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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
, CO �� RACTORsINFORMATION =«
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BUI LDTNG ADDRESS:
LOS GATOS ROOFING
PERMIT N003O80OO4
OWNER'S NAME:
1771 SMITH AVE.
PERMITISSUEOATE
CHOI UI K AND SUJA
DR/01/2003
ONE'
(408) 298 -9399
SANITARY NO. CONTROL NO.
ARCHITECT /ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
1 he arfir that 1 em licensed under provisions of Clmpmr Y (commencing
Job Description
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with Styy'n7glUl of Division 3of lkBosine mRO(essium Cads. andmylicenu i,
ins NToCe and Offect.G3 Lk.N S'OD'7D7
REROOF
Dam Contractor J ArM NCO xJZ
ARCHITECTS DECLARATION
1 understand my plans,hall W used as public records
`- 1 v 2003
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Licensed Prefab.. I .
OWNER-BUILDER DECLARATION
I hereby alarm that 1 am exempt from the Contractors License Law for the
BUILDING
following mason. (Section 71171.5, Business and Proressiona Code: Any city or county
which requires peril to construct. alter, improve, demolish, or repair any structure
Prior in its issuance, else requires the Applicant for such permit to file A signed,tawmem
that he is licensed pu brom,to the provisions of the Connector's License Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7") of Division 3 of the Strainers and Proressions Code) or
34245028.00
that he u exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for peril subjects the apploolL 10 A civil penally of
not more than five hundred dollars (SSW).
❑ I, u owner of the property, or my employees with wages u their auto compensation,
��p��J'�d Inspections
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will do the work. and dlemurtua, is Ml intended or oRCRd for sale (Sec. 7040, Business
and Profmamis Code: The Contssclors Lictve law does not apply to an owner of
307 — I NSULAT I OPj
property who builds or improves thereon, and who doessuch work himself or through his
own employees, provided that such improvements +re not intended moRerad retrials, if,
601 — ROOF TEAR OFF
however, the building or improvement is sold within one year of completion, the owner.
builder will have the burden of proving that he did not build or improve for purpose of
602 - ROOF PLYWOOD NAIL
sale
603 - ROOF BATTENS
0 1. as owner of the property, am exclusively comossing with licensed common to
604 - ROOF IN- PROGRESS
consumer the project (Sew 7000, Business and Professions Code:) The ComrAerar' Li
come law does not apply to an owner or property who builds or improve thereon, and
who contracts for such projects with a contnmor(.) licensed pursuant to the Contractor'
Lim. Low.
❑ I am uempl under Sec B A P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby Ar0r under penalty of perjury one or the following declarations:
I have and will maintain a Certificate of Consent u, ulf-inau a for Worker's Compere
s+tion, As provided for by Section 37W of the labor Code. for the perfaruue of the
wore for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, u required by Section
37W Of thq Wbbr Code. for the Performance or the work for which this perit is issued.
My smk'erA Compensation Instance terrier and Policy number am:
artier i}` GW^,b Policy No.: Zy7gI 7003
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This uctinn need not becomplemd If the Permit is for one hundred dollars ESHA))
or kss.)
I certify Net in the perforance of the work for which this Permit is issued. I shall net
employ any person in any manner an a As beams, subject to the WOrkar Comper a0ort
'
Laws of CAliromi&. Date
Applicant
NOTICE TO APPLICANT: If, altar making this Castilian, of Exemption, you should
We.me subject to the Worker's Compensation provision, of the labor Code you most
forthwith comply with such Provisions err this per it shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I berehy affix Nat there is commNnn lending agency for the lerfurance of
the work for which this peril is issued (Sec. 3097, Co. C.)
Undoes Name
Lenders Address
I certify that 1 have mad this Application and sou that the above information is
'
coma I +&roe to comply with all city and county ordinances and show laws relating to
Wilding conemetion, and hereby authorm espmsenutivc, or this city to enter upon the
above.meminned property for impenfon purposes.
(We) agree to save, indemnify and keep hmmlat the City of Cupertino against
liabilities, judgments, costs and emenscs which may in any way accrue &&alto, said City
`
in consequence or the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOT! -POINT
SOURC EGUL
aO /
Issued by: Date (%J7
Re -roofs
Type of Roof
7 3
ign lure of APPlicanVCOmractor Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant tar furore building occupant store or handle harudoes matertal
as dcfited by the Cupertino Municipal Code. Chapter 9.17, And the Health and Safety
We. secreazsslz(,)?
All roofs shall be inspected prior to any roofing material being installed.
� Ym ❑ No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
It haysmnus air comamimnts u dcfocd by the Bay Area Air Quality Management
all new materials for inspection.
is0ia?
❑Yes El No
I how rcet the reyuimments under Chapter 95 the Calding
/
Cock, -tv na 23505, if
ale HCalthdSOfcty Codc,Scetira 37 5115.15533 and 135]4.1 undcmund that lithe building
stand
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rcmants whi I e. aanee arm& canoe+, or acery^cy.
Signature ofApplicant Date/
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All roof coverings to be Class "B" or better
Owner
onuthodand agent Dow
Dow
•
Building Division
10300 Torre Avenue
Cupertino, CA 95014 -3255
Telephone: (408) 777 -3228
Fax: (408) 777 -3333
Building Depar' bent
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.
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 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,
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection, will
5 require the removal of all new material down to the sheathing so that the
proper City inspectiaz► can be performed.
t
IMPORTANT:
1. Flat roofs must have a minimum of %,I 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 Compan3
Applicants Signatur
Joe Antonucci
(Chief Building Official)
6/25/01
--0
•
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CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
3,112- 4/_5_ D2
Date:
Building Address:
35 /iG /R
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BUILDING
Owner's Name: CCU- � /�
v
BENERGY
Phone��
// /i
725— O 2
Contractor: Phone #:
Las 6rwfos �'�'
8 39
License #:
0070
Contact: n Phone #•
Seismic Commercial
Cupertino Business License #:
C�
lq [
BPLANCHK
2348/
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
>t Asphalt Shingles
Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Wood Shingles
X Other (Specify) % ose
Number of existing coverings 1
❑ Provide I.C.B.O. Rfeport # ;
'GY To be Removed
Provide Mfgr. Installation Specs. [rP.
I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Policy:
Job Description:
7 /b O's
7-4
Residential Commercial ❑
Fire Zone: Yes ❑ No
Confirmed with Planning Dept. if
there are an restrictions: u
: Type of Constructi
Cost of Proje�3
Occupancy group:
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A icabl;3 / FPP m
BPERMFEE
Bldg Permit Fees
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BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING