03030034 a CITY OF CUPERTINO 'yd fmr«jw� a'(�ws ;'7;r, .: 3/-°y"��
BUILDING DIVISION PENT �A%�%j� ,7 may^ y�p�° .1� r iylATI�ON-
BUILDING ADDRESS: FISHERMEN' S ROOFING PERMITNO,
t
OWNER'S NAME: 760 S 10TH STREET PersMIT Lau
DOUGLASQ'I
c (408) 297-0826 SANITARY N . C 0L N0,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0
30G LICENSED CONIRACMR'SDECLARATION JobDescription
I 1 hereby+flow that 1 Am licensed under proviclou of Chapter 9(commencing _ _.
with Section 7000).f Dlvitlm 3 of the Busincaa and profession,Code.end my license is
r mfull ma�syyertc -7 (�� p REROOF
r�S LicenseCl
Dam Cont REMOVE EXISTING ROOF, INSTALL W�/CmOMP. 2/12 PITC
ARCHll teased
R ON qR1�A`LZ�
Inndtnundmypl.Meh.11lKnaed.epobliemenrdr DOUBLE 30LB FELT & 1/2 PLYW MP.
=o Licenced Professional
OWNER-exempt NotDECLARATION
I hereby reaso eOlnm that 1 1. exempt farm the Contractor's Coca:
License Lew for the . MAR 1 2003
O o following moon.permit
t 7071.1.Business and Improve,
ednn Code:Any tiny or county
S$ which reyulmA A ponmh re umgruck alms,improve,de ermit t on repair ed madam
�k+ Prtormialuuedpuruarcquiroe thrwisiocant for such ComeacmrsLice se LAW, statement Y �aho
2 < thathekcinwdpursuantmtheprwigoeso do ofthoB niers nkenclaw(Chapeor9 Sq.F[.Floor Area BVILa1J11V�t
3 (rote Is exeingmpt
pthherfom,and the
basis n7 nflMBudnueand Pm(MY vi Code)or
$
that he u exempt memfrom and rise hack for da alleged nemptiea My violation of
Section 7071.5 by any Applicant for a permit subjects the APPlmm'm A civil Penalty of APN Number O Bg9y Type
not wort dun Ove hundred Co11us(5500).
❑1,As owner of Weptopeny ormyempmytec with wegesuthetrankcompetwtion, -
wllldothework.and the xtrugure6not intended orotferandtonak(Sec.70N,Budnau 37513002 . 008 uiredInspections
and promWons Code:The Conmcrors License law dors m'Apply m an owner or �I
property who Wild,or impmsxa memon,end who doeaauch work himself or through his
Own employees.provided that such improvement,arc notlnaMM oroQered forWer If. 305 — FRAME
however,the building or Improvernent k aid wtmin ane year or completion,the owner
builder will haw the burden of proving that he did not build or Improve for purpose of 307 — INSULATION -
sale')' 601 — ROOF TEAR OFF
❑1,as owner of the property.am exclusively contracting with licensed conuacton to
consumer live project(See70w,Business and Profession Crain)The CMUWWecLl- 602 - ROOF PLYWOOD NAIL
ata=law does not apply manowner of property who builds orimprovademon.and, 603 - ROOF BATTENS
who canuecu for such projtere with a antnWon(G licensed pawn to the Centngefs
Lk=m law. 604 - ROOF IN-PROGRESS
❑1 Am exempt under See ,B&P C(or this reason
Owner Dam
Aikk WORKER'S COMPENSATION DECLARATION
1 hemby Ohm under penalty of pedury one of the following declarations:
haw end will mdntaln a CeWOate ofComent waif-ineum for WorkersConran-
utlon,As provided for by Section 3700 of set labor Code,ran me performance of the
work for which this permit is issued.
❑I haw and will maintsin n
Warren.Compensation In=una,a required by Scale.
3700ef the labra Code.for tie pegomancee(the work for which ark permit Is Issued,
My Wo ex Cempcnation Insurance ander and Policy number Lie
C�,,9 J A.P 7=W1F 14- _amy Ne.: 1 5 9�Z2-OL
ERTIFlCATE OP MEMUTION FROM WORKERS
COMPENSATION INSURANCE
(Mi.cationneed not he ampleted If the Permit is per one b undud Callan(S I00)
or IOL)
—" 1 centfy that in the performance of the work for which this Permit is issued.I Mall not
employ any person in any manrorso u m become subject to the Worken'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this CertlRcaa of Exemption,you should
Income subject to the Worked Compensation provisions of the labor Codc,you must
.,O foahwith comply with Inch provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby aff m that mea is a construction lending agency for the perromawm of
]i
than work for which this permit is lasted(Ser.3097,Civ.C.) '
31Q Lender's Name .�
7 Z Lender:Address
J I=try that l have read di Application and cam that me above information Is
0..4 correct.l Agree to comply with ell city and county ordinances and sum law=mleting to
UC building convection.And hemby authorise representatives of this city to enter upon the
a show-mentloned property for Inspection purposes.
(We)aFO to sew,Indemnify and kap humlea the City of Cupertino again'
r W Iiebllitlea,judgmena,cuts and expense=which may in anyway accrue,against Wd City
J
LICA Me I RSTANDStAINM WILL OMPLY WITH ALL NO Issued by: Dat2YYe
SOURC LATIONS. _4
Re-roofs
%Signalli of ApplicanuMmurmter ' Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Applicant orfuture building occupant gore or handle haArdou material '
a dented by the Cupertino Municipal Code,Chapter 9,12.and the Health and Safely
otic,Secllon 25332(q? All roofs shall be inspected prior to any roofing material being installed.
❑Ya o
W
tht.npntml or mitrrebomm�g ocenpam pa equipment or demces which
If a roof is installed without first obtaining an inspection,I agree to remove
II heundna olreonamianu u dellmd by the Bey Area Air Quality Maegemcnt all new materials for inspection.
Irmo
❑Yes AN. /)
I haw read dm bunNmg materials requirements under Chapter 695 of me Califon. ,`////r/
nk Halm@Salety Cunt.Seci=25505.33533end2553Aiund=maWagiHhe Nnlding ��Q 2
does not ntiy have a awn,mat It my secpouihlllty m notify de acupat or Ne e�
requlm whichmwbc met u of Occupary.
Signature of Applican Date
w rmmthoriad apem Data All roof coverings to be Class eBe Or better
Community Development Department
Building Division
City of Cupertino
LL��1111LLLLLL������ i 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
CU PERTs NO
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: 14r-
job
rjob Site Address: Q �o YGI��ll GG
Roofing Company Name: er m.e,o.
A plicant's Signature:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper