03070132 CITYOFCUPERTINO
PERMIT z>OR'fc AY nA, ,T• IOf'1vN'a-"F
BUILDING DIVISION AO =
r
BUILDING ADDRESS: ADVANCED ROOFING TECHNIQUESERMlrrdoO3O7O132
094R ATITER DR.
a OWNER'S NAME: 1179 MYRTLE DR PERMrr ISSUE DATE
NE: SANITARY NO. CONTROL NO.
(408) 249-4937
ARCHITECf2NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Loo LICENSED CONTRACTOR'S DECLARATION Job Descrlp tlQn'gpnp
1 hereby afErm that 1 am licensed under provision.of Chapter 9(cmmmencins
With Section 7M)).f DiAxion 3 of dm Buinessend Profusions Code,and my license is
"u LiC,a.Cl full antic f�yT.'3 C '31 t,�(p�j REROOF t� 20Q3
Daterc=n Lie.. _ /11
Dem -�a_ _CS acre
ARCHITECTS DECLARATION
1 understand my plans hatl be used Is Public records
3C Licensed Prof c..onto
OWNER-BUILDER DECLARATION
F I hereby.from that 1 em exempt from the Contractor's License law for the
00 following trump.(Section 7031.5,Business and Profusions Cede:Any city or county
$ which requires a Permit m consumes,a@k improve,demolish.Or.,I,any structure rno
Fly pdorm its iuuancc,alxu"Wreathe applicant forauch Permit whits Silmdrils[Challit
< that he is licensed pursuant to she previsions of the Contractors License law(Chapter H Sq.Ft.Floor Area Valuation
HM (commencing with Section 7W0)of Division 3 of the Business end Professions Code)tar
$ Nes he u exempt thcnfmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by a,applic.m for.permit wbjeelz the applicant lm a civil pemhy of APN Number Occupancy Type
not mon dun five hundred dellen(2500).
❑I,u owner of the property,or my employees with wages u their sale compensation,
will do the work,and the$nacre la not intended or offered for sale(Sec.70th,Business Required Inspections
and Professions Code:The Combictoc's Licmue Law data not apply to an owner of 307 - INSULATION p
property who builds or improves thn,a
ercond who doessuch work himself or through hit
own employees,provided that such improvements an not Intended in offered for sale.If, 6701 — ROOF TEAR OFF
however.the building or imp WCMCM is sold within one year of completion.the owner
bonder will have the burden of prating that he did nm loud or improve for puryose of _ 602 — ROOF PLYWOOD NAIL
01, 603 - ROOF BATTENS
❑1,as owner of the property.em exclusively Business
and confessions with licensed macs ren m
consumer the
oes not apply 7Ma,Bminwand Professions Co or
The C;themor.Li 604 — ROOF IN-PROGRESS
cense low dose not apply b ts owner of property who helms or improve Conan.and,
who contracts for such pmjecu with a conuacnm(s)licensed pursuant to the Conuanar'.
LWunse exempt
[:]I am exempt under Sas .B k P C for Ihls trams
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby ofE,m under peony of perjury am of the following declarations:
w
and will maintain•C.niOnte of Consent to selfdns m,for Workers Cempem
action,u provided for by Section 3700 of the Libor Code,for the lerformemx of Co
work for which this Permit is issued.
ja,Maw and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this penult in Woad.
M Workk a Cnm�enu' n lnwnna t
e.�nijf and Polis number ani
Ctrtmv L '_ icyNOY f5-VOef33_
CERTIFICATE OF EXEMPDON FROM WORKERS'
COMPENSATION INSURANCE
(This secsinn recd not W Computed little Permit is for one hundred dollen(SI00)
Or less.)
1 Unify NK in the performance of the work for which this Permit is issued,1 shall not
employ any person in any mmar an as in became subject to the Workr W Compensation
L.wa of California.Data
Applicant
NOTICE TO APPLICANT.If.after making this Crni0cete of Exemption,you shnuW
become subject to the Worker'.Compensation provisions of she Labor Code,you must
.J O IorthwiC,comply with such provisions or this Permit shall he deemed revoked.
z " CONSTRUCTION LENDING AGENCY
fw^ IWitty norm thin them it.construction lending agent'for CO lcrfurmenm of
fix
we work for which this permit Is issued(Sec.3097,Co,C.)
lfi A Lender's Name
Z) z Linder.Address
V Q I Ceniry Net 1 ban read thisAppliestion and rete the,the above mfmmulun is
It, F correct.l agree to comply with all city and county ordinances and sm,e laws slating to
pec building Construction.and hereby authodn mpreonutives of this city to ewer upon the
U ahovememinned pmPeny for inspection purposes
gy (We)ecru to save,indemnify and kap harmless she City of Cupertino egiinst
y liabilities,judgments,costs and expenses which may in any way action against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE REGULATIONS.
Re-roofs
Signewrc of ApplicaAZA DO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or(alum building a Chapter
store or handle Health and
u defined by the Cupertino Municipal Code,Chapter 9.12,and the Health mtl Safety
Code,Scsiion 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yee We
will the applicant or future building Occupant use equipment or device.which If a roof is installed without first obtaining an inspection,I agree to remove
It hamodnus air contaminants u defined by the Bey Ana Air Quality Managcmenn all new materials for' peetion.
Woo?
❑Yes
I havered the Neartltms meter'elsmquimmematin der ChaPterb.95ofthe Glifor
pia Hul my e,Sec.0 ,25533and 25534.1unticrsmod thnifthc building
docs Z2
n curtcndy he a teunt.l t is my responsibility to nodly ube reopens of the
rcqu' menuwhich'n Cc �'I swanceofaConirteteofaapancy. ignature of Applicant Date
ow nwhnrivedegcm Date All roof coverings to be Class"B"or better
r
.� Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
L U P E kT i N® 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:
Job Site Address: 20 CPC-r O p
Roofing Company Name:
A plicant's Signature: Date:—? ' f C
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper l l
CITY OF CUPERTINO
REROOF 93 c, 7o
UPEI�TINO PERMIT APPLICATION FORM
APN# Date:
—Z -- ( (fl.--o
Building Address:
o 4-7'L-( E.
Owner's Name: Phone#:
✓qs ��. K h'L C(o2—Z3C1 -0c� C,I
Contracto : Phone#: License #:
��� e c � CCc 3 Co ��
Contact: Ph #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
is— Wood Shakes ❑ Wood Shakes
L3 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.
Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
ob�Description: �Q' � 1 idle k
Residential j5— Commercial ❑ �"iP
Fire Zone: Yes ❑ No ❑ onfirmed with Plannin fft. if
�1 t ere are anrestrictio s: fJ
Cost of Project: TAe of Con iocc ancy gro L:
SC?d .e , Q
Qty. i
AppliabjcFee 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
J /