030701751
C
C
CITY OFCUPERTINO
r
BUILDING DIVISION PERMIT
CONTRACTMIN,FOOkAkTI�ON:
BUILDING ADDRESS:
0927 AlAIRS DR.
ADVANCED ROOFING TECHNIQUE
ERMIT N003070175
OWNER'S NAME:
1179 MYRTLE DR
PERMIT ISSUE DAT.
ONE:
(408)249-4937
SANITARY N0. CONTROL N0.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hucby affirm Nn 1 am liceoucd under p orts of Chapter 9 (commencing
wish Susion7 )lar IvuionJof NC Businuyr9 Ro(cuinns Code. and my license is
in full fomeond '. %�C�S��"
-- S
REROOF
Litems Clns' Le. N
Dam cmion.ciak
ARCHITECTS DELL ION
,,I understand my plans shall he used as public records
Licensed professional
OWNER -BUILDER DECLARATION
1 Wreso . (Slim ,has 11. ,Bump, from the Cnnln& Co License law co IW
reason. (Senium 71131.5, Business and Professions Any tiny or county
_
s,
h, to tatucwm
which requires a peril, re .Twit imgmve, demolish, lace
which M
{ ,
ed
"ire rho aligned
iense Lw(swemem
requires the pMvigilicanl fnr such Conrector'tLicense
Por at he issie sed e. pursuant Ll
Purction7 he
.S � Area })
Valuation
Poressw(Chagmr9
orDiainna 3 of tCnmcuwr'a
(commis ming ith hce l of the and Pr. ata CMe) of
With
�j`
from, and th ballon
aged ext Any
WI he u uunp' Ihert(rom and the beau for dw alleged exemption. Any vloblion of
that Me exempt
q
- APN Number ``
Occupancy Type
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of
not more than fin hundred dollen (5500).
U
❑ 1, As owner of the property, or my employees with wages u their sole compensation,
Nvx
Inspections
p
will do the work, and timmucu, is or intended or offered fornle(Sec. 7044, BusinessReaired
and Professions Code: The Continent's- ent's License Law does not apply he an owner of
progeny who builds or improves thereon, and who does such work himself or ONmugh his
3 0 I NSUi ON
own employee, provided that such improvements are not intended croffered for ule. If,
601 — ROOF TEAR OFF
however. the Wilding or improvement is sold within one year of completion, the owner.
Wilder will have the hmden of proving that he did Am Wild o, improve far purge a of
602 — ROOF PLYWOOD NAIL
late.).
603 - ROOF BATTENS
❑ I, as ownu of the property, am exclusively contracting with licensed min ecmrs to
construct the poom,(Sec.7044, Business and Profesaiam Cade:) The Contractwt Lb
604 — ROOF IN -PROGRESS
moue 4w does not apply no an owner of property who Wilda or onpmw" Merton, ma
who comracts for such projects with a toms teimb.) licensed punuanuo Ne Committees
-
Liccnse law,
❑ 1 Am exempt under Sec. . B k P C fnr this reason
owner Dau
_
WORKER'S COMPENSATION DECLARATION
1 hereby 01ion under Peully of perjury oro of the following doelonione
1 ,r
I have and will nummain • Cenifnm id' Consent m mif-Immo far WmIrm's Compem
"then, la provided for by Section 3700 of de labor Code, for the performance of the
work for which this pnmin is issid.
01 hive and will mainuin Wakei s Compensation Inurance, n required by Section
a
3700 of ate labor Code, for the performance of the work for which this permit is issued.
_
�/ V
My Worker'. m matron lnsunnce ea7uu mml Policy mon r •m:
hyo 1 37-
Ce r. Policy 4
CERTIFICATE OF PION WORKERS'
COMPENSATION'IN�SU1RANCE
(Dissection need not IN, completed If, tach is for one hundwadollau(Slip)
to mss.)
I certify that in she performance of the work for which this Permit is issued, I Nell not
employ any person in any manner an As to hccame ubjut to she Workers' Compensation
Laws of Califumia. Dow
Applicant
NOTICE TO APPLICANT: IL after making this Ccnificae of Exemption, you should
Woome subject to the Workers Competuasion provisions of she Labor Code, you most
forthwith comply with such provisions in this permit mill be deemed mrokcd.
CONSTRUCTION LENDING AGENCY
1 hemhy effort Nn Nen, is a connruninn lending agency far the Performance of
due work (or which this permit is issued (Sec. 3097, Civ. C.1
Lender's Name
,
Lender's Address
I certify lost) lave read Nis application and We Na,,hc above infmmatiun is
correct, I agree to comply with all city and county ordinances and sura laws tela,ing ,o
building counnion,and hereby auNorin Mpreunu,ive or this city turner upon the
alWn-mendexd property for Inspection purposes.
(Wc) agree w save, indemnify and keep harmless Ne City of Cupertino against
Iiebili""' cues antl eapensos which may In my way taut against aid Cisy
ibit
AnPPnu ANTel1NDe STANDS�AN� IL MPLY WITH ALL NON -POINT
Issued by: Date
SO CEREGULA ONS.
21`
Re -roofs
Type of Roof
Si are ppbsanl/Conuumr '/ Dau
HAZARDOUS MATERIALS DISC�4f1RE
Will the applicant or fluor building occupant store or handle hrrudous material
"defined by the Cupenuo Municipal Code. Chapter 9.13, and the Health and Safety
Cnote, Section 15533(,)?
All roofs shall be inspected prior to any roofing material being installed.
Uflu
0Yrs
If a roof is installed without first obtaining an inspection, I agree to remove
ill the applicant or Imam building occupant use equipment or devices which
It ha"Nnus air conuminanu As drMca by the Bay Arca Air Quality Management
all new materials for inspection.
istrict7
❑Yes s*b`No
I have read the hanrdnua materials requirements under Charwr&95 of the Califon
v/\•,
jo—
niI Health&S c,Satiom255(I 5533and25534.lundenunatha,ifthchuilding
2�r �•
dies ally hove hoes nt, the m gonsihilisy no notify the a an of the
cou, WhlCh a1 bC met ante ora CCNRraw ofa
Sig Of Applicant Date
_e
All roof coverings to be Class "B" or better
lav, onxtl agcnn Oanc
�, 37m
�' Cm
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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 cl I ith the above stated policy on re -roofing.
Homeowner's Name:' \ J
Job Site Address: 2 d C Z� A4 (A -a-5 0-r—
Roofing Company N
Greg C4teel
Building Official
Revised 1/30/03
Printed on Recycled Papei
Date: 2-- _1?_T- a"_7
u
ITY40
CUPERTINO
is
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
03 6 01) Is
APN #
Bld Permit Fees
BUILDING
Date:
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
Building Address:
BSEISMICOM
Seismic Commercial
Z (✓
C .
Plan Check Fee
Owner's Name:
BUSLIC
Business License
Phone #:
,,;
c
�3� cJ Z-�(
Contractor:
Phone #:
a ( c
License #:
Co t:
one #:
Cupertino Business License #:
`-( `Z -- L(
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
9W Asphalt Shingles
JW* --Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
O— Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu
ertino's Tear Off Policy: ❑
Job Description�• p
1
AD
Residential 2jr
mmercial ❑
Fire Zone: Yes ❑ No
Confirmed with Planning if
there are any restrictio
C �Pro� Project: `
ype of Const
tion: �1 OccS�upancy group:
Antyi&Annl' a-ble�
Fee Til
P.. riner^irf:nn
moo r
BPERMFEE
Bld Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING