03070170 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRACTORR�INF§RMATION• _
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BUILDING ADDRESS: PERMIT N003070170 3070170
OW
AS NAME: PERMIT ISSUE DATE
122,,62
NE: SANITARY 0. CONTROL N0.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
woo LICENSED CONTRACTOR'S DECLARATION Job Description
ad I ion 7D affirm Om 1 am licenced under provisions of Chapter 9(commencingsis
ad with Section by anio that I am f the licensed Business pr Professions Cada. 9 my Cenci is
??� in full force oadcl(In.� J� S''d7[-f/�
Lken.0 a J Ls.« J REROOF
Dam Coat ECI CONTRACTOR: NEW AGE ROOFING $ /
1q- ARCHITECTS DECLARATION {J`
D@ otic sand my plain shallbeu dos poetic months a
;Qo Licensed P.feain..I O3
OWNER-BUILDER DECLARATION
g3 m I hereby affirm that 1 am comps from IM Can..&.License law for tw
0 0 following match.(Section 703 1.5,Business and Professions Code:Any city Or county
6:00
V which requims a pcmtit to construct,site,improve,demolish,on repair any straaure
m�'^ poor m its issuance.also requires the applicant for such Notation rile a signed statement
that he is licensed pursuant m the Provisions of she Cnmacsor's Lear.Taw(Chapter 9 Sq.Ft. Floor Area Valu t
y G (commencing with Section 7")of Division 3of the Business and PmfessiomCodc)tar , 103500
y
that he la exempt therefrom and the basis for the alleged exemption.Any vinladon of
Section 7031.5 by any applicant for a Permit ubjects the applicant 1..civil penalty of 3 alg�rgT�erO0 Occupancy Type
not more than rive hundred dollen(5500).
❑1,a owner of the property,or my employca with Wages as their Wale compensation.
will do the work and the someone is net hemmed or offered for sale(Sec.7044,Business Required Inspections
ad Pmfessiom Code:The Conest ne.License law does nal apply to an owner of q P
,.party who builds Or improv tlmreon,and who domauch wink himalfor through his 305 - FRAME
own employers,provided that such improvements an not intended nroRered forsale If, 307 - INSULATION
however,the building or improvement is said within mm year of completion,the owner-
wpder .will have the burden of proving that he and not wild or improve for pmpoti of 601 - ROOF TEAR OFF
ale.).
❑1,as owner of the properly,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
comn.ct the project(See.7W,Business and Professions Code:)The Contractor's U. 603 - ROOF BATTENS
came law dome not apply to an owner of property,who wilds or Improv domain.and 604 - ROOF IN-PROGRESS
who contracts for such projects with a cottontails)liamto the ed punamal Contractor'.
License Law.
❑1 am exempt under Sec. .B Al P C far this recon
0. Data
00 WORKERS COMPENSATION DECLARATION
I hereby affmn under penalty of perjury oro of the following declarations:
I hew and will maintain a Con ficam of Continuo alf-insure for Workefl Compere
ation,as provided for by Section 37110 of the labor Code,fm the Penicillin.of the
o k for which this permit is issued,
1 have and will maintain Workers Compentlo
an Iasunna,a requited by Section
700 of do,lath
c Labor Code,for e perfanmmec of the wok for which this permll is issued.
My Worker pe axion lneunn.7amrend Polity number..:
Cantron. p7 /vin (/ Policy No.:
CERTIFICATE OF FXEMPOON FROM WORKERS'
COMPENSATION INSURANCE
(Dissection need not be completed](IN comis is forum hundred dollars(Sim)
carless)
1 certify that in The performance of the work for which this Permit is Isswd.l Scall not
employ any,cam in any.m caner a as In become subject to the Workcts Compemetion
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become suhjm to the Worker's Compensation provisions of the Labor Code,you must
.J O forthwith comply with such Provisions or this permit shall be account minted.
E7 CONSTRUCTION LENDING AGENCY
�-+� Ihereby sfrmm that there is a contraction lending agency,forte Performance of
C .� the work fur which this permit 1s issued(Sec.3(N7,Civ.C.)
W Q lender',Name
a ,z correct.Address
U Q 1 certify that I have read this application and auto that the above Information is
C)U bonen.I agree to comply with all city rie county ordinances and sole leve relating e
�U .1m.ngcomwctpro ad hereby authodaempreanutiws of this City tocnmrupon the
W shovo-(We)are to ertysave fm inspection an pure p ha.
(We)agree so sew,indemnify and tree ha roan the City of Ukinino against
h incoisequenc judgments,gratsing ape.uwhtcM1 may in any Way ac.c gainslaid City
UZ APPLI ANT If NC granting this Permit.
^ APPLICANT LING STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
j/6�
SOURCE EC ON
'�71d�'103 Re-roofs
S"fircil'Ap,licinifiC.011ml.r Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle huallous material
as dallied by the Cupertino Munieip&I Code,Chapter 9.12,and the Health and Safety
Code.Section 25532(a)?
as �N. All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
Will the applicant or!mum wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
IIhximaim oit conominam a dapped by the Bay Am.Air Qmlily Managcmcnl all new materials for inspection.
i rict?
[]Yes VN.
I have mail the wordous materials requirements under Chapter 6.95 of the Califor- /
nit HcslNKSafety Code,Sections 255!15,25533 and 25534.1 undersand that lfthe building amu, / o. oG
does not curattly t tenant thm h is my reapomihility to nndly the eccu,al of the F
requimmc uslIN m P' rtotaaaecofa Ccnlpcateof cups ^�
��-��� 72 5, Signature of Applicant Date
Owner m e.hoore0 a'gem Dine
All roof coverings to be Class "B"or better
Community Development Department
Building Division
ant
City of Cupertino
10300 Torre Avenue
* CITY Of Telephone: (408)777-3228
UPEkTINO 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:
Roofing Company Name: '/ a
A plicanYs Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF 63° 7 ,11 Z
CUPER, TINO PERMIT APPLICATION FORM
APN# - 06 - 0,23- pb Date: -) a a 03
Building Address: �Sp/
Owner's Name: Phone#:
Contractor: Phone • License
yw �oo � So �f7— /syo 5075`13
Contact: Phone • -Cupertino Business License#:
,?r/ T dA,-;, Seo 71Y-?61
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
oAsphalt Shingles 13Asphalt Shingles
-
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles Wood Shingles
❑ Other(Specify) Other(Specify) '"
Number of existing coverings ❑ Provide I.C.B.O..Report# Toro
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
. I Have Read, Understand and Will CoiEply With Cu ertino's Tear Off Policy:
Job Description: emovt_ S,A4re fw io p 11 7//` 9J� 30 (b, fel I p a,-,./A4 tqe4
n!`,
Residential Commercial ❑
Fire Zone: Yes ❑ Nolz Confirmed with Planning De t. if
there are,any res ons:
Cost of Project: Type of Constructi Occupancy gr p:
Qty
A ca le 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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