03040091 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 5 CONT"CTOW4NFORMATION f,'
.sat ..�, •!'mce,x�&�.,x l�i�; •.��
RYIY§�fDn.Y,WOOD DR PERMIT N0.03040091
FREDERICK J 11ITL$UB4
A7
Bl6/2003
ONE: SANITARY NO, CONTROL NO.
ARCHITECnENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
Too LICENSED CONTRACTOR'S DECLARATION JobDescri O O O
rd I Wns
mby affirm that I Am licensed under provisions of Chapter 9(commencing Description
x with Salion]0110)uf Division Sof Ne Business end Professiums Code.iM my licenses np
< infofnme roti erred. ..r��p�n /� ��
icon.Clazs _ - Lic.g Cos 1 c, REROOF II— II WS/.f,�,
ale - 1 Contractor n s a.ktt �.I'I
ee ARCHITECTS DECLARATION J
Y ImalMstandmyIm used As public recards
SMAY 0 6 2003
aU
k C� Licensed Profcssioml
OWNER-BUILDER DECLARATION
<E I hereby affirm that I am exempt from the Contractors License Law for the BUILDING
�1 1'7 Y1�pg/'�
yOC following rtuon.(Secdon 703 I.S.Business and professions Code:Any city in county IDU L.YJ gNG
5$f! which moria A permit to Movisoct,Alto,.immune,demolish,or repai,soy rmcture
�my prior to its issuance.also requires the applicant for such permit to rile a signed statement
F� that he is licensed pursuant in the provisions of the Comm.mri License Law(Chapter 9 Sq.Ft.Floor Area l(y4g*ion
(commencing with Section 7000)alDivision 3 of the Business and Profession&Code)or
y Nat he h exempt therefrom and Ne bash for IW exemption.enption.Any violWon of
Section 7031.5 by arty applicant fm a permit subjects the applicant to a civil penalty of 3 DIOfYI�r 0 0 Occupancy not mart than five hundred delta.($5001. P y TYPe
0 1,As owner of the property,or my employees with wages a than sale compensation,
will do the work,And the swmure is not intmWed proffered far sale(See.7044,Business 305 RA
and Pmre.ims Code:The Contractors Liave law does not apply to an owner or - ReT fired Inspections
property who builds or impraws themon,and who doessuch work hineselfar through his 307 - INS ULATON
man employees,provided that such improvements Am not intended aro@red foriale.If. 6O1 - ROOF TEAR OFF
however,the building or improvement h sold within one year of completion,the owner.
builder will have the human of proving that W did not Wild or improve for parpo.of 602 - ROOF PLYWOOD NAIL
ITh.).
0 1,as owner of the property.am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
cmmwcl the project(Sea 7044,Business Add Pmfessiom Cod.0no Comr.lors U. 604 - ROOF IN-PROGRESS
come law does not pply to an owner of property who Wilda or improves thereon,and
who contracts for such projects with a contractor(s)hemsed pu.uam to the Contractors
License Law.
0 I Am exempt under Sec. B 6 P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aR an under p molly of perjury,am of the following declarations:
have and will mahout.A Ccniflale of Consent to self-in.u.for Workers Compere
tion.As provided for by Section 37M of the IOW,Cade,for IM performance of the
work for which this permit is issued. •
0 1 ban and will maintain Workers Compemtion Insurance,As required by Section
37W of the labor Code,for the perfarmmce of the work for which this permit is Island.
My Worker's Compem.tion Insurance Grier and Policy nmoher Arc:
artier. HOW-l)rtlVJ PolicyN..TM-yZz-7A29 l
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thia..Ii.need not W completed if tW permit is faro..hundred dollars(5101)
or less.)
I certify that in dm performance of the work for which this permit is lased.I shall raw
employ any pMxon in any manner.As to become subject to the Workers Compen.tion
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Ceniricate or Exemption,you should
become subject to the Worker's Compmration provisions of IW law Code,you mut
D O forthwith comply with such provisions or this permit shall W deemed invoked.
Z,' y CONSTRUCTION LENDING AGENCY
1 toothy Afro.that than,is A comtruetin t lending agency for IW perfmma.or
too work far which this ptmil is issued(Sec.3097,Civ.C.)
10 Lenders Name
z Lander'a Address
Q I mnify that I have rtad this application me sum that that Above information is
L f+ emret.I ag.A It comply with all city.d coumy mcinamms and stale laws Missing la
�U above-gcananct!pm,md nembyaulhartmmpreun.tiws ofthiuitymcnmr upon lM � .
W abovo-memioncd propc costs
for d e pe expenses
purposes.
ti gL (Wu)agree to save.indemnify and keep harmless the City of Cupertino against
fq IiabiliOes.Judgmcnts.costs and expenses which may in Any way accroc against said City
JZ in can e of the YmnliAge thisM It. /
^ APP NT UND AND N ILL COMPLY WITH ALL NON-POINT Issued by: Date
AP C CrREGUL
y— 6-0-3
Re-roofs
HAZARDOU ---__
gra rc of ApplicaOIL Data
HAZAAng occupant
upa DISCLOSURE Type of Roof
WIII the a Cupero or forum building occupant erre m handle Heardeua material
As defined by Ito CupertlnQ Municipal Cuda Chapter 9.11,and the Health and Safety
ode,So ban
tion:sslz(A)7 All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building decuponl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
horardous air contaminants az defined by the Day Area Air Quality Management all new materials for inspection.
❑Yes Nu
Ihavc mad the .S M,smamriah mquimmons under Chapter 6.95 arthc Cal'
hie Health Yr Safety Code,Secduns 1550W. a
I underalwmd tht iftha bulldin
doas not cu by hanatonA*W ",
ed.
Ytonntil'y the cecuP.tofthercquiremen wichmut p' niEcamafOccupancy. SI ter of Applicant Date
C ��C'-�� All roof coverings to be Class "B"or better
Owner m ria.d amn, Dine
Community Development Department
� Mi Building Division
i , City of Cupertino
S
..^ 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
CUPEkTiNO 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: 'V E� E l / L U 17 W t G7
Q q
Job Site Address: 1 I-L/ ( �I A Y U--) (0 Q �
Roofing Company Name: P-((�SC l d f c � ' 2 o O
A p'icant s Signature: Date: 63
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper