04110113CITY OF CUPERTINOr
"
BUILDING DIVISION PERMIT
� CONTRACTOR INFORMATION
owcDINGADDRFSS:
WOODS ROOFING
PERMIT N`64110113
2I BAHL ST
OWNER'S NAME:
PERMIT ISSUE DATE ,
ANN HUNTSMAN
2179 STONE AVE
4
ONE:
SANITARY NO. ' - CONTROL NO.
(831)637-5576
"
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG - EIFCt _- PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
d under provisions of Chapter 9 (commencing
I hereby afpsm Nat 1 am Recanted
p
wiOS,cti.n70f10)af Division3ofdae Busin=adP fP ,�dorylieenuis
-
Lfullforteandcrect.]�
REROOF
Licenu CI Lk.
- -
-_
ARCHnE DECLARATION
1 understand my plans shall W used as public records
Licensed Pmfcssional
OWNER -BUILDER DECLARATION
1 hereby affirm 1 am exempt @c Conuacm Licenu law for the
er an Code:
followingon RBL5,Businessand Pmfestium Cod,:MYcity or county
- - V -- 2 C, 8 C,—_
al.. Becht L alter, ndpmve, err repair tmb,na
which squires a relaims
Sq. Ft. Floor Area ._ _
_ Valuation
PermiN,
ed
issuance. also M In file signed statement
such Contractor's
reclaims dM .pions nt of Me
that m s l easedppursuant hapecr
that
cingwitpursuant7")ofDivioesnftheheBuiness ndPreftaw(Chapun9
(commencing theeged Business endor
that
he Mexempthamion]OndM basison3of
on. AnynnsCndin
Nat he u exempt therefrom and Ne baso for the alleged exemption. Any violation of
Occupancy Type
Section 7031.5 by any applicant for a permit subjects Ne applicsnna a civil penalty of
non more man five hundred dollars ($50(B.a
0 1, as Owner of the pmpcny, or my employees with wages u melt sale mmpevWon.
will do the wort and the structure isnot intended oroflarad for ask (Sec. 7044, Busbw..
. • �.• Required Inspections
and Profcesiom Cade: The Contractors License, Law does Out apply m an owner or
.... ... _ L ,�.
propeny who builds or improves menton, and who does such work himself or through his
own employcee, provided that such improvements are not intended unopened fmsak. If.
however. me building or improvement is sold within am year ofcompletion, me owner-
Wilder will haw the burden of moving that be did not Wild or improve for purpose of
sale.).
❑ h as owner of tbe property, am exclusively contracting with licensed contractors to
consumer the project (Sec. 704,1. Business and Professions Coda:) The Contractors Li.
.
cense law dots not apply to an owner of progeny who builds or improves daemon, and
who contracts for such pmjecls with a conuaaor(s) licensed pursuant to the Contractor's
Lkenu Law.
❑ 1 ver exempt ander Sec. , B & P C for this ¢tion
Do r Dem
WORKERS COMPENSATION DECLARATION
1 hereby aRmm under penalty of perjury, one of the following recursions:
I have and will maintain a Canmcvm of consent o scieinsum for Workers Compen-
sation, u provided for by Section 3]00 of dw labor Code, far the Performance of me
work for which this permit is issued. - -
-
❑ 1 have and will maintain Workers Compensation Insurance. as acquired by Section
-
3]00 of me labor Code, for me performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number ate:
Gnricr: Policy No.:
CERTIFICATE OF MEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not hcomplcmd if the Permit is [won hundred dollars BlW)
err less.)
I cenifv that in the performance of the work for which this permit is wood. I shit net
'-
employ any person in any mamorso as in become subject o tbe Workeri Compensation
Laws of California. Data
Applicant
NOTICE TO APPLICANT: If, afar, making this Cenificare of Exemption, you should
become subject at me Worker's Compensation provisions of the labor Cape, you muss
fool ith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm than inert is a coowctinn lending agency for me performance of
0te work fur which Mia permit is issued (Sec. 3097, Civ. C.)
lenders Name
tenders Address
I ccnify that 1 have mad this application and show out me above information is
correct. I agree no comply with all city and county ordinances and sum laws relating to
building construction. and hereby authorise representatives of this City to enter upon me
above-memimad property for impaction purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities. judgments. costs and expeou which may in any way accrue agsimt said City
in cmuequcnce of am granting of this pcsmit.
/
GG'
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
. a
SOURCEREG TIONSN O a r
tl/•
Re -roofs
Signawe
mi r a o mr Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will de applicant or future building occupant smm or handle hazardous mamnel
u defined by me Cupertino Municipal Code. Chapter 9.12. and me Health and Safety
Calc, Section 25532(.)?,
❑ Yrs
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
Will thc applicant or future building occupant use equipment or devicca which
mit hvurous air conuminanu u defood by me Bay Area Air Quality Management
all new materials for inspection.
Dinrict?
0Yca Qn
Iban mulmelts,allousma505, 6,95
7T
ilia Hcalm&Safety Code, Section 255(15,255]] and 255Jd.1 unrcrsmntl man if dm Funding
Wilding
ji��
dues not comently hoc mucam, mat it u my rc pomihilily w unify me oceupam alone
rcyuiremcm wA car beme or uancc or a eni0caw .1`014-10,1
i"�gtI�
Signature ofApplicant Dale
`.-
All roof coverings to be Class "B" or better
Owner ar monad agent / Dam
t
�J
't
�C`1La 11CD �M
pa3i 81
10300 ceemY.iDrgbps�ot
7erro Aver
Tgkpb M off)
7"433
fa (408) 777.3333
i
r
r
t am nct using any "bco awtm; `Q�,'a
PiRaaf dlecic atxiNf-■M}t w.1.n..wM.ww.�. ..,1 �..r�t �n �-^-----'-`_-...
Date
.v.c r.� •vrv� r YMV{iIMYV{L
sue
CONTRACTOR BUSINESS NAME BUSINESS LICENSE N
Cabineb & mmwoek
cluma.F
Blae�ical ;
Ewvatiaut
uncle= /-Wood
ciw Gwgft
In.�l.aat,
OenamenW S�lwt M�aii
P w ou
Pa
ftunbir
Tank'
shoat Metal'
!loft Rock
Tpe
Date
u
! CITY OF
'CUPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Telephone: (408) 777-3228
Fax: (408) 777-3333
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 coveringsshall 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.
� N
Homeowner's Name: a�
'Job Site Address:2333 " 1�7/J_��/
Roofing Company Name: �P�p-s 4 YO ��
5x
A plicant's Signature:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
61 Y
Date: / Oy
4
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
c, � I I X 1(3
32j (3 D �?
APN # _32j
Bldg Permit Fees
Date: -5/0
Building Address: 2z 3.33
2 n n
Owner's ame:
SEISMICRE
Phone #:
i3Z-i9Gz
Contractor:
G.)07 P's
Phone #:
GC/O -vgv3
License #:
32,3/31
Contact:
Ir Phone #:
Cupertino Business License #:
BUILDING
BUSLIC
771- 0
BUILDING
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof -
❑ Asphalt Shingles
�.. Asphalt Shingles
V Wood Shakes
_
❑ Wood Shakes
❑ 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 scnn'pttAn: - . •• •••-
Residential _ :.
Commercial ❑.
Fire Zone: Yes ❑ No ❑
Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: of
Type of Construction: Occupancy group:
a9.5r-S
�b'� 1
Adblicahle Fee TD
Fee Descrintion
Fee Group
BPERMFEE
Bldg Permit Fees
BUILDING
ENERGY
Energy
BUILDING
SEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee -
BUILDING
BUSLIC
Business License
BUILDING
2,77 �3
X0370. 20