03060101BUILDING DIVISION PERMIT
BUILDING ADDRESS: I LOS GATOS ROOFING IreMMII ""'03060101
309 LICENSED CONTRACTOR'S DECLARATION
F 1 hereby affirm that I sin licensed under PMVWOM of Chapter 9 (Commercials
with Section] ) of Division 3 of the Buep and Pmfwdmu Code. mtl my licemn is
full fo effect. J
yeaZ License Cl 11
Lk.N SZ-007
7S Da C [ 1!,& -,n W IN
ARCHARCHITECTS S DEC DOM LARATION
1 understand my plena dull be used of public records
C
Licensed Professional
! � Oat I am exempt fr DECLARATION ft Com un
I hereby .(Sete Net 11. exempt from Rte Communes o License Lew for the
5 $ following moron. permit t 703 1.5, t, alnwe and ow. khaiun Code: Any oily or county
which requires a permit re construct, n @e hnpmw, d permit , u c a sigsoy structure
pdormsBco eMSursuatok, Me the applicant fw Con Pennllm Rleee Law(WlnmGn
F
(commencing llancd puement7O0) of Division of the COwranoriUC emelJw(Cooter9
y+ $ (cat Ant. xempthhonlon7U0dil basis n3 of the Business arrop ar, Any Coon) or
..
that ha ts exempt thertfrom and ar buts it uo Alleged exemPtioe Any viniallon of
Seaton 7031.5 by airy radiant fw a permit subjecu then Applkmt m •civil pwlty of
not mom thm Tier hundred dollars (5300),
0 I. as owner of the property, wmy employee with "IM, as their Able Compensation,
will do Bework, and themucture is set Inunded wanemd forsale (Sec. 7044, Budwe
and Profession Cade: The Conlraaor's Licase law don not Apply u m awwr of
w, provided that such lmpmvemenu sae not intended araEered for sale If.
:building or improvement Is mid within one year of Completion. the owwr,
have the burden of proving Chat An did rot build w Improve for purpose of
1. sa owner of the property, m
who contracts for such projecu with a contramor(s) Iluned pursuant in the Comracmrs
License Law.
0 lamemmmkinde Sec .113PCfuthbraamn
Owner DOW
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under paWty of perjury one of Me following dnlarsdon:
I have and will maintain a Certificate of Conant to relf-inum for WorYereCompen-
sation, u provided fw by Section 7700 of the labor Cade, for We perform. of the
work for which this permit is issued.
0 1 haw and will mainWn Workers Compensation Inormce, u required by Sutton
7700 of We labor Code. for Rte Performance of the some for which this permit is load.
My workers CO peweaon laswana amiu and Po l' number.:
c.1T�/ Z1aJp'iv�d Pal ZZ7`i-2403
CERTIFICATE OF EXEMPT FROM WORKERS'
COMPENSATION INSURANCE
(ntis mien uetl not be completed Ifthe Permit tsforaahundmddollars(SI00)
that In Rm performance of the work for which this Permit is issued. I mail not
my person in any manner. sa in become subject to Me Workers' CompeueRon
Applicant
NOTICE TO APPLICANT: If. after making this Certifnate of Exemption, you should
become subject in We Workers Compensation proWions of the labor Code, you am
70 forthwith comply with such provisions or this perenitshall be deemW revoked.
Z 2 CONSTRUCTION LENDING AGENCY
I bembya ..dot Were isscomtrwdnn lending ageocy for ft performsms of
Y RE We work for which this Permit is issued (Sec. 3097, Clv. C.)
Ji 0 Lender's Name
S Z Lenders Addma
J O 1 certify that 1 haw read this application and mac the the show information is
g-! current. I agree to comply with sll city and county oNlnanas and ante laws mining to
O IS.^J Wilding construction. and hereby mthodm mPomnudves of this city to enter upon Cher
iw G .bow- mentioned pmpeny for inspection puryroses
(We) agree to saw, indemnify and keep hamless the City of Cupertino against
r in liabilWes, judgments. Costs and expenses which may in my way acme against Mid City
J 7 in consequence of the Starting of this permle
A APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REG;ZMhM— Q L _ /_ .k -
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building wcupmt cam or handle huardous malarial
defined by the Cupertino Municipal Code, Chapter 9. 12, and the Health and Safety
de, Section 25531(a)?
OYn Kilo
Will the applicant at future building Occupant use equipment or devices which
tit ba ardous air eomminmu u defmW by Rte Bay Arta Air Quality Management
steel?
O Yes (PNu
1 have mad the hvardousmawriats requirtmem underChapterd.95 of due Cdifon
Healthk Ssfcty Cade, Savors 15505,25533 and 25534.1 uWemand thmifthc building
n not currently haw a ¢liana that II bury msmnabllity to tmdl'y the ...Pan[ or the
requirements
1771 SMITH AVE
(408)298 -9399
REROOF
11'®bh `Sd`gA/ 13 / 2 0 0 3
Job Description
JUL 16 2003
BUILDING
-J 1 n
- r rvmunb RRee d Inspections
307
- INSULAT�Y�fS
601
- ROOF
TEAR OFF
602
- ROOF
PLYWOOD NAIL
603
- ROOF
BATTENS
604
- ROOF
IN- PROGRESS
Issued by:
Re -roofs
Type of Roof
Date
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better
•
r r ,
L
Building Division
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: (408) 777 -3228
Fax: (408) 777 -3333
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
I 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 reroofing 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) Preinspection and /or tear off approval
2) In progress inspection approvaL
3) Final inspection approval
a) Spark arrester installation.
F
-.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 that the
proper City inspecti6ii can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of'/" 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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address:
Reroofing Company N
Applicants Signature:
Joe Antonucci
(Chief Building Official)
ITOP iii
R
s
10
00
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
3yz- �s- a 27
Date:
4, �� a3
Bldg Permit Fees
1'00 VIvu
BUILDING
Building Address: O yZS Alicia C-�
BENERGY
Owner's Name-
and SxAne id e r
BUILDING
Phone #:
ya8 S8y -Z y 12-
Contractor: Phone #•
dos Q os G %ay J
-95 99
License #:
800707
Contact: Phone
BSEISMICOM
Cupertino Business License #:
BUILDING
9
z 41$
Type of Roof Covering:
Existing: Proposed:
• Built -Up Roof
❑ Built -Up roof
• Asphalt Shingles
); Wood Shakes
)!4 Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Wood Shingles
)d Other (Specify) / _36* f'e /f
Number of existing coverings 1
❑ Provide I.C.B.O. lkeport #
XTo be Removed
?Z Provide Mfgr. Installation Specs. l
I Have Read, Understand and Will Com1)lV With Cu ertino's Tear Off Policy:
Job Description:
4��K �/qw
Residential/Is Commercial ❑
Fire Zone: Yes ❑ No
Confirmed with Planning Dept. if
there are nn restrictions: LJ
Cost of Pro' ec : f Type of onstruction:
Occupancy roup:
Ddlit>
PAP m
Ila
i
-P'- z-L-�413
*(f-a.30
BPERMFEE
Bldg Permit Fees
1'00 VIvu
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
-P'- z-L-�413
*(f-a.30