03050114 CITY OF CUPERTINO + "'?T:ffa vv m'«'w �°ate '' r.
. 1 BUILDING DIVISION PERMIT ;Ic ;'1 PAC O#WORM TZ 'g<',r.
BUILDING ADDRESS: PERMIT NO.
DONE RIGHT INC 03050114
t MAV PRRMIT ISSUE DATE
1129 LONG FELLOW AVE' 05/23/2003
(408) 377-8777 SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BQ O PLO MECH
3000 LICENSED CONTRACTORS DECLARATION JobDescription
f I hereby arnret 1 am d under pro
visions of Chapter 9(commencut FINALE
�p g I�
with Scm NI(mnse
climb 70M)or Divldon3of the Business ProfeuioonsCoft dmy Newhall, Y�IB�25A�ai. D
?�Z tLkeltimoGl end ettec4) (/ ,a y !!rte REROOF
°awl ARC1rrECr01` ECCLARAnGN JUN 0 4 2003
1 understand my pedes shall N used as public meerm
s
Licensed Prefcesimod pp'�/�
b OWNER-BUILDER DECLARATION BUILDING
I hereby affirm Net 1 em exempt from the Contractors License Lew for the
ZOO following notion.(Section 70315,Business and Profession,Code:Any city or county
5$ which rm dres a permit to construct.ahn,improve.demolish,m repair any malum
r palm to its iuuenu,alm requires the applicant formch permit m rile a signed Stswmcni
2 < loathe Islimmedpursuanttothe pmviciomoftieContrmmrsUumelaw(Cloper9 Sq.Ft. Floor Area $14�'aarion
Schon(commencing with 7000)of Division 3 of the Businessland Professinm Op le)or
Nn M I.eawpi ti fmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ppm,l61in1 r0 P y 1YP
not mom than five hundred dollars($500). 3 5'TV'1•lJ 7 1beL O ecu arc e
❑I,uoww of the proprrtY•mmy emplayse with wguetheR role compensWon,
willdotewokknd NesuunuRbnotintenMAmonemdfmule(Sm.7W,Businm 305 - FRAME Required Inspections
and PmfeWmz Code:The Contractors Lomme Law docs not apply to an owner of 9 P
property whobulldsortmpoves themon.and who does such work himself orthmugh his 307 - INSULATION
own employees,provided that inch improvements am nithemoded oroffered for sola If, 6O1 — ROOF TEAR OFF
however.the building or Improvement u mid within em year of chmpledon.the omr-
bulldtwin bavetheburtle of proving that he did no,build or improve I.pumoseof 602 - ROOF PLYWOOD NAIL
sold .
❑1.as Manor of the property,am eulusively conuaeting with Ihewd mnoaemn to 603 - ROOF BATTENS
.,=I me,project(Sm.7044.Business and Pmreasiom Code:)The Contractors U- 604 — ROOF IN—PROGRESS
eenm taw drove not apply m on owner of property who builds or improve Merton,red,
who contracts for such projects with a contractors)Reserved pursuant he the Contractor.
l.hoeme law.
O 1 am saemp uncle Sec. .B k P C for this reason
owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby IIRrm under penalty of perjury had of the following decoandoese
I have and will mdnWn a Cm bimm of Consent to self-hnsumfor Worker'sCompen-
sation.as provided for by Section 37M of the labor Code,for the permmance Of the
work for which this permit is issued.
01 ban and will maintain Workers Competition br mmum.u required by Section
3100 of the Iabor Code,for the performance of the work for which this Permit is issued.
My Workers C m woo Iwunm carie and Policy number ,—
Carrkrr c Policy No: Van
CERTI KATEof FXPMPTIONFROMWORKERS'
COMPENSATION INSURANCE
(INS modus teed no,M computed If tie permit w(mom hundrtd dollars(SIM)
on Imes)
I comfy that in the performance of the work for which this permit is issued,l shall not 1
employ any person In any memcran as an Memo subject o the Workers'Compmeration
Laws of California-Dam
Applicant
NOTICE TO APPLICANT:IL after making this CeniOcae or Exempion,you should
become subject to the Worker.Core ewdon provisions or the LRW,Come,you mmt t
vet o fm,hwith comply with Such provisimu or this p rant shall M deemed revoked. J.
CONSTRUCTION LENDING AGENCY
(—t IMmby affirm that there is a construction lending agency for the performance of
Kt> ftwork for which this permit Is Issued(Sm.3097,On.C.)
aE Lenders Name
0 z lender's Addrtss
U0 I ttNfy NII I hem rad this application and slow that the above Informmien Is
U.!'. cornea I agree to comply with all city and county ordinanws and saw laws-hong to
0rV^ building construction.Red hereby Authosim reproseffil of this City M enter"MR ft
D7 aleve-memioned property for inspectionxpert purports V`^v!Y ni/�
(Wc)agree to eve,indemnify and keep harmless the City or Cupertino against
r�y Iiebill0u,}omgmenu.cesu andespeeses which may In any wyaceroe against aid City
V to
!An coIN
URC N ERSfANDS AND WILL COMPLY WITH ALL/NON-POINT Issued by: Date 2
SOUR ONS. I�/I
�/L Re-roofs
Si urto(Appli HAZARDOUSMATERIALS DISCLOSURE
Dow
Type of Roof
Will the applleant or future building acupanutore Or handle hazardous material
So defined by the Cupen on Men a Code,Chapwr 9.13,and the HuIN and Safety
Code,section 15531()7 All roofs shall be inspected prior to any roofing material being installed.
❑Yca No
Will the applicant fir rules ildins..past use equipmcm m devices which If a roof is installed without first obtaining an inspection,I agree[o remove
mit hanumn air un 121. defined by the Bay Ares Air Quality Management all new materials for inspection.
District?
❑Yee 4N
(have aMou maunah rtquirt ehlot under Che r6.95ordmodifm-
rah Hulth kS , marks 25505.15533 uW 25534.les du, the Wilding
tloes not ve a wnmt,that it w, rtspomlNifty w Iffy typ out of Mc
mquiro n utemelpdorener ore m (r]/g0/� gnatureofApplicant Date
Dw r suthorind agent Dow All roof coverings to be Class"B"or better
Community Development Department
Building Division
r City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E RTIN 0 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
Jwith�the above stated policy on re-roofing.
Homeowner's Name: V I /��1�'/ A-J
Job Site Address:
Roofing Company Name: /
A plicant s Signature: Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO S
REROOF D 3
CUPERTINO PERMIT APPLICATION FORM
APN# -357 —Cl /
4 / ✓ Q `/ Date: C 2�
Building Address: I J
Z22, V G nLj 40
Owner's Name: YU �' nil Phone#:
Contractor: / Phone#: License#:
DRis�ht �2 i 37 3 77L C) b?-
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles /J ❑ Wood Shingles
El� Other(Specify) tt e ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
y• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Descri tigp f mac:
/ere-
7
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
l --` there are any restrictions: LJ
Cos ,of, mje&t:/�/ � Type of Construction: Occupancy group:
Qty. if
Applic4bM 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