04060208 CITY OF CUPERTINO Axr1.; "�"
BUILDING DIVISION PERMIT C0NTRACT0R,INF,9RMATION
BUILDING ADDaFss: CERTIFIED ROOFING CO. PERMIT NO 04060208
218
OWNER'S NAME: PERMIT ISSUE DATE
MARCOS UNDERWOOD CONTINENTAL DR ._.. .nrZ2,; Z2nn4
NE: SANITARY NO. CONTROL NO.
(408) 489-7982
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
LOa LICENSED CONTRACTOR'SDECLARATION Job Description
uF 1 hereby airrm that 1 am lianaed under provisions of Chapter 9(commencing N^``o
Zr:t withS I)of Division 3 of the Busi an Pbefcsm.Codc.and my],cense,.]
pin ten ro tea arrest. "�
License clot �- d C REROOF
n=p Date ARCHITECTS ECr TION // ��[c /
IundcnnnJ my plans shallWuscdupuhiic ranNs 'fVJ�"liN% JUL (o- 2004
3 Lice fessionel 1 BUILDING OW NER-BUILDER DECLARATION p 1B�®B B,�
zi S 1 Wrchy affirm Nal 1 am cat."from the Contracme.License Law for the BU I tl
i o C following mason.(Section 7031.5,Business and Professions Cade:Any city or county
y,o which requires a Permit to construct,alter,impmve,demolish,or repair any structure
Fiy
prior I[) issuance,also requires the applicant ror such Permit o File aligned statement
< that he is licensed pursuant to the provisions or the Commam'sLiause Law(Chapter 9 Sq.Ft. Floor Area Valuation
�H$ (commencing with Section 7")of Division J of she Business and Professions Cade)or
to 9— that he is exempt Ocnfrom and the hesis for the alleged exemption.Any violation of
Section 7071.5 by Ary applicant for a permit subjects be applicant to a civil penalty of 3 ckTIDi3s11J®7fger0 0 Occupancy Type
not mom than fire hundred dollars(SSW).
❑I.u owner of the prepeny,or my employees with wages as their sole compensation.
will do Ne wart.and Ne swctum is not intended oroffered fortslc(Sec.70,14.Business
.it Profauions Calac
c:The Contrtnse or's Licelaw does oat apply to an owner of Required Inspections
property who builds or improv thereon,and who does such work himself or through his
own ampluycas,provided that such improvements Are not intended oranered for We.IL
however,me building or improvement is sold within one year of completion,the Owner
builder will have the burden of proving mat k did not Wild or improve for purpose of
..In L
❑1.As owner of the property,am inclusively contracting with licensed contractors in
construct the Project(Sac.7044.Bnsiam and Profusions Code:)The Contractors U.
cense law dors not apply to an owner of prepeny who builds or improves Iherton,and
who contracts for such pmjects wit a comeactor(s)licensed punuam m the Contractor's
Li ns Law
I am exempt under Sec. B A,P C for this moon
Owner Dan
WORKER'S COMPENSATION DECLARATION
1 hereby Orion under penalty of perjury one of the following declarations:
1 have and will maintain a Cenificam of Consent m self-insure for Workers Compcm
cation,u provided for by Section 37M of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Iruu ..u mquind by Section
37M of me labor Cock,for the performance of the work for which this permit is issued.
:1-1S4
WOrker3 Compensation Insurance canner And Polity number an:
Ca Po'cy Na.:
CERTIFlCATE OF EXEM NFROM WORKERS'
COMPENSATIO INSURANCE
(ITuscction wed not W complcvA if do pamtit is foroahundnddallars(SIM)
or less.)
I certify thal in the performance of the work for which this permit is issued.I shall out
employ any person in any manso comesu 'cltothe Workers compensation
Lawsof Cal' at
Applic t
NOTICE TO APP CANT:If,after making this cmica a of Elcmption,you should
become subjccl in the Worker's Compensation providons of the labor Code.you must
�Z forthwith comply with such provisions or this permit shall be deemed hawked.
ZO CONSTRUCTION LENDING AGENCY
j-. 1 hereby frum mal men is a consuuni[)n lending ageary for the I e furmento of
C 7 she work for which this permit is issued(Sac.3097,Civ.C.)
[[7 Q Lenders Namc
IY Lender:Address
U Q 1 certify mat 1 have read this application and into Net the above information is
B,F' correct.1 agree to comply with all city and county ordinances and sate laws relating to
0Ubuilding construction,and hereby euthorrre representatives of this city to enter upon me
r CCabove-(WA)a re propene for inspectionnifakeep ea. /
Fa (We)greeto cove,indexponandkap harmless the City o(Cupcnit sad City
p) Iiabiliues,judgmenu.costs And expc•v.which may mAny way Accrue against said City
U z in-cAP[)n CANTSTANDS
eUNDEof due Rranting of this Permit. Dale
AND WILL COMPLY WITH ALL NON-POINT Issued by:
!l /
SOUR TI S. !Z_7—0J
/ -'�— Re-roofs
Signature of manUConuacmrDetee e
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant tam or handle hasedous materiel
m defined by the Cupertino Municipal Code,Chapter 9.12,and Bre Health and Safety
[)tic,seNea zss3z(a)q
Yr � All roofs shall be inspected prior to any roofing material being installed.
❑
LWill the applicant or future wilding occupant use equipment or devices which .If a roof is installed without first obtaining an inspection,I agree to remove
t hazardous air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection.
District?
�Ycs }C'No
Ihaverad me1c ScclWnn25rialsnquiab under Chapter6.95irtM Califao �b
nu HcalIh&e betal Calc,Sections 25Yd5.25577 anJ 2553d.l undersand thtirthc Willing E7-z 3 L
does Int emnmly how a tenant,that it is my respmuibility In Owly the occupurt of aw
� hih Ltsscof.CCamaf OccAnawy. Signatu of Applicant Date
c� st
Owner or autho Japem Oeste All roof coverings to be Class"B"or better
Community Development Department
Building Division
{ (J `' City of Cupertino
4 mN 10300 Torre Avenue
OUPCITY OF A I Telephone: (408)777-3228
E IST I I!I® 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 withoutfirst 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: -r-- ZQ la 1/(U S V N��l/KJC�pG�
Job Site Address`s CJ s� V VA26
Roofing Company Name C I/ • T L eGl i �G
A plicant's Signature: !L/L//�o-- Date: —Z3-0y
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO /PERMIT APPLICATION FORM
APN# Date: ^ z 3 - b
Building Address::
( 85o ou e C�
Ow s Name: Phone #:
Gf
05 V1UjeVLU2C2C2
C tractor: hone#: �� Z License#:
v ; �n v L 6 06 6C
ntact: p P one#: q Cupertino Business License#:
�t v I'c/ Ca rpt vv iv dS�7z-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
>2� Asphalt Shingles >d-- Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings oL ❑ Provide I.C.B.O. Report#
XTo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No`L Confirmed with Planning Dept. if
there are anyrestrictions: LJ
Cost of Pro'ect Type of Construction: Occupancy group:
QtY i
A " ble 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
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