03070164 CITY OF CUPERTINO vCF�*O. ,NxT d. CRznT,Ne
rx• ,jAFa .. „�
TBUILDING DIVISION PERMIT RMAT-1
LONG ADDRESS; YORKSHIRE ROOFING PERMIT"'03070164
OWNER'S NAME: 7275 NATIONAL DRIVE PERMIT ISSUE DATE
\-
ONE: (925) 484-1900 SANITARY NO. CONTROL NO.
ARCHITECT,ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
41OZp LICENSED CONTRACTOR'S DECLARATION Job Description
1 barony aRum that 1 em I Wenscd under p vi4om of Chapter 9(commencing' P
SZ with Sceeion]OfK�tof�iviaion3of due Business r ea4ons GOdC.and mylieenu is
�q_ Li�eni¢Cles rte ernAC_ 9 Lm.« REROOF
^ Dam J Contncm"r
ARCHITECTS ]ON 1LK0� AUG 1
U `I undcmend my Plain ahml w used es PUMm records 2 2003
zi�its to Licensed Professional BUILDING p
q�O� OWNER-BUILDER DECLARATION ILDfdp
�G
<x 1 botchy affirm that 1 em eacmPL from fie Contractor's License Law for the ®IP
o D following rossnn.(Seem.]03 1.5,Business and Professions Cole:Any city Or county
$ which requires a Permit to cnnatrlmt,alter,impmvc,demolish,m mPair any mm UM 1417100
FZ j, prior to its Issuance,also rtynlRsthe applicant for such Permit to file a signed amement
20 that he is licensed pursuant e0 the provisions of the Contrsclur's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
ad$� (commencing with Section 7000)of Division 3 of the Business and Prufuslo,u CMe)or
^ that he Is exempt therefrom and the thesis for the alleged exemption.Any violeuon of
Section 7871.5 by any applicant for a Permit subjects the applicant to a civil Penally of APN Number Occupancy Type
not mom than five hundred dollen(g300).
❑I,ae owner of the property,or or,cmploya.with wages as their ante compensation,
will do the wan.Rod meawto.unorimandedorartclwrorRare(Sec.7Ba.,Business 305 — Re wired Inspections
and Professions Cade:The Contractor's License Law don not apply to an owner of P
property whobullds or improves thereon,and who does such work limselforurrough his 307 - INSULAT ON
own employes.prodded that uch improvements are not intended or offeree forme.If, 6O1 — ROOF TEAR OFF
however,the building or Improvement Is sold within an year of completion,Ne owner
builder will nave dte burden of proving that he did not wild or improve for purpose of 602 — ROOF PLYWOOD NAIL
mea.
❑I.as owner of the property,am exclusively contracting with licensed monarchy to 603 - ROOF BATTENS
coeswct the project(W.7044.Business ane Predressioes Code:)The Contractor's Li. 604 — ROOF IN-PROGRESS
cense law docs not apply m on Owner or property who wilds or improves Merton.and
who convects far such projects with a eomnctoot)licensed pursuant to the Conuamr'a
License law.
O l am nempt under See ,B k P C for this recon
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby aRtm under penalty of perjury oro or the following dslaretionc
in haveand will maintain a Cerdficum of Conocnt m self-inaum far .Worker'sComiscm
lien,as provided for by Section 37M of the Labor Code,for the Performance of the
work for which this permit is issued.
rl 1 have and will maintain Weaker's Compensmino Insurance,as required by Section
37M of the Laser Code.for the performance of the work forwhich Nis permit is issued.
M Worker's Compensation lnsunnee:artier end Policynumwram: 'g
m Ef7NTG J?N/�Poliry No.
E IFICATEOFEKEMPTI'NFR WORKERS
COMPENSATION INSORAfjgll
(This section need not wmmphred if the Permit is fortme hundred dollen(SIM)
or loss.)
1 unify that in the performance of Ne work for which this Permit u issued,144411 nm
employ any Person in any manner an as In wcomc subjwuo the Workers'Compensation
laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CcniOcuc of Eacmption,you ahauW
become anhjnl to the Worker's Compcesseion provisions of the labor Code,you must
.J O foMwith comply with such Provisions at this permit shall w deemed revoked.
z"'v CONSTRUCTION LENDING AGENCY
N
(•w l herebyoldwh thi that them its construction lending agency for performance of
a> thcwurk for which this permit is issued(Boc.7(191 Co,Civ.C.)
lLl Q lander.Name
� z lender'sAddress
O Q 1 eeniry,0.11 have rod this application and cute dust the above u(ommiun is
LL
F^ correct.1 agree to comply with all city and county ordinancesnd sine law mining to
C)C) building construction,and hereby suthorim rcprescnmives or this city to enter upon the
W ahovc W�17
(W e)age properly for...try on pugases.
Ly. (we) sed m save.or holy try ane keep harmless the City Of Cupertino against
Ly h
liabilities,judgments,costs and expenses which may In any way stere:against said City
C.)Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON. 01 Issued by: Date
SOURC,REGULATIONS. ✓�/V�
Re-roofs
tgnuurc of AppliceMComnclor 07-71'611 ate
HAZARDOUS MATERIALS DISCLOSURE 1 Type of Roof
Will the applicant m future building attupsm sore or handl:husNous material
az defined by the Cupertino Municipal,Codc,Chapter 9.12,and the Health and Safety
cadc,sacdon1ss71(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes )§gW
Will the applicant or future vending occupant are equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haxandous air contaminants es defined by the Bay Area Air Quality Management
xlriel] all new materials for inspection.
❑Yes No
r Ihvvowmad
cAmthe
tunbrcthommdsmaterials
ismsouqanuZlcemmncfnalsCunder
cCemhapmOrcd.95 of
3Of NCali for.
annixHeslh C.,.Sd . oedi
JasOteurtenllyM1owatenethatItismyesponsibilitytonn �
rcydmtoptorthe
,
ofn
c , //��/ Signature of Applicant
Date
Owner or uhmind agent �
_ Cia
Dom' All roof coverings to be Class "B" or better
07/21/03 09:23 '8'4087773993 CITY CUPERTINO 2003/003
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CI Telephone: (408)777-3228
CU PEkTINO _ Fax: (408)777-3333
Building Department
Subject: Re roofing policy for the City of Cupertino
1. Prior to sermit issuance,you must agree to comply with 1997 UBC Standards
and ma afacturers specifications on re-roofing,
2. New ro :coverings shall not-be applied without first obtaining all inspection
and wri :en approval from the building inspector. A final inspection and
approve shall be obtained from the building inspector when the re-roofing
is comp .!ted.
3. All roof shall be inspected prior to any roofing installation.
4. To recei e a final sign off from the City, the following steps are
require!
1) Pre-i spection and/or tear off approval.
2) In-pi egress inspection approval.
3) Fina nspection approval.
iis a) Sl lrk arrester installation.
5. If plywi )d is installed, a plywood nail inspection is required.
6. Any roc ing which is applied without first obtaining an inspection,
will req i ire the removal of all new material down to the sheathing,
so a prc er City inspection can be performed.
IMPORTANT:
1. Flat roo i must have a minimum of 1/4 " per foot slope and demonstrate
that the t is no ponding.
2. An I.C.: O.report is required to be on the job site at the time on inspection.
I understand a id will comply with the above stated policy on re-roofing.
Homeowner's ame: �S A-T—
job Site Addre: �(Jlo l i Z_ �x—
Roofing Comp Name:
Applicant's Si€ a
Greg eel
Building Offici l
Revised 1/30/03
PAn1ed an Recycled Paper
`07/21/05 09:22 V4087779999 CITY CUPERTINO 16001/009
CITY OF CUPERTINO 3 7 ,) 16
REROOF
CUPER iNO PERMIT APPLICATION FORM
APN# � � � Date? D�
Building Address:
Owner's e: i L ® Phone#
Contractor. ' P ne#: License# 7
U(ot707-) 3
C t: 0 Phone#: Cupertino Business License#:
c
Type of Roof Covering:
Eiristing: Proposed:
O Built-Up Roof 0 Built-Up roof
❑ 4sphalt Shingl C1 Asphalt Shingles
-� Wood Shakes O Wood Shakes
0 Wood Shingles O Wood Shingles
0 Other(Specify: Other(Specify) l�) ,S kt7+
Number of exisfing werings 0 Provide I.C.B.O.ReportS .C2i L4
UK To be Remover o Provide Mfgr,Installation Specs.
I Have Read, Under, and and Will Comply With Cu 'no's Tear Off Polic
•
Job Des x � S/fA7
Residential Commercial ❑
Fire Zone: Yes [ No ❑ Confirmed with Planningll�ept. if
there are any restrictions: ❑
Cot f Pro'c: Typ of Constru 'on: Occupancy group:
Qty.
Applfc4ble Fee ID Fee Description' Fee Group
Bl I-R VUME Bldg Permit Fees BUILDING
B) 14ERGY Energy BUILDING
B! IUSMICRE Seismic Fee Res BUILDING
B: USM1COM Seismic Commercial BUILDING
Bl I.ANCHK Plan Check Fee BUILDING
Bl SLIC Business License BUM13ING