03050095 CITY OF CUPERTINO �»
BUILDING DIVISION PERMI sicT r_CQ; NTRACTQR14NF0AM, a
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i DIN G ADDRESS: MONKS ROOFING PERMIT NO.03050095
ATT TV ER'S NAME: 4 794 BERRYESSA ST " 3'b/21/2003
V
NE` (408) 262-4797 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTORS DECLARATION Job Description
1 bertby affirm W,1 am licensed under provision of Chapin 9(commencing
with SeNan 7000)ar Division 3 which, Prof myficcrmb
in full(.a,&&<tt
f -3 fie'`
t53 ueenc�fa y see.« REROOF
i Da Cameamrmnniici n�nt
AR&hallW 1'J DEQI.ARATION
l 1 uMenund my piste shell W use M a exceeds
' ,JUN 012003
t aid
Licensed professional DECLARATION
1 Wlehy.(fine that I em,exempt from IW CssionstCo Lieease Law for IW
�00 which ngleresa permit i 70313,BUSlaessand
de use Cade: paurm at county
[= BUILDING
$�
which requires•permit W cmwsmk alien Allman.demolish,m lepair any avucluro
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pow an its usuatae.abo rtquiret the applicant fm such permit to Ble a signed moment
E5FFG thuheis licensed pumuntth the provision o fMeConuecmts License Law(Chapter 9 Sq.Ft.FloorArea $6Y�Ig�ion
Cd9 (commcncdag with section 7000)of Division 3 of the Business and Profession Code)of
lL Net M Is eaempl Me rfeem and the exam,far the a1kgW Ass mpllm Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of 3 Affil NOMIMt 00 Occupancy Type
not mom than live handled Militia($500).
0 1,u awner of the property,ca my employee with wags u deb sale eampenutlon,
will do the work and the structure is not Intended araffeted foraale(Sec.7014.Business 305 - FRAME Required Ins actions
and Profession;Code:The Cannata Uesme Law data net apply he in owner or 307 — INSULATION p
pmpenywlmbuildaorimproves Utereon.andwho dnessuch workhimmif mlluough his
Avon employcee.provided wuauch improvements rte not intended mortised fmaJa If. 601 — ROOF TEAR OFF
however,the building W improvement is sold within am year of mmpledoo.the wave.
builder will have the bathes of proving that he did not build in improve far purp am of 602 — ROOF PLYWOOD NAIL
°I`')' 603 — ROOF BATTENS
0 I,u owner of the property am exclusively camrnc,in{with Bcemoed conmctms to
construct the ponea(Sec.7 014.Bomeaa and profession,Cade:)The canaaetars U- 604 - ROOF IN-PROGRESS
cone law dace not apply W an owner of property who Wilds or Wprom datean,and,
who contracts fat such projects with a contranm(s)licensed paramour in tie Comnetoes
License Law.
O l m exempt under sex. ,B k P C fm this rtawn
Owner Dale
WORKERS COMPENSATION DECLARATION
1 hereby affirm under peon ly of perjury one or the following declarations:
a! I ban ad will Wasina Centiliausaf Can¢ntal self-hem.fMWohCYaConpen-
some.as provided far by Section 3700 of the Labor Cade.far the peafonaence of the
work for which this Permit is issued.
0 1 ban and will maintain Workers Compensation Inwuance,u unfilled by Section
3700 of cite Labm Code.far the performance a!the work far which this Perrault blued. ,
My Wahera C mpenmtion Wurance n Policy nu bet
Cancer: SOU fG fi'l'th Pat o.:/ r Ol-ZDUy
CERTIFICATE OFEKEM FROM WORKERS'
COMPENSATI INSURANCE
(This aecdan mail not In compmbdBtW Permit b for we hundred doBan/$1M)
W less.)
I cero(y thal in the performance of the work for which this permit is issued,I shall not
employ any pension in any Wenner an u in become abject W the Wodmn'Compeeution
I..of California Or-
Applina
NOTICE fO APPLICANT:IL after making this CemOcam of Exemption,you should
become subject b mC Wafkef's CompenHlian provisions of the Labor Cade,you most
.,O foMwah comply with such provisions or this penal,shall W deemed invested.
Z 7 CONSTRUCTION LENDING AGENCY
[r I Wmhy affirm that them is a construction lending agency for the performance of
at.? the work ter which this permit Is tuned(Sec.309'1,Civ.C.) V
t>J Q Lended am
N •
z Lender,Add---
U O I«Nfy that I have read this application and mm this the aWvc information is
contact.1 agree to comply with all city and county odinaeces and stem law rtI.dng m
Wilding construction,std hereby anthorice representatives;of this city to enter upon Me
Uj above-mcntiamd property for iupenian purposes. n �-
gy (We)agree ro save.indemnify and keep numerical tie City of Cupertino against �
to
liabilities u,Judgmcnu.cotu and capcmoes which may In any way agatulWdClry (,G n mefue of the granting of this pemil.APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON��3PPPOINT Issued by: Date
SOU GULATIONS.I Q A — - — y
Re-roofs G/ /
Si under Applicant/ or /
RD Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the aPPlimon,ar fulule Wilding nceupan,aloe or handle haurdous mamriJ
As donned by the Cupertino Mun 11 Codc.Chapmf 9.12,and the Health and Safety
ode•section 25532(a)T All roofs shall be inspected prior to any roofing material being installed.
4 ❑Yes
Will the applicant or future Wilding occupant use equipment or devmes which If a roof is installed without first obtaining an inspection,I agree to remove
ill huardnus air coaumimonts u Med by the Bay Am Ail Quality Managcmcn, all new materials for inspection.
uzcmT
❑Yu u
1 mad Nehuadwa mamrlals requlremenu under ChePmrA95afthe GlUar-
Malin &SafclyCadc,Soniamo 25503,25533aW 25534.iundcmm�d this ifthc Wildin{
dais p6lturrently bone a mean,that It It my respeulMlily m early the pent of the
rc c n .1 ' rmiuu ofaCcrofmam �/ Signature ofApplicant Date
G b,anthatizedagent y�y3am All roof coverings to be Class"B"or better
Community Development Department
t 4 F Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
UPEI�TINO 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/e " 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: S'=ry l�01 �Z e
Job Site Address: j b / 3 3 Q1} Iu tJ c,
Roofing Company Name: (11 >) fJ k S Rgo 0-f i,
A plicant's Signature: /`/ Date:
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
t CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# �/ -?,a Dater
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Building Address: / D / ? 3
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Owner's Nam Phon #:
S �NO�2A Z-e-� �_ yo� '7aS- ov6z
Contractor: Phone 11 License #: 6 }� �U
m O oks ��t��`,'�v g qoY 1? U
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
Cl Built-Up Roof ❑ Built-Up roof
�9 Asphalt Shingles - -"O Asphalt Shingles
\ O Wood Shakes ❑ Wood Shakes
�B Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O. Report#
�O To be Removed ❑ Provide Mfgr.Installation Specs.
/j I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: ❑
Job Descri tion:
—move F.xSTin �o9S ,TiJSS�61 OS � I0- jTg1) �i �1� cor-p
Residential commercial ❑
Fire Zone: Yes ❑ Nc ]` Confirmed with Planning De t, if
there are any restri ctions
Cost of Profit: � pe of Construction Occupancy group:
Yp
Qty f_—;�
Aplyficjtblq Fee ID Fee Description Fee Group
( / BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING I
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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