03070088 CITY OF CUPERTINO '
BUILDING DIVISION PERMIT � CONTRACTOR�INFOI2MATION ;'
BUILDING ADDRESS: FRAGUGLIA ROOFING PERMITND.03070088
a OWNER'S NAME: P O BOX 1435 PERMIT ISSUE DATE
NE' (408) 257-7663 SANITARY NO. 9 CONTROLNO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
0 1 hereby affirm that I am licensed under provisions or Chapter 9(commencing
ezS with Sauon7M)).f Div Won Sof the Business and Profculom Code.and my lieem^is
❑', m full tome o^Oforee effe 6 Z Z Z / REROOF IPO mil A�+a t�
Y�Z Llcenu Cl LIC.N .v LrvM
p Dam Convector
ARCHnECTS DECLARATIW V
p p ']
I understand my plans shall W used u public records J U L 2 9 ZOOS
.c� Licensed Professional
5 OWNER-BUILDER DECLARATION
i p I hereby affirm that I am exempt from the Contractors License Law for the BUILDING
1 I�A 1'1�pT�1
OO O following reason,(Salon]1013,Business and Professions Conic:Any city(IT county LLJ g V G
5 a which requires a Permit in construct,almr,improve,demolish,or repair any structure
Zi prior m its issuance,also requires the applicam for such permit to rile a signed statement
< that he is licensed pursuant to the previsions oflheContractor*&License Law(Chapter 9 Sq. Ft.Floor Area Valuation
$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)er
that he ts exempt therefrom and are bum for the alleged exemption.Any violation of 36921008 . 00
Section 70313 by any applicant for a Permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not moo then Eve hundred dollars(5300).
❑Lasowncrofthc property.mmy employees with wages ulheirmlecompenatlon.
will do the work and One structure is not intended or ofcmd I...I.(Sm.]061,Business — FFUIME
anProlamin Code:The Conuutor's Limnse Law docs not apply m 99 an owner of 3 0 7 — INSULAT 1 ONd Inspections
property who builds or improve hemon,and who does such work himself or through his
own employess,provided that such improvements are not intended orofemd for sale.If, 601 — ROOF TEAR OFF
however,the building or improvement Is sold within one year of completion,the owner.
builder will have dm burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
ale')' 603 - ROOF BATTENS
❑1.as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.70/N,Business and Professions Code:)no Contractors Ll. 604 — ROOF IN-PROGRESS
cone Law does nm apply 1^an no,of property who Wilds or Improve,thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to he Contractor's
License Law.
0 lam emmpt under Sec. .B&P C fm thlsmoon
owmer Data
WORKER'S COMPENSATION DECLARATION
1 hereby effum under pcultY of perjury ore Of the following declarations:
have and will maintain eCenifcem of Cnnuu
no u14m
1nre for Workers Compcn•
erten,u provided for by Seniors 7700 of the labor Code,for the performance of the
work for which this permit is Wood.
ave and will maintain Worker's Compensation Insurance,u required by Section
3 of the labor Code,for the pedommue.of he work for which this permit la issued.
MWor aC mpensdonlnlunrrier and Policy number am:
I
Cartier. arts✓ ce caPolicy Na3l3-0L
CEID IFICATE OF MEM MON FROM WORKERS100r-17
COMPENSATION INSURANCE
Tfltlsuetim reed ret bccnmPlcwd if the pemtit is fm one hundreddollaa(5100)
nr leu.)
I cenlfy that in It.perfmnance of the work fm which this permit is issued.I shall not
employ any person in any manor an as to became subject to the Workers Compentetlon
Law,of California.Data
Applicant
NOTICE TO APPLICANT:If.afmr asking this Cenibeue of Exemption,you should
become subject to the Worker's Compensation provisions of the Lnhor Code,you must
0 z forthwith comply with such Provisions or this Permit shall be doomed revoked.
y OCONSTRUCTION LENDING AGENCY
[•+� I hereby affirm that here is commotion lending agency for he performamcc of
I3: he work for which the permit u issued(Sec.3097,Civ,C.)
W� Q lender's Name
z lender's Address
U C) I certify that 1 have ed his application end sum that the above information Is
OP comecL I agree to comply with all city a
d county ordinances and atom laws elating to `
U building construction.and hereby authorise minnuenutivcs of this city to cnmr upon the
W aM1ove-mcntioncd property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
r/f liabilities,jedgmt^u.mots odea,.which may In any way aceec aNrul to City
I;)7 in consequence of ranting of this Permit.
F7 APPLICANT AND LL COMPLY WITji AL ,/ POINT Issued by:3 Date
r)
SOURCE iy/a !
t/ Re-roofs
rc oHAZARDOUS
AZARf ApplinDam
HAZARDOO US MATERIALS DISCLOSURE Type of Roof
Will he applicam or fretum building Occupant store or handle husrdou.ef nal
u defined by the Cupertino Municipal Codc.Chspmr 9.13,and the Health Safety
Code.Scene.33533(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes Is S;
u
Will see applicant or rot bonding o cupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haafdous air contaminants rood by he Bay Arca Air Quality Management all new materials fol 'nspection.
vict1
❑Yes
on
Ihrvcreadthehaard., aerials requircmentsundc,Chapmr6.95 club.Califon
Tia Health&SefctyC Stttions333113.3333J ad233M.1 un@rstsM thwi(ha(wilding
,.a not tune a ens..that It u my rc,pmuihiliuy to notify ac Pant of the
reyuircmcn wiavencomaa Re 'cy!1
T R gnature of Applicant Date
authorised agent Dae I All roof coverings to be Class "B"or better
CITY OF CUPERTINO
REROOF
CUPEf�TINO PERMIT APPLICATION FORM
APN# f Date:
Building Address: /0
55 f �...8 vl✓tr
Owner's Name:
/4&S a (.t c, Sic c-1/"A c
Contractor: Phone#: License#:
F,AH (Jh- Gtia
Contact: Vone#: Cupertino Business License#:
nto � Yx2r - oa
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
ood Shakes ❑ Wood Shakes
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:
Job Description c� O �tT f,ti5AI
ResidentiaN Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
ther e an re ictions: LJ
Cost of Pro' ct: ' 2,-1-00 T f s ction: � cup y u : SF�
Qty. if
Applib'lv) 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
.� 22 `f72
2P e, 30
1
Community Development Department
Building Division
' 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 with the above stated policy on re-roofing.
Homeowner's Name:: 414 5;C1 Y u k, r 5 g n L-1
Job Site Address: I � �/�U^ce�` 1
1
Roofing Company Name:
A plicanYs Signature: Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper