03050055 1 CITY OF CUPERTINO - '` {
BUILDING DIVISION PERMIT , A MT
, OA
ION
BUILDINGADDRESS: A L RESIDENTIAL/COMMERCIAL PE "NDO3O5OO55
OWNER'S NAME: 14893 E HILLS DRIVE "8T713/2003
OHN WALLACE G AND FREDA 1. RT
ONE (408) 729-6100 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 t�
LOp LICENSED CONTRACTOR'S DECLARATION
YmF 1 bemby affrm that 1 am licensed under provisions of Chapter 9(rommcncing Job Description
<Z�y with Sention 7")of Division]of the Busfrcv and Profession Cade,and my license is �@�gaA /0 ��I®
a<a in full force and effect, 6 D®9 A�"'C. ISS
�'_ License clan REROOF
=�
are Contractor .1
££
ARCHITECTS DECLARATION MaY 2 ZOOS
d� l undersand my plans shall be used u public mentis
OyV
C Licensed Professional
3 OWNER-BUILDER DECLARATION BUILDING
I hereby.(Tens o n I am.sestet from tic warm Co License Law for Ibe
p O following ti soa(Section 7031.5.Bniness and Re,dem di Code:My tiny or county
ee which ¢Sodas•permit m c tree th L aper,approve,h Permit t or repair any structurent
prior to iuuencc,also mquiru the applicant for such Permit filcasigned statement
££xxQ ourom singwitpSection7(dmpmvivisRnfdmoBusimlandProfeIw(Co,h)or Sq.Ft.Floor Area $B��I®tion
y+F Usthe or
Section7(M)bof e basis for
of theered exempt Profession Cmlc)ser
$ But be u canner therefrom armd tic Eau for nM Waged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant On a civil penalty of 3&MO`0311'6erO O Occupancy Type
not more than five hundred dollars($SM). P Y YP
❑I,uowner of the property,ar my employccs with wagvulhev sole mmpevaUon,
will do the workend the aWcam is not immmded or offered forsale(Sec.7044,Business 'p.`, -ns�
and Profesdon Code:The Conus cto'.Lt..Law docs anm ner t apply an ow.of IN d Inspections
property who builds or improves thereon,end who doessuch work himself orthmugh his 307 — INSULA 1 I V
ownemployen,provided Out such improvements ammo,otaded oroffercd foruk.It. 601 — ROOF TEAR OFF
however,the Wilding or improvement is sold within one year of completion.me owner.
Wilder will have the When of proving that be did not Wild or Improve for purpose of 602 - ROOF PLYWOOD NAIL
"k')' 603 - ROOF BATTENS
❑1,u mvner of de,Property.am exclusively contracting with licened conoacmrs to 604 - ROOF IN-PROGRESS
construct me project(Sec.7064.Business and Professions Cade:)The Conro
recrs Li-
cene law does not apply to an owner of property,who Wilds Or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to in,Convector's
License Law.
❑I an exempt under See. .B&P C for this won
Owner Date
WORKER'S COMPENSATION DECLARATION
I hembY aRrm under penalty of perjury one of the following declarations:
I love and will maintain a Certificate of Covera to self-inu eforWorkersCompcn-
s pion,as provided for by Scene.3700 of nW Labor Code.for the perfmout.of one
work for which anis permit is issued.
❑1 have and will maintain Worker's Compensation In mmol.as required by Section
3700 of the Labor Code,for the berformantt of the work for which this permit u issued.
My Worker's Compensation In mmuce tamer and Policy number are:
Cartier. Pollry NO.: 0Z32Yf3-0
12
CERTIFICATE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becompleted iftan permit u for one hundred dollars(SI00)
or lass.)
I certify the,in the perfnrm uce of dime work for which this Permit is issued,l shall not
employ any person in any mannersoum me sexynct to me Workmd Compensation
tty
Lawsof Califomiaa�ate �� i—�7-s—
Applicant \" 3.f ffV
NOTICE TO APPLICANT:1L aRermaking m ifcam of Exemption,you should
become subject to the Workers ComPewtion pm 'ions of the Labor Code,you most
�0 forthwith comply with such provisions or thpermit
is shallbe deemed mwkcd.
'�"' CONSTRUCTION LENDING AGENCY
w�+ IMreb alpon that there is a mnsvuction lending F Y g agcnry for the Performance of
a i the work for which mu permit is issued(Sec.3097,Civ.C.)
z LeMcr's Name
�Z 1<Wer's Addw
U Q I certify that 1 base read this application and sum met the shove informaniun is
C)F conch.l agree m comply with all city and county ordinances and sum laws r upon t e
pU Wilding construction.and hereby authorise rtpresenunivcs of anis city to enter upon me50,
4 above-menioned propcny for inspection purposes
(we)agree On save,indemnify and keep harmless the City of Cupertino against 7
H y Iiabilidu,judgments,costs and expense which mayin any way acctuc again,said City C'../ 7 D�
U Z in consegvnce of the Sawing of this permit. Issued by: Dale '
APPLICANT I/(�DERST DS AND WILL COMPLY WITH ALL NON-POINT
RD,E REGt14AT1ON
`Tx}'IT F, J' t'�-03 Re-roofs
Signxtureof Applicam Conus r'9 Date
HAZARD ATERIALS DISCLOSURE Type of Roof
Will be applicam or future Wilding Occupant slow or handle hasudous mammal
u defvd Ey me CupeninO Municipal Code.Chapter 9.12,and the Health and Safety.
ode,Section 35532(4)?
0y. ❑No All roofs shall be inspected prior to any roofing material being installed.
Will ow applicant or future building Occupant use equipment or dcvims which If a roof is installed without first obtaining an inspection,I agree to remove
i,havurdous air contaminants as armed by use Bay Area Air Quality Management all new materials f C ins action.
Disvmn7 sQ x P
❑Yes ON. IIIVl
I have read thehvardnusmaarialsmquimmenu under Chapter 6.95 Olin Califor-
niceHealth&SafeyCodc.Swouse,25505.25533 and 25534.1 undersand ma,irthc Wilding V\J 3
does net currently 4e a umem,mL I,Y my mapnntlhdlty m humly me Omnmed of the
m ntswnicI nakp pnorwirsaancceracemfcamnr npmc. S ignature of Applicant Date
S(3 03
Owner err cent ri.d agent D,a All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEkT1NO
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) h1-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 Y4" 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: r 7) t l/)
Job Site Address: Ce AD L- 1,9 �Ih:S l nA`P{^
Roofing Company Name: A-• L • 5 .
Aplicant's Signature: Date:_ -3 -C7 3
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
1
CITY OF CUPERTINO
REROOF U � S
CUPERTINO PERMIT APPLICATION FORM
APN# � _ ) � O 2 Date:
Buildin Address-
Ego l -0
111
O is Name: Phone #:
ontractc Phone#: License#:
.L. 1s � g 724 -4too '-"J Z"3 W7
Cntaect: P neI: Cupertino Business License #W :
- c t— O 2— `t S�
Type of Roof Covering:
Existing: P ved:
Built-Up Roof Built-Up roof
Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes Cl Wood Shakes
Cl Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
ob Description: I
Loy lsTtA r r JCI r0 } Seryl' rA h VPI h00t�
Residential K Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: LJ
02-st of Projec Type of Construction: Occupancy group:
0—;3
Qty. if
A licable Fee ID Fee Description Fee Gro-
u
1 BPERMFEE Bld Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING