03090033 CITY OF CUPEWFINO
BUILDING DIVISIONPERMIT ,' CONTRACTOR INFORMATION:',s
BmLDINGADDRESS: CAL/WEST ROOFING COMPANY PEaM""03090033
NER'S NAME: 3508 CUESTA COURT I'ERMR LSSUE DATE
TONE: SANITARY C NTR04 N0.
(408) 531-1961
ARCHITECTIENGINBER: BUILDING PERMIT INFO
f\ BO ELECT PLO MO
+ori
LICENSED CONTRACTORS DECLARATION JoblDesbli •on
I hereby efGrm that 1 em IittocJ under provisionsof Chapter 9(commencing (p
with Section VgggofDi,hkm Sof the Businev�rmfc,wor,Cndc,and my license is ✓ / '
' in full co iterr
.Mz ueen l _ " 39 _ue.g RE-ROOF-REMOV XISTrI-NG _
q Dam 'e ctommar �oiw REPLACE W/50 YF2
ARCH] CTS DEATION I�''dG'7711``fES
f TEV r/
aderstanJ my plans shall M used to public records
6
C Licensed Professional
3 OWNER-BUILDER DECLARATION
<f I hereby alarm shat 1 1. exempt from The Contractors License taw for the
5 pO followingmoon. .it(Section7onstr Business and Pto(demols Code:Any tiny or county
$� which require a 1.it to construct,,trot,improve,demolish,or repair any xwcsum
prior.,its isarcnec.also requires the applicant for such permit to Glc a signed statement Sq.Ft. Floor Area &a/'�0 the,he is licensed purauanuo the provisions of the Convectors License law(Chapter9 VaIU
dt- (commencing with Section 7")of Division 3 of the Business and Profcaioo Cndc)or
y $ that he i exempt therefrom and the bola fm the aItc,.d exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penally of 3 i �yy�yel'OO Occupancy Type....
not more than five hundred dollars($500). -" ---- "
I,as owner of lie pmpary,or my cmployces with cages as their able compensation,
will do the write,and Ne structure is not intended as offered nor We(Scc.7004,Busixa
and Pmfealom Code:The Cenuacto .Lt..Law Com nes apply to an owner of Required Inspections
property who builds or improves thereon,and who docsioch work himselfor through his 305 - FRAME
own employees,provided that such improvements are nor intended oreffered for ale.If. 307 — INSULATIONhowever,the building or improvement is sold within one yea of completion.the owner
builder will have this burden of proving that le did not Wild or improve for purpose of 601 - ROOF TEAR OFF
ale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
construct the project(Sec.7044,Business and Professions Code)The Convector's Li. 603 ROOF BATTENS .
cense law docs not apply in an owner of property who Wilds or improve themes,and 604 - ROOF IN-PROGRESS
who contracts for such pajecu with a convactor(s)licensed pursuant m the Conmetors
License taw.
❑1 am exempt under Sec. .B At P C for this moon
car Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury em of the following declantians: -
1 have and will national a CeniBcam of Consent m self-Imam for Worker',Compcn-
order,u provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
01,1 have and will maintain Worker's Compensation lomme.a required by Section
3700 of Ne labor Codc,for the performance of the work for which this permit is laved.
M orkers Compenaadot lmunma carrier• cy number am: ,
'car:<TA77G NJJ cY No.: S
CERTIF�OF PXEMP170N FROM WOR
COMPENSATION INSURANCE
(Tho section need not w completed If be Permit Is fm am hundred dollam(510tB
or leas.)
1 certify that in the perfnrmamu of the work for which this permit H Banat,l shall not
employ any Nixon in any manner an as to hecane subject o the Worker Compeoalon
Laws of California-Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cent fees,of Exemption,you should
become subject to the Worker's Compensation mvisions of the Labor Codc,you must
�O forthwith comply wits such provisions or this permit hall W decmct revoked.
y Vg CONSTRUCTION LENDING AGENCY
I hereby affnm Nu there is a construction lending agency Inn the per(ormamm of
]5? the work fur which thin permit a iouctl(Sec.3097,Civ.C.)
Iandcr's Name
z Lender'sAcidmas
J 0 I ttnee that I have mad this city
and court and sum that the salve information hissing is
comet.1 agree to comply with all city and county ordinances and cute laws r upon
a
a Ww-gconswctfor and hereby amhorimrpoesenunives of this city to enter upon the
0. ehovcmenri alto surly for indmnify an keephi.
(We)deme to ave,Indemnify entl keep harmlw the City of Cupertino and
/
-'y liebililie,judgmenu,cam and opcnses which may in any stray accrue against aid City
L) in consequence of the granting of this permit.
r-t APPLICANT UND ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
•
SOU CE RE LATT .-. �
_ Re-roofs
Si mui2vf Applagnt/Comracter Dam
HAZARDOUS M�Tum ERIALS DISCLOSURE Type of Roof
Will the applies.,irhousm bui ng tacupintsmarmot,handoas mumrial
a refined by the Cupertino Mandel,I Code,Cbapur 9.12,and the Health ad Safety
Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant or future building occupani use equipment ordevims which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazamnus air wmominanu a coined by the Bay Arca Air Om flly Management all new materials for inspection.
District?
[3 Yes ?Nu
1 hove mad the hammrms materials requirements under Chapter 6.95 of the Califon
t ma Hcalthgs Safety CotlC,Sector 25505,25533 and25534.1 understand that Bribe Wilding O3
` docs not cunently h that it is my mdpoaihi)ity m nodl'y tM mcupml of the _
rcy 'rcmc Ic m bcmnp wiaaanccrir.ce 'n„mrirOccupancy. IgnatureofApplicant D
O
0 r,dfirchmued agent m All roof coverings to be Class "B” or better
1
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEI�TINO
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. t
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: 1110 !L! "/ 7 z Ra
Job Site Address: 2- 1 3 C- -SO-el 4e,, S 4+
Roofing Company Name: C•T
A plicant s Signature — Date: 9/4/�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF C/)30 ��d33
�CUPEI�TINO PERMIT APPLICATION FO
APN# Date:
1 � O
Building Address:
3
Owner's
Contractor: Yhone#: License#:
CAI C!f o _T383h
Contact: Phone#: Cupertino Busine s License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �9' Asphalt Shingles
_a—Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Cl 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:
µQvG
Residential mmerctal ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. '
there are any restrictions: LJ
Cost of Projec • Type of Co n: Occupancy group:
T5-0v s.•,. i� <
Qty. if
A Lica 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