou min s air cmma ta ss defined by the Bay Area Air Quality Management all new materials for inspection.
District,
❑Yes Nu
In vc mad the hastrdous materials requirements under Chapter 6.95 of the Califor.
nia HOlth&Safety Cate,Secmuns 25505,25533 and 25534.1 undmaWnd that lithe loilding aQ.G( /
Jma not curtcnlly ha a Icnant,Nat 11 Is my responsihility to madly site oecmpmt of Nc
mwuemem tan a nor to issuma on cent to r(kcup cx. Signatureof Applicant ,)bate
Q" Q' �at All roof coverings to be Class "Bi' or better
0 rursutharim goal a bate
Community Development Department
Building Division
t
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
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 Y4 " 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: 1-T,90611 7- ;4 �//C 1
Job Site Address: /6110 Ad(I A f, 4 (+,�t l u�p(r 11'e b j �A 9Sb!H
Roofing Company Name: 'lam 4e ` ' f
A plicanYs Signature: r —L�� � v Date: 7 '
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO G y
REROOF 3 °Z
CUPERTINO PERMIT APPLICATION FORM
APN# Date: 7/22/03
Building Address:
m/i0 well &I; L� t C APP. i� D� (l4 9so�y
Owner's Name: f Phone#
Tn nP� T on k
Contractor: Phone#: License 4:
/j it /Qc �o07ri�y 6i0) 6s7- I-s3`o 50?5�3
Contact: / J d Phone ^) Cupertino Business License#:
•CQ�% �a viI S� 71Y -&17
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes 1( Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings O Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
t
I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy:
Job Description: ,Pr..vvc &&,:(A - ✓-f4oee /�-oci.
�1/1`-A /� ilPl/Y/' ii ,Q i. ,f qa A Ap07 O YPi .��/�� /O ��r /Ali�7/P/7
Residential �+ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with P mg t. if
_ there aze any trtc ons:
Cost f Project: Type of Constructiori Occupancy roup-
ion ��s o a Af «l//
Qty. i
Appli1abl Fee ID Fee Description Fee Group
( BPERMFEE Bldg Permit Fees BUILDING
/ BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM I Seismic Commercial I BUILDING
BPLANCHK Plan Check Fee I BUILDING
BUSLIC Business License I BUILDING