03110105 CITY OF CUPERTINO77777777
BUILDING DIVISION PERMIT C�ONTRA.CTQR INF�,URMATIOIV I"..
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BUILDINGADDRCSS: MONKS ROOFING PERMIT NrO 3 110 10 5
6S1 BARHART AVE
OWNER'S NAME: PERMITISSUEDATE
SSE TOMAS 794 BERRYESSA ST 11/20/2003
NE: SANITARY NO. CONTROL NO.
(408) 262-4797
ARCHITECGENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+00 LICENSED CONTRACTOR'S DECLARATION
mC 1 thereby affirm Thal I am licensed under provisions of Chapter 9(aomT�ocing Job Description
£Zzy wire Secti IXIII)of Di=ision3of Rusin An u ai o my�cen¢is
m 7 N in full fo cad effe IJCitfJa fV_ RER I I F
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-Fp Dam Cont or
'y ARCHITECTS D ATION
U I u land my plans mall W used a tic rtcmds /
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mai
Licensed Profcui.nel /
3
OWNER-BUILDER from
DECLARATION
i E I hereby affirm that 11. ,exempt from IW Contractors Code:License ty o for tW 3/
00 followwhichinguiresa Panic n?(Ds6,Business uar.imd w.deoesh,iAny city or roomy
$ which its requires a permit re ennatmm,elms impmm,demolish,m e a sig any tammurc $3400
°itrn that hor nsLL tensed e.also pursuant
the Provisions
sor for such Pcrmiuofense La (Chapsstammer,
< that me cansedPursuao 7 the ofDivioan(the Conwness Licenselsw(CNpmrY Sq.Ft.Floor Area anon
rcF 0 (cat he I,(commencingwith
donations
.4 of Division r of the
.led sax and Proon.Anynvi Code)or
$ Net W is exempt tWm(rom and the bats fur Ne alleged eumpdon.Any violation of
Schon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 37f*1*15�10 0 Occupancy Type
not more Nan Bm hundred dollars($SM).
❑1,as owner of the property,or my employees with wages as their sole companaadon,
will do the work,and Ne structure is not intanded or oRemd for sale(So.7W,Business Required Inspections
and Professiou Code:The Common's License law does not apply to an owner of q p
property who builds or improves thereon,and who doessuch work himself orrbrough his
own employees,provided that uch improvements arc not intended oro0ered toluic.IL
however,Ne building or improvement is old within one year of completion.the owner
builder will ham Ne burden of proving that be did not Wild or Improve for purpose of
talc,).
0 1,as owner of the property,am exclusively contruting with flowed ormicums t. -
construct the project(Sec.?014,Business and Professions Cmw:)no Conuactor's Li.
cave law does not apply to an owner of property who Wilda or improms Ihemon,and
who contracts for such projecLL with a contucmr(s)licensed pursuann.the Contnetoes
License Law.
❑Iamerimpruulo Sec. ,B&PCforthmrcaon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of IW following declarations:
I have and will maintain a Certificate of Consent to ulFlaurc for Worker's Compcm
71a,l
on,u provided for by Section 7700 of the Labor Code,for me performance of the
rk for which this permit is issued.
1 ham and will maintain Worker,Cont nudon Insurance,u required by Section
0 of the IaWr Code,for the pcAormuc f the work for which Nis pctmir is issued.
`Worrkers JCpmpenutimi 1a7u�anno art r e P hay nu'm(ppbccer Jka: �'1'l
r1�:S� / wl of No.:� ✓'v`�
VVV CERTIFlCATE OF FJ(EMPI'IFAOM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed If IW permit Is fmone hundred dollars(SIM)
or less.)
1 calcify that in the performance of me work for which this Permit is issued.l shall not
employ any Peru.in my manner an as m Wmme subject to the WoMars Cc mpcnudon
Laws of Cslifamia.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cenincem of Exemption.you should
become subject m the Workers Compensation provisions of IW Laws Cade,you must
O forthwith comply with such previsions or this Permit W deemed mvoked.
Z^ CONSTRUCTION LENDING AGENCY
I Wmby affum that them its construction lending agency for tW perfurmuox of
x ti the work for which this permit Is issued(Sec.3097,Civ.C.)
Qlenders Name
= z Lenders Address
U Q 1 certify that I ham read this applicuion and tum that dm allow Information is
IL (•' corrm.l agree to comply with all city tad county countries and mule laws milting to
0U building construction.and hereby aumorim representatives of this city to enter upon me
�+0. move-menduned property far iapecdon purposes.
(We)agree to um,indemnify and kap harmless the City of Cupertino again �/ T
F'(Z) liabilities,judgments.costs and apcaea which may In any way acerae agdnn a id City CJ ,
U z in conseq ce afthe gamof
of this permit.
APPLIC UNDERST NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S( GULATIO . q�.� J
n !/! �/-oZll �� Re-roofs
Sig urea Applicam/Comracmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building occupant umrc or handle hazardous material
a lolrml by dle Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
oda,
Section zss3z(ar All roofs shall be inspected prior to any roofing material being installed.
❑Ya 8Vo
will the applicant tar(futures Wilding oaupant on cywpmem or devices whore 'If a roof is installed without firs[obtaining an inspection,I agree to remove
..a'rardnua air contaminanLL as JCOncJ by me Day Arca At,Quality Management all new materia r inspection.
Id=
let?
0 Yes
I have mad the hazardousimemalsrequircmcnrs under Chepmr6,95 of the Califon
ead, "dcry Codc,SccOuns]5505,1557)and 25574,IundentanJ mollfthm Wilding o -, 03
no a rally hem mount,that 11 LL my responsibility m notify rbc coupon of the lrc c awhichmost nM olsmuuT faCcnifcamofOttupancy. .l� Sig re of Applicant Date
Own Amhmized agent I Dam All roof coverings to be Class"B"or better
I Community Development Department
Building Division
City of Cupertino
T '
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U�w,��,'�O 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 hail 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 r--, c)
,/
Job Site Address: - �6 I >C)a f j lad
Roofing Company Name S ��� 6''1^
A plicant's Signature: Dake:
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO D vs
O, REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
/ -av -v3
Building Address: J I n A j V'
Owner's Name• J Phone
�a�e-
Contractor: u ( )� Ph e#:
Contact:: l Phone#: 0 1 Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
c=*� Asphalt Shingles <B, Asphalt Shingles
❑ 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 Cupertino's Tear Off Policy: ❑
Job Description:
eG,X 6�F 2otiT o�s� � S5'�tl Ct7r,
Residential (K. Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plann'
there are anres ions: )
Cost of Project: ` T�e of Constru ti . Occupancy I!
k3 — ---- X
Qty .
A cable Fee ID Fee Description Fee Group
BPERWEE 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
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