03100205 CITY OF CUPERTINO
Emt.Dwc D1vIs1oNPERMIT CON-TRACR�INFORMATIQN -
�I ,
BUILDINGADDRESS: STATEWIDE ROOFING INC PERMIT N003100205
10101 BUBB RD
I} OWNER'S NAME: 5542 MONTEREY RD PERMIT ISSUE DATE
MARCHESE MARY TRUSTEE & ET AL 10 29 2003
NE: 4 0 B 2 S S-8 6 S 0 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
CJ t� (� 0
!00 LICENSEDCONTRACTOR'S DECLARATION
I I hereby affirm that I em licensed under pmvaiom of Chapter 9(commencing Job Description
wish Scctiun](llyl)nf Division Sof Nc Busincas drimfessionscm1a.mderyliccnxis
ash in mu mrtc aB02ffca' REROOF
j 2 License cIµ(� LIt.•If .
3`o Date Gbnlrxlbr T�0 EXISTING BUILT-UP, REPLACE IN KIND/CAPSHEET
MT rs DE ION rO v-Q F
I gent my plans shJI W used as pas m record& y"
:.0
40 Licensed Professional
s 3 OWNER-BUILDER DECLARATION
<F I hereby affirm Nat 1 am exempt from Ne Conuactor's License Law for the
20 following mason.(Section 7117 1,5,Business and Pmressions Code:Any city or county
5 m 6! which require a permit to cosmic,,ahcn impmw,dcmnlish,Or repair any atrbmu2
Prior it)its issuance.also requires(be applicant for such permit to Nc a signed sulsmem
ado that he is licensed Farman,tothe pmvisions(if the ConlractoriLiccnxLaw(Chapter 9 Sq.Ft. Floor Area Valu$i5k469
(commencing wish Section 7000)of Division 7 of the Business and Professions Code)or
3 $
that he u exempt therefrom and Me baso for do alleged exemption.Any violation of
Section 7031.5 by any applicant for a pemnit subjects Ne appiicmuo a civil penalty ofWWWOWnOGCG
not mom Nan five hundred dollars($90(h. Occupancy Type
❑ I,u"net or she property,Or I, employe"ntende with Bred for
their aide compensation.ess Pg�'ITt its:
will do Newark.and the&o caut Contrsnot intended Law edfor aslepply in in Owner or 7+. t } It
and Protusion&Code:The improves
enon.License law does not apply to an owner of EX
e"d Inspections 1
own enywho
yces,provi id thatuchimprovndwho daessuchwork ed imffendthrough his � I I , 1 {I1
ownemployeu,ping or improvement suc iswmentsinomicar intended forele.lL
boweveq the buildingofmovingmxldedid one year of completion,Ne owner-
builder will haw J¢burden of proving Nel W did not Wild or improv for purpose of t1ull
tile.).
❑1,as Owner of Ne property,am exclusively contracting with licensed comomm(s ll)
conswct Ne project(Sec.70".Built.and Professions Code:)The Contractors Li.
cense Law dots not apply to an owner or property who Wilds or improv&Mexon,and
who contracts for such projects with a contractor(&)licensed pursuant o Ne Convector's
License law.
❑I am exempt under Sec. ,B k P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pculty of perjury oro of Ne following declarations:
I have end will maintsin•Certificate of Cement to self-insure for Worker'aCompcn-
etion,u provided for by Section 3700 of Ne Inter Code,far the perfa(mance of Ne
work for which his pcmd,is isueQ
❑1 haw and will maintain Workefs Compensation Insurance,u required by Section
3700 of IJte Labor Code.for Ne performmen of Ne work for which Nis permit I.issued.
My Werrlmr C ns cam and Policy, m fart:
"D.mi �/ igJn;= ll pi?i nut3 8—Opo
CERTIFICATE OF EXEMPTION FROM WORKERS' p
COMPENSATION INSURANCE 7J /�'
(This sectimr need not W completed ifthe parol I.for one hand dL(Slq))
Or kms)
I certify that in the pmrorm ince of Ne work for which this permit is issued.l shall not
employ any person in any manner an as to become subject to the Workers Compenotion
Law..[California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of Inc labor Code.you must
7z forthwith comply with such provisions or this perm it shall be deemed revoked.
Z'y CONSTRUCTION LENDING AGENCY
1 hereby affirm Nat there is mnstme inn lending agency I'nr Me perfuromme,of
Y' the work fur which on,permit I,issued(Su.3W7,Civ.C.)
Under'm Name
3.
3 z Lender's Addmas
Q I certify Nat I,haw mad this application sanden sate Nil the above information is
f•a corms.1 qme m comply with at city and county orimances and stale laws misting to
U abowngcanarecd construction,ad hembyauNorixrepresenutiws of Nis city to came upon Nc
„ 4 gable-mentionedproperly for inspection purposes
(We)agree to save,indemnify and keep harmless the City of Cupenina ag¢insl
fq inconseq judgmentse costsan of this
expenses which may in any slay seem against soiO City &s
7 APPLxgAuecafNERS7rngO5lAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
�7 s ups
LkL10 ✓� Zy Re-roofs
Signature of Applicaem
HAZARDOUS
US M ERIALS DISCLOSURE Type of Roof
Will tlmapplicant of future buildinge.Chaptstoreor handle HealM and
as deRSed by I25 32(s)?rib Municipal Code,Chapter 9.12,and Ne Health and Safety
We Section 25573(¢)?
❑Yam 6+l All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hoverdnu air contaminants m dcfmcd by the Bay Area Air Quality Management
isuict7 all new materials for inspection.
0 Yes �tQ
Ihavemad thehvSecdoo akfl 2553imdZS34 Jcrdersoudthatif Ne Wilding
nlellcalN&SafmyCade,Secoons257(15 25577 anJ23534,1 understand Not iflW Wilding J
docs n t currtn are 4 Net' my mapomihility m amity IM axuPanl or Ne
mgairt m t eenf.ecrdfemeaf9eap •y. S' ate
atureofApplicant O
owns m.mbo lea ascotDam All roof coverin to be Class "B" or better
Community Development Department
Building Division
j City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
qUPEkTINO
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) hi-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: 7,4
Job Site Address: I O W 94J613 R 7
Roofing Company Name: S7 G �� f /�✓ G
A plicant's Signatur Date: 2 S/o3
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO d v Z v Sr
Q REROOF
CUPEkfiNO PERMIT APPLICATION FORM
APN # Date:
Building Address:
��
Own r' Name: Phone#:
Contra t License #: /
.G r0
Contact: Cup rtino Business License #:
Type of Roof Covering:
Existing: Prvsed:
)( Built-Up Roof Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes Cl Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report k
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Jo Descripti
r
Residential ❑ Commerci
Fir ne:1Les- No ❑ Confirmed with Planning De I. if
there are an restrictions: u
Co��oject: Type o Constructio : � Oce ancy oup /
Qh'• ' f/!
App4c4bje 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
'12- 3o/ 1o"-34V �r e 46