03060164 CITY OF CUPERTINO
lJ BUILDING DIVISION PERMIT CONTRACTsQRINFORMATION`fit
BUILDING ADDRESS: SAN JOSE ROOFING CO PERMIT NO 03060164
as
OW NE0.'S NAME: 350 SENTER RD PERMIT ISSUE DATE
ONE: (408) 227-4931 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
'loo LICENSED CONTRACTOR'S DECLARATION )Ob DBSCrIpIl00
1 hereby affirm that 1 am licensed under provisions or Chapter 9(commencing
with Sectio.7"k 7000)o(Divialon J of NC Business and Pro(wiom Code.and my licemc is
;qiin full force and&/P�cL 3�]qQ
uanseclasaLm.x 2 °� 2 REROOF
'r Dam Cont
`
ARCHITECTS D RA ION
i I undenund my plana shall M used in public records �-
Licensed Pndcssinnel
g
OWNER-BUILDER DECLARATION
A e q 1 hereby affirm that 1 am exempt from Ne Connector's License Law for the
p O fallowing maann.(Satiun 7117I.J.Business and Professions Cole:Any city or county
u$ which requires a Permit to conn mct,alter,improve,demulixh,or repair any atrumum
prior ht its issuance.also requires the applicant for such permit to file aaigncd statement
xp Nat he is licensed pursuanttotheprovisionsordmCotractr'sLt..Lw(Chapm,Y Sq.Ft. Floor Area IDaI ❑
(5tt$ (commencing with Section 70M)of Division l nftW Businw and Professions Code)car
C 3 Nat he Is exempt therefrom and the basis for the alleged exemption.Any violation of 31602085 . 00 1
Section 70113 by My applicant for a Permit subjects Nc applicant to a civil penalty of APN Number Occupancj Type
not ream than five hundred doll..(SSW).
❑1.as owner of the propeny,Or my employaa with wages as their sole compensation.
will do the work.ndNeswctom is not intended or offered fonalc(Sm.70 N.Businw — Reguired Inspections
and Profession,Code:The Contractor's Liaman e law denot apply m an Owner of 307 - I NSULAT rON p
Property who beiIdsor improve;Nanton.and he Oaou
tch work himselfmthrough his
own employers,provided that such improvements am not intended or offered for side.Ir. 601 — ROOF TEAR OFF
however.the building or improvement Is sold within one year of completion.the owner.
builder will have the burden of pmving that he did not build or improve fee purpose of 602 - ROOF PLYWOOD NAIL
In 1.
603 - ROOF BATTENS
❑L as owner of the prof am oaclmlvely contrating with licensed contractors in 6 O4 — ROOF IN-PROGRESS
construct the project(Sec,7054,Business and Professions Code:)The Comrsemes Li-
cense Law dee not apply to an manor of progeny who Wilds or improve Neuron.and,
who cont.cu for soh projects with a ci oods.,D)licensed pursuant o the Commute,
License Law.
0 lamexcmptunder Sea ,B&I'Cforthisrwon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby a(Ilnv under penalty of perjury one of the following dalssnlons:
I have and will maintain a Certificate of Consent to self-insure fir WorkebCompen-
cation,as provided for by Section 37W of the Labor Code.for the performance of the
wmk for which this Permit is issued.
❑I Tuve and will maintain Workers Compensation hi u mbec,as required by Section
37W of Ne labor Code.lir the Nor...of the work for which Nu Permit is issued.
My Workcra �lo"Insurance card.and Policy nu qcr c>3
/� Carrier: /A T� Polity FROM
1 CERTIFICATEOMPE SATIONI NFROM WORKERS
COMPENSATION INSURANCE
(This section need not W completed If the permit Is for one hundred dollen(SIM)
se less)
I certify that in the performance of the work for which this permit Is Issued,I shall not
employ any person in soy rommerso Is err become subject to the Workers'Compensation
Law.of California.Dam
Applicxnl
NOTICE TO APPLICANT.If,alter making his Cenifieate of Exemption,you should
become subject to the Worker's Compensation provisions of the 1aMx Code.you must
�O forthwith comply with such provisions or this Permit W deemed revoked.
'�
r~IV)., CONSTRUCTION LENDING AGENCY
[—r 1 bemhy affirm that Neve Ise construction lending agency for Ne performance of
fY,> Nc work for which Nis permit 1.issued(SaJ097.Civ.C.)
fy 0 Lender's Name
Z lenders Aldrw
U0 1 cenify that I have resit this application and state that the above information is
ty r' cosma I agree in comply with all city and county oNlnamn and sum[awl mhdng to
rV'
building construction,and hereby auNmien rtprewnutivcs of this city an enter upon Nc
(•+wahove-mentioned property for inspection purposes.
CL. (We)agree in save.indemnify and kap hannlw Ne City of Cupertino aga me,
Tag
in consequence of the Coming of Nis Permit.
liabilities,judgment.cosumd expenses which may In any way acerae against said City
V 7
r7 APPLICANT UNDERSTANDS AND WI COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RfpULATIQNS.
O 1B-a,f iA Re-roofs C7
Signmorcof pplicandContnctor Data
111 HAZARDOUS MATERIALS DISCLOSURE Type of Roof LO
Will the applicant or future building Occupant nom in handle Insndous material
as defined by Om Cupertino Mut I Code.Chapter 9.17.and the Health and Safety
CWe,Sectionz55Ja(a)7 All roofs shall be inspected prior to any roofing material being installed.
Cl Y., u
Will the applicant or(carom Wil 'ng Occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
h havardnus air conuminanm as d ned by the Bay Area Air Quality Management all new materials for inspection.
strict?
Q Yes
Hit mW Ne hnaNrmsmaterials mqulmmcnu under Chapter Q95 if dm Gli(or-
ni.Heal"SatetyC.W,Sccdons25505,255JJandM534.1.m .undthnlfdm Wilding
dao err currently have.tenon this my respo tory m atify Ne acuPant of Ne
rcyuimmc whichmmlWm brluiuuanecof �ertirmamirOccapanry. Signature of Applicant Date
Owner car aumori'rad esem Dam All roof coverings to be Class "B" or better
Community Development Department
Building Division
I City of Cupertino
10300 Torre Avenue
4CITY 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: 10 NNrit/Sa C1t �K(lC2h �rJ
Job Site Address: /O(nD 1 4-�1pue N /JUS— �.1� AEAfYrw0`ex_
Roofing Company Name: Sp lv SOst I:fOO F r rV� ed
A plicanYs/Signature: �eltYf f �1 lc c Date: �`�/� 3
\Il/'dWOIJ�
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
r
CITY OF CUPERTINO 3 o 6
REROOF
cl
CUPEkTINO PERMIT APPLICATION FORM
APN# '3 O � 6 � � Date:
Building Address:
avloo
Owner's Name: Phone#:
D
y Contractor: Phone#: License#:
F 49,9-7- X93 sa
Contact: Phone#:of'X-' 1'07 Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �rc-Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
Cir, To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
7-riqr2E- foo
Residential 0 Commercial )
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
000 — - CaQ0 F -�
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY En;rgy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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