03070027 CITY OF CUPERTINO �,i .;r,-'•F , .a•.., sa:.:,� • aid..°.:r's; ..
BUILDING DIVISION PERMIT CONTRACTORINFORMATIONig'
BUILDING ADDRESS: R E ROOFING & CONSTRUCTION PTM"G03070027
777L7 TT (`TT PL' Dil
OWNER'S NAME: --� _ 15230 CLYDELLE AVENUE PERMIT ISSUE DATE
I= TWPMP f)7/n,:i /90n3
"E' (4 08) 925-9995 SANITARY NO. ' CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
aOp LICENSED CONTRACTOR'S DECLARATION lob Description
1� I here rm by afr then 1 em licensed under provisions of Chapter 9(commencing P
wINSa.tO.7OM).f D' si 30fhe B.sirc and Profcuium Code,udmylicenseia
L en Tome and e(fea REROOF /
g? License C lac.D
Date
ARCHITE DECLAR I
I unde.0 J my planuhall he u u Pu ,S
Licensed Professional
y G
g OWNER-BUILDER DECLARATION
A<8 I hereby elan that I am exempt from the Contractor's License Law for the
p O following reason.(Section 703 1.5,Business and Profcuii na Code:Any city or county
<$� which requires a Permit to construct.alter,improve,demnlieh,at repair any urucmm c n,7 n n
Prior in its issuance.also requires the applicant for such permit to file a signed mummer
mmG that he I,lmmsad pursuonnu he provisions of the Contractor's License Law(chapter 9 Sq.Ft. Floor Area Valuation
1- (commencing with Section 7W)of Division 7 of the Business and Professions Code)or
fast he is exempt therefrom and he buts for the alleged memption.Any vinlninn of 34244025 . 00
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred delta.(S500).
0 1,as owner of the prope.y,or my emplayces with wages as their mole compenullon,
will do the work end flcswaun is not intended or offered far side 70x4,Business .iUb — r'tLHP91; Required Inspections
and Prolusions Cock:The Contrumrs License law dam oat apply u an owner of 307 — INSULATION P
propesty who Wilda orimprovu hereon,and who does suchwmk himmdf orhmugh fast
own employe¢,provided last uchnmpon ve no mu are not intended proffered for sale.If. 601 — ROOF TEAR OFF
however,the I riding or impmvemeni Is sold within one you of completion,he owner.
builder will have the unman of proving that he did not Wild or improve for purpose or 602 — ROOF PLYWOOD NAIL
gala')' 603 — ROOF BATTENS
01,aa owner ofhe(Sec. Bulocas and contracting Code:)no to 604 - ROOF IN-PROGRESS property,am exclusively conse Lo the project(Sec.7094,...toss and Profusion Cade:)The Contractor's Li
¢nse law them r such P apply le.........f Pmpeny who Wilde rs improvra theater,end Out
who contracts for such pmpcu with a conuumr(q licensed Pu.uam to the Contrumh
Lkense law.
❑lten exempt under Sec. _ .B @PC for miamuon
Owner Dow
WORKER'S COMPENSATION DECLARATION
1 hereby alllmt under penally of perjury one of the following declualions:
I have end will meinuin a Ccn rimM of Conant to ulhmsum for Worker'scompen.
u art,u provided for by Section 5700 of the IaWI Code,for me Performance of he
work for which his permit is issued.
0 1 ham and will maintain Wolters Compensation Insunnu,as acquired by Section
37W of he Labor Code,for he performance of he work for which mm pissued.
My Workers CnmPena lion lnw.ntt emitter enup olity a ram:
Center. Policy Nu.: `I— 0;2
_
CERTIFICATE ION FROM WORKERS'
COMPENSATION INSURANCE
(This mccuun mad non becamPleted fine .1.1,raronc hundred dollars(Sip))
or lug)
I minify that in he performance or de work for which his permit u issued.I shall non
employ any nation in any manna an sew become subject mhe Workers'Compenudon
Laws of Caldamia.Do,-
Applicar
NOTICE TO APPLICANT:If,after making his Ccnincate of Exception,you shou lJ
become subject to the Worker's Compensation provisions of the Labor Code,you mull
.J O forthwith comply with such provisions or his Permit be dccmed mmkcd.
z� CONSTRUCTION LENDING AGENCY
[—i I hereby affirm that dent is a convection lending agency for the PCrrmnamec of
a> he work for which this perm l is issued(Sec.3W7.On,C.)
W�; Lender's Nam^
z Lender,Adder
fJ 0 1 certify mat 1 have mad this application and sum hit the alien information is
Ikv f" corms.1 agree to comply won all city and county delineates and sure Ion relating to
pU building convection,and hereby summix representatives of him city to enter upon the
W abovomenuoned propeny for inspenion Purposes n
G (We)agree to save.indemnify and keep humleu he City of Cupcnmo against
n IimilNU.judgments,costs and expenses which may to any soy seem against said City
eZInce of he granting of his permit.
ERSTANDS,,ArNNDDD WIILLLLCOMPLY WITH A LL ON.POINT Issued by: Date
NS,/It' `/� — 7�I I I]�muc.ptosel., / \ Dam Re-roofs HAZ 0OS MATERIALS DISCLO�IRE Type of Roof
Wilntter future building oceupantamm o andlchamreomntatenal
u dcBned by de Cupmma Municipal Code.Chapter 9.13.and IN Healm and Safety
Code.Section 25531(x)7 All roofs shall be inspected prior to any roofing material being installed.
Yu d
Will the applicant Or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It havamous air edntammenu as dcroma by the Bay Arc.Air Quality Management all new materials for inspection.
dricR
❑Yon u
Im,c000 dra Wx emous, aerialamquiremenuuadcrCMper6.95of Califon _
' .W&Saf ctycadc,S=m25505.25537and255341unMreuM bud Wilding
Joan t e m..1.met responsibility m n tufy ae rre���p'scccup he _
myu' rot m r u
Fear emMam of udmc 1 Ore OfA_7 7lic \ Date
/� l t
Owner u tho....aJ e�cm ,� rote All roof coverings to be Class "B"or better
r,
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY�F Telephone: (408)777-3228
UP 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: �✓ L R��
Job Site Address: Z Z- 2 A t- C A L D e -R p" ,
Roofing Compan Iw�T16W I C- .
Applicant's Si ature: Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o 3 70 o 27
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 41,,1 // 41 0 2 6--� Date: � o,t�
Building Address: n LC A CD p 0�
Owner's Name: E % (( 11 Phone#:
� 4d-292 - q013
Contractor / Phone#: L}0�_q 2�_ License#: q
1
10 ,oXwl- s GJU Tr—uw qkm, 10 c . �3�lq�i 2-75 l
Contact: 1 Phone#: Cupertino Business Licypse#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) >X,Other(Specify) C�tRk�D SI��L III.E
Number of existing coverings ❑ Provide I.C.B.O.Report#
1To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: X
Job Description: � F�toW' �Z(l$TiN(t LA-tterl-- 0f Woop SWKZ, (uSTA-t4— UoAJ
Jk)d- A51 Y- S n_ mil_ TI tom_
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: uU Type of Construction: Occupancy group:
-�Q.2�i
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING