03100081 k CITY OF COPERTINO '*%T'!� 'h' fa'~� �y 7�,� * �Y
BUILDING DIVISION PERMIT CONT"CTOR P R RI, ATIUi ,'„
` BUILDING ADDRESS: PERMITNO.03100081
1
-46 BARNHART P1_
OW NER'S NAME: PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MECH
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:0p LICENSED CONTRACT'OR'S DECLARATION
:0m I Mrcby ef0,m that 1 am licensed under provisions of Chapter 9(commencing Job Description
s< with Scotian 7")of Division 3 of On Busincas nd Pfafcuionx Co dc,and my license is
,Oy D.f.
llf see dcffect. '
,y3zuanaeli NSI L .a 7aJ'79'9W REROOF
o Dam Contractor CONTRACTOR: SKYLINE ROOFING Zj
Mr QH� ARCHITECTS OE ,/tR'A c^OP -c
2 I undcrsta y plagf'khell MyseJ aapyfli'
A. X -- 3
:0 Lkcnud Pndessio al '
OWNER-BUILDER DECLARATION
f 1 hereby affirm that 1 am exempt rmm the Contractor's License Law far the
.
00 following reason.(Seetiun 7031.5,Business and Professions Code:Any city or county
which requires a pencil to construct,alms improve,demolish,or repair any structure
l prior to its issuance,also re4rone the applicant for such permit 10 fie a signed statement
s••< that he is licensed Pursuantwthe provisions ofNCConnectors Liam.Law(Chapter 9 Sq. Ft.Floor Area Valuat'
IFn (commencing with Section 7")of Division 3 of the Business and Professions Gyle)of
Nat he u exempt therefrom and Ne hissu for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of 3 604ti0er00 Occupancy Type
not mare than rive hundred dollars(5500).
❑1,As owner of the properly,or my employees with wages As their sole compensation,
will do the work and thx,nmra is not intended or offered f MIA(Sec.7W,Business Required Inspections
and Professions Code:The Camosctoh Lt..Law does not apply to an owner of q P
propeny who buildsor improves thereon,and who doessuch work himulforthreugh his 305 — FRAME
own employees,provided that such improvements are not intanded oroRera for sale,If. 307 — INSULATION
however.the building or improvement iuold within ane year of completion.the owne,-
builder will have the burden of proving that he did mat Wild or improve fur purpose of 601 - ROOF TEAR OFF
talc.).
❑1,as owner of the property,am exclusively contracting with Itamed contractors to 602 - ROOF PLYWOOD NAIL
convect the project(Sec.7W,Business and Professions Coda:)no Convaetor's LF 603 — ROOF BATTENS.
cone law does not Apply to an owner of property who Wilds or improves theater.and 604 - ROOF IN-PROGRESS
who contracts for such projects with a conaactor(s)licensed pursuant to the ContractoM1
License Law.
❑I Am eaempl under Sea B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 Mrcby aRiror under Nulty of perjury am of the fallowing dedantiom:
1 have and will maintain a Cenifate of Consent to self-insure for Worker's Compcn-
1371M
on,u provided for by Section 3700 of the labor Code,for Ne performance of the
rk for which this pnmil is Issued.
1 haw and will maintain Worker's Compensation Inxunnue,as required by Section
of the labor Code,for the performance of the work for which this permit is issued.
Workeh Compensation Insurance tunic,and Policy numberrtier: Policy No.:
CERTIFICATE OF EKEM PTION MOM WORKERS'
COMPENSATION INSURANCE
(Thu section rued not W completed if the permit is foroac hundred dollars(SIM)
or less.)
I certify that in the performance osssssffggggggftyyy work for which this Permit is issued,I shall not
employ any ,son any manor bjmcsubiect.O Wmkai Compeaudon
Laws of at
!"� i QQ SS
A{pticy�1 ass+
areTO APPL : after making this Cenificate of Eaempuon,you should
date subject to the Workers Compensation provisions of the IatWr Cade,you most
OfoMwidt comply with such pwvistnrs or this Permit shall W deemed revoked.
Z M CONSTRUCTION LENDING AGENCY
1 W reby alfam that them is a construction lending agcney for the Performance of
x the waft for which this permit is issued(See 3M.Co.C.)
yQ Lender's Name
z Iend,es Addreu
O 1 unify that 1 have read this pplication and Aum that Ne aWw information is
H correct.I agree w comply with all city and county ordinances and sum laws relating to
�U building construction.And hereby authasiae representatives of this city to enter upon the 1
N W alwimpc
ve-mentioned Property far edon Pu,puas.
(We)Agra to save,indemnify and keep harmless too City of Cupcnino Against
�y liabilities.judgments.costs and expenses which may in any way accrue against Mid City r
JZ in coasNuence of the grsntmg of this Permit. /
ti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
Z yml;�_7
SOLD REG` _
ONS.
��$' _ /s.•9-o Re-roofs
Vure of Applo:Mu
✓Conutor Dam
s\7oHAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dos applicant or fmuro Wilding mavpMt aom or handle harudum motorial
u defined by the Cupertino Municipal Code.Chapwf 9.13.and the Health And Safety
Code,Section 25532fa)? / All roofs shall be inspected prior to any roofing material being installed.
pYee �
Will the applicant or future building occupant on equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hararanus air contaminants as dcfned by that Bay Arca Air Quality Management all new materials for inspection.
1(z
❑Yes fNu 'I haw scud the haaNtmsmawriaisrequimmcnuunderChPmr 695ofdrc CalifonqWilding — / —C)
rsnotcurrenyuiem hich metpn iauanceof.ccnri,:M (LycnPtncy. IgnatureofApplicant Date
An04rer or authorixed agent DateAll roof coverings to be Class"B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U PEf�TI NO 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: T fir, Po 5ra, 1 0 A L1
Job Site Address: ro�f6 r9 2N Ll4 1?J P1
Roofing Company Name: 5' 11 Y Li ji r /CBO rr-!Al
A plicant �
s Signature: - Date: /0— -0 7>
\�l/QS1AfOt�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO0
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# , Date:
OC� �1 t73
Building Addtess:
7 13 R1v 12-f �� C� �(zt�1vp
Owner's Name: Phone#:
Contractor: Phone#: SCOOP License#:
Sk`lLttJC 2ooFL&sL, SS —3 7 ` -74i-cr-I
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 0' Asphalt Shingles
Er Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O.Report#
,of To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
P,CROuE_ 5H14KE.5at 57ALL %2PLY v)coP d- :ON�S'IA-L 30,� AS N LT-
Residential
J�3 Commercial ❑ StfING
Fire ne:-- es ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: ❑
ost f Project: Type of Constru Occupancy group:
£ F
Qty-
AppvcLq Fee 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
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