03070180 r CITY OF CUPERTINO
BUILDING DIVISION PERMIT .CONTRACTQR INFpRMATION `z
BUILDING ADDRESS: KEVIN SULLIVAN ROOFING ""NO03070180
OWNER'S NAME: 1696 VALLEY OAKS DR. PERMIT IS!i13a DATE
ONE: SANITARY 0. CONTROL NO.
(408) 842-1057
ARCHITEC(ENGINEER: BUILDING PERMIT INFOEC
BLDG ELT PLUMB MECH
0 0 0 0
nor, LICENSED CONTRACTOR'S DECLARATION ]obDescription
F I herby affirm that I am lian¢d under provisions or Chapter 9(commencing
with Sectio 7,M fDivid'n 3 ofthe Bua
uainand Pio zshns Code,md my license is
in full forte freer.
iqz Ltemmelma ue.g TEAR. OFF WOOD SHAKES
vi D RCHOFC SDECLA to INSTALL 7/16" OSB & 30 LB. FELTFUNALEU
lundc and myplauahallbeused"public recarda 30 YR. DIMENSIONAL SHINGLES
6" 2003
C
Licensed Pmfcuinnel AUGAU G
OWNER-BUILDER DECLARATION
0 I hereby.(Sorter that 1 1. amropt(rum the ramdnctor's License city
o for the
XDo whfollnwinga emittoco1.5, t.aliessand prove, ssinmh,inreairAny ityerrcountn BUILDING
$ poochitsissuance,
requires a permit to enneweL ellen imfron,demolish,err repair ed statement BUILDING
Vl
tpoorhat Ire its censed e.atonalLD to muhe applinnt for such Contractor',
ice se Law(Chapter
�y�xx< tham WislicenseJpurtuantmthefmvicinm of the Cnnmcmr's License law(Chapnr9 Sq. Ft. Floor Area Valuation
e�F� (commencing with Section 7")of Division 3 of the Business and Professions Code)or
e R g that he is eanmpl therefrom and the hu4 for On alleged eumption.Any vimauon of
Section 7031.5 by any applicant fon permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mon than fere hundred dollars(5500).
❑I,mowner of the prupeny,mmy employee with wguutheir sok rompenmtion, 32644038 . 00
will do On wak and thestncSure u not intended or offend fnr.1.(Sec.IDN,Business Required Inspections
ted Profession Code:The CanuactoYs License Law dots not apply Su e an owner of q P
propsny who builds or improves tha rm m.and who Oaf such work himself or through his
own employes,provided that such improvements an,not intended or offered forule.If, 305 — FRAME
however,the building or improvement is sold within one year of completion,the owner-
builder .will haw the burden of pmving that be did not Wild or improve for purpose of 307 - INSULATION
tele.).
❑1,as owner of the property,am exclusively contracting with licensed contractor,to 601 - ROOF TEAR OFF
construct the project(Sec.7Ba.Business and Professions Cade:)The Consumers Li 602 — ROOF PLYWOOD. NAIL
cense Law dues not apply to an maer or property who Wild.or Improves Marano. it 603 - ROOF BATTENS
who contracts for such projects with Contractor'soos)licensed pursuant to the Contractor's
License Law. 604 - ROOF IN-PROGRESS
0 1 am exempt under Sec. .B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby aRmm under family of perjury one of the following declarations:
I haw and will maintain a Certifies¢ofCmuma to selFlmum for Workers Comper.
moon,u pmvidc0 for by Station 7700 of the IaWr Code,far Ne pertormma of the
woo for which this permit is issued.
❑1 ban and will maintain Workers Compensation Insurance,u required by Section
3700 of the Labor Cade.for the performance of the work for which this permit is issued.
My Worker's Cnm�en I Ineuroom artier and Policy number rt:
d r. S-!dti-(C� A�� policyNO
U+�7^2'—r$D—D3
CERTIFICATE OF EXEMPTION WOAFRKERS'
COMPENSATION INSURANCE
(7thh aatlan iced our W completed if the permit Isfm one hundred dollars(51(¢1)
,it Ins.)
I cedify that In the performance of On work for which this Permit is issued.I shall not
employ any penin in any manner an u m become subject to the Workeri Compenutima
Laws of Caliromia.Data
Applicant
NOTICE TO APPLICANT:Ir.after making this Ccr i0cate of Exemption,you should
become subject to the Workers Compcustion provisions of the Labor Cade,you must
.JZ forthwith comply with Such previsions or Nis permlt&hill be deemed ranked.
zO CONSTRUCTION LENDING AGENCY
Iherchy Mon lhar Neroi a construction lending agency for Ne performance of
ai the work for which this permit is issued(Sec.3(P77,Civ,Cd
WQ Leader',Name
R. z Lender's Addreas
U O 1 cenify Nat 1 have reed this application and suss that the soon Information is
lT. P correct,I agate to comply with all city and county ordinances and sure laws.],ar t to
pU building construction,and hereby mahorin rcpresenutins of this city to enter upon the
W above.mentioned properly for inspection putpoxs.
W (We)agate ro sew.indemnify and keep homeless the City of Cupertino against
y liabilities,judgmcmu,costs and expeues which may in any way accrue against mid City
UZ incomcguermcofdmgremingof h*..,.it.
APPLICANT UNDERST WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE VGVLAnON
7 Z316 3 Re-roofs
etumof man COr1n ar bar.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant stare or handle hmsm ous material
as darned by the Cupertino Municipal.Code,Chapter 9.13,and the Health and Safely
Code,Smith.25532(07 All roofs shall be inspected prior to any roofing material being installed.
yetWm lbe app icanl err metre 'ld ng on.pant a s agwpmem or devices which If a roof is installed without.first obtaining an inspection,I agree to remove
mol huurdnus air cnnmminanu u Encd by the Bay Arca Air Quality Managcmcm all new materials for inspection.
Districl7
C]Yca
Ihavcnml Ce .0 msm 505.25uls qui 2554.1e Chapter 6.95 ifthe Celdinn
iias not c&Salctybana mount,
7sm135534.I to natty to occucm off
fres not currently hen a mnanL Nn it u my respomibiliry w nntifY 1W oecupant of Ne
onto mchmu Ter prior 1.MammalsCcnifcauofOcc/uyy''^^c% Signature of Applicant Date
wnm oranhu inda� 7All roof coverings to be Class "B"or better
Community Development Department
f+ Building Division
iF l 'r City of Cupertino
`l 10300 Torre Avenue
CITY 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) ht-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 Nanzo
Job Site Address: i_/0i 3��4,Jg If V2
Roofing Company NaOf
��• � (y�
A plicant s Signature: �3
7
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
D �D-7 0/30
CITY OF CUPERTINO
40 REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# - � — Date:
23�d3
Building Address:
(7Sl (�AS7rlE 4V&.
Owner's Name: Ph o e#:
Contractor: Phone#: License#:
i� E. S w.a� /�0>4,��SER✓,cEs Coo -roS7 80374r
ontact: Phone#: Cupertino Business License#:
tr/fu u�✓✓ 2_-taS"�7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ ¢sphalt Shingles N1,/Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings _�_ ❑ Provide I.C.B.O.Report#
p/`fo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: �� 30 �• �hktFrt fcOwAf.
F¢ I.JOtaa. bW4153 -7,15MLt- ~716 65,& f 30(6. F-&r.aio
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with ning- a t. if
there are anx estrictions:
Qost of Project: Type of Construction:" Occupancy rou Qty.lif-
Appricable 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
�a
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