03030097 n CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONI'.R `kC�r'COIi RMA'TTON `;
BUILDING ADDRESS: ROOF ROOFING PERMITNO.
OWNER'S NAME: 5577 VASSAM DR PERMIT ISSUE DATE
NH' (408) 265-9270 SANITARY NO. CONTROL NO.
IHITECTMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB0
LICENSED CONMACTOR'S DECLARATION ] bDescription
1 homey affirm that 1 em licensed under provWons of CWo
p ser 9(commencing
mith Section? )of DivWon 3 ofthe Business p Protection,Code.andmy ties=is
mltlb da cck ✓ g-9sb REROOF
i14 License Lie.w .
qr Dau' '= j"\� tomo TSO. COMP. , INSTALL 30 YR. ELLC SHINGLE
Y$q ARCH TECI S DELL ION
1 enund my plans shall be used as public records
.6 Licensed Profcadnnal
OW NER-BUILDER DECLARATION
1 hereby anirm Net 1 1.,Business
s anrom tic Cssion,Co Lken Law for the
O o following reunn.(Session 7031.3.Buds and w.do di Code:Any oily or county
whicht its isu ape rmitrocounsel.alter.Impasu demduh,"mptlr ed twment
pd.miubsuercc.aur mquima movill n f for awhPermit's ale a mens,Lnedauumem
< wntKiali«mwpmiX"d'dill
fDi 031ft 0f[WBuunmllJ«meaw(Cupu9 Sq.FL Floor Area Valuation
$ (commencing wird Serif Divuion3nftbe Budnnand Prrfculona Cnde)w
..
that he b earmpt tertfe balls for the alleged eaneopton.Any NOINon Of
Season 7 nls br.m ar a permit subjats the applicant m a elwl penalty of APN Number Occupancy Type
not mart Nan five hund �(Vw).
Ol,as owner of Neproperty,or my employees with wages u their solo compention, 31633047 . 00
will do the work.nod mcaotcuhe hoot mmended orafrmw foraale(Sec.704+,BusinessRe ulnad Inspections
and Professions Code.The Conuacto Llcenae ns re
Law dans apply m an owner or 305 — FRAME q p
property who builds cr improves themon,a4who does such wurk hi msel f or through his
own employees,provided thatsuch imprommenu are,not mended oro6artd tweak.If. 307 — INSULATION
however,the building or improvement It sold within am you of«mpleton.the owmr-
bulldm will hive the burden of proving that M did not build"Improve for purpose of 601 - ROOF TEAR OFF
tele')' V '' 602 - ROOF PLYWOOD NAIL
the
0 1.u owner of property alve
am exclaly comrantt with II«nsed cmtrwmn to
construct the project(Sec.7044.Business ad Formation,Code:)T1e Coruscate,u- 603 - ROOF BATTENS.
cense Law does not apply in an owner of property who binds grimp,rons Lemon.and, 604 — ROOF IN-PROGRESS
who contracts for such projects with a contractods)licensed p%gi nt tt the Cmtnuoe, �–
License Law. ( ��,,��
❑l am exempt under Sec. P C far ihl�reatr`i`\Owner Dam
WORKER'S COMPPNSATION DECLARATION /SI/
1 hereby afRrm under Penalty of perjury ore of the following dal
If
luve and will mainulnaCeNRwm ofGnnuoselfduurt(e ed omn�IpPeem
worn,u provldhi for mi Salon 3700 of to Labor Code,(m th<per(orma (me \`_–/' ✓R //"
work for which ed or by
R issued.
0 1 have and will maintain Wurbefs Compensation Imuran«,u required by Session
3700 of the Labor Code.for the Performance of me wort fur which this permit is isaued.
My Worlecel{Co penton Insurance units and Policy number sure:
Cartley , 7 t.es�� Policy NoJD
CERTIFICATED EXEMPTION ORKERS'
COMPENSATIONINSUR NCE
Ohlss timnwdmikcompleudifther4mit lsformchundred $1
"less.) `C
-- 1«ni(Y Net In the performanceof the wort for which 11,164-91 ' nm
employany person in any manmrm as to become subjeci le to Wo ensu jgaw an
Laura of Gll(amle.Dau %, u_a ht
Applicant
NOTICE 7O APPLICANT:If,after making this Cenifi«te f Ex- cp.j u aw,
become suhjat to N Wngl4r's Campenition pidissins of fie LOW' �pum
zO forthwith«m such,pmrltlinoaoF1hispeim0ahei\adcenhod a.
CONSpRQ ION I',BfiDINo AOBfjCYU
4 r�i Ibero III tmert aW nlending agency for me Performa"e of
the work for w crotid'I ser S c. 7,Civ.C.) i
Y)Q lender's Name
=z Lenders Address
U0 I cenlfy th cad this application and some that the above Information Is
y cornett 1 gree to c ply withall city and county ordinances and sum law existing to
0 building constructan,and hereby authorise mpmsentstes of this city in enter upo the
4 abeve-mumned Property fm inspection pulp=,
(We)agree m an.indemnify and Imep be rmleu the City of Cupertino.0.1
.~.rn Iiebllltu,judgments,aasuandeap:nsea which ayin anywayscer«agaiul Wd0ly
J7 FFII in consequence of the granting of this permit.
APPLICANT ND COMP•L,Y jTH ALL NO -POINT Issued fs9 Date
SOURCE U `Iy—. a�
Sim r / I Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or ruture building uccupantstore"handle husrelons material
u defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
aria.Sector 2553:(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes fd No
WIII the applicant or futum building occupant Lite equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hawrdous air ammminame u defined by the Bay Am Air Quality Management all new materials for inspectio .
ndct7
0Yea Nu
Ih vcmWthehauNnusmaurlmlzmquimmcnuunder ,Chapor6.95ofthe Callfar- _
ole 13ce1mI SarclYCo@,SmllonslSN)3,15533 wu15534.1 unMtsund thLLifsaw Wilding
does not currently hove n mnant,Net It la my re nsWilly u nod ooe t of me –
u
ones which to mel armor gNcerdficara Signature ofApplic Date
� e3
Owner m aulhatrcd agent Dam All roof coverings to be Class"B"or better
Community Development Department
Building Division i
City of Cupertino
" 10300 Torre Avenue
CITY OF Telephone:-(408)777-3228
C PEkT]NO 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 arev
required:
1) Pre-inspection and/or tear off approval. 4
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 Y4"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
dppolicy
�onn re-roofing.
Homeowner's
Homeowner's Name: -�r 1 `—� `-"^ w ►7�']
Job Site Address: Ay`t30
Roofing Company Name: �Qoo�'
(�ADate: C>- t�n
eel
Building Official
Revised 1/30/03
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