03090044 CITY OF CUPERTINO
Bu1Lo1Nc DIVISION PERMIT �CONr §Tf', R�NFORMATION
BUILDING ADDRESS: AMCO TRU-TEMP PERMITNO,03090044
a NER'S NAME: 161 CENTRAL AVE PERMIT 15.911E DATE
NE' 4082934313 SANITARY NO. CONTROL NO.
ARCH=1ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3G0 LICENSED CONTRACT'OR'S DECLARATION
I I hereby effort that 1 am licensed under provisions of Chapter 9(commencing Job Description
with Secti ] ))of Division Sol Ne BmineavaW,Professions Code.and my license is
.n„ mrwl mnfd er t. ✓ TEAR OFF (1) NON FIRE RATED SHAKE ROOF, INSTALL
i 9 Z Litt ass Lic.g
Dam cantemor SOLID SHEATHING THEN INSTALL ELK 30 YR COMP
RC LTSD RATION
f tient nJ my enashall M uud as public records I
e0 Licensed Pnmfcuionel ■ a'NALED
OWNER-BUILDER DECLARATION
COY I benhy.(Seco that 11, exempt from dee Caston oe License Law roe the
00 (allowwhichingmas n.APer Permit
71arntr Business and ve dermili Co dc:Any city or manly O Q 3�g
COO
� which requires a Permit re cothe alcor.impose,demolish, fl mash ed structure OCT 1 LOOv1
-4�, pnomiucensed issuance.also requires pursuant tohe lbe isioreani for such permit to Ncae signedstatement<
that heercial,withSection7")ofvisiooanofthenuei....ttns Uw(Chap¢r9 Sq.Ft.Floor Area Valuat(coi 9865
'1$ that ha s exam with Section7")and of basis for que al Business and exemption.
vi laaak)or Bunni f
that io u exempt any applicant
li and or bun far the subjects
the soman to Any it penalty
of
Section ID71.3 by airy red dam far a permit tubjecu the applicant to a civil pemlty of 3 6919$OWYEr 0 0 ecupancy Type
not mart dun five hundred dollen($500). --
D I.a owner of the property,or my employ=with wages as their sate compensation,
will do Ne work,and the structure is not Intended or offend forsalc(Sec.7W,Business Required Inspections
and Profadou ns Code:The Characters License Law does not Apply to an owner of 305 — FRAME q p
propenywW Wwts builds or improihn
een,and who does such work himself orthrough his
own employ=,provided dot such improvements art not amended o offered for sek.if. 307 — INSULATION
hwewr,the building or improvement is sold within oro year of completion,the owner.
builder will have de burden of proving that he did not Wild or improve(or purpose of 601 - ROOF TEAR OFF
ole.).
D 1,as owner of the property,am exclusively contracting with licensed examacton to 602 - ROOF PLYWOOD NAIL
mnsovct the project(Sec.70M,Business and Potassium count The Conracmes Li- 603 — ROOF BATTENS
cera Law does at to an owner ofporman,who WBdser imVrower ft...and 604 — ROOF IN—PROGRESS
who contracts for such projects witha eonnsctor(s)licensed pursuant to the Covuacmrs
License Law.
❑1 sus exempt under Sea ,B k P C for this mason
mer Dam
- WORKER'S COMPENSATION DECLARATION
1 thereby of mer ends,pealry of Perjury arc of dte following des'lantimu:
I have and will maintain a Certificate ofConent to sal6inan for Wor use,Compcn-
Milen,as provided for by Section 37M of the Labor Cade.for the performance or tbe
work for which this permit is issued.
D 1 have and will maintain Worker's Compensation Insurance.as required by Section
370D of the Labor Code.for the Performance of the work for which Nis permit is iasoed.
My Workers CCurrismerudi n Insunrc��e c�art�iy)and Policy number am
Cerra r c7l rte 1 C4 F't/x[�sY Policy o.: A2 1
CERTIFICATE OF EXEMPTION WORKERS' '
COMPENSATION IN ANCE
(Thnuctim need oat Mcompleed iftbe permit Is fmooe hundieddnllan(SIM)
or mss)
I ciniry that in the pei fnrmence of dm work for which Nis permit is isaucd,I shall not
employ any parson in any manner an as in become subjecuo tbe Workers'Compensation
Laws of California,Dam
Applicant
NOTICE TO APPLICANT:If,after making Nis Conincam of Exemption,you should
become subject to be Workeri Compensation provisions of the Lahm CMA,you mars,
'z rhMwith comply with such provisions or mu Permit a hall W decmod mwkM.
Z O CONSIRUCfION LENDING AGENCY
1 hemhy afnnn that there is construction lending agency for the performance of
the work for which this permit is iuucd(Sec.3097,Civ.C.)
Q Lender'sName
Z 1<mdsri Addm a
I
J 0 cemfy that I have rod this application and sure Net the amide ws reining is
y
coma I agate tocomplywith all city and county es nNinan es and sum Iewe mining to
bulldingcoloned ogand hereby inspection
representatives of this city to corer upon the
o
above-(We)JgMha to
for An keep a.
(We)egme to ave,indemnify and keep yInharmless the City of=me
id City
tiZ liabilincoisequs.eneofthegrenutlor this expenses which may in Any way acerva geinA aid City Q
Jz inconsequence UNDERSTANDS
or this permit. `tel
APPLICANT UNOERST NDS A L COMPLY WITH ALTI,, N- Issued by: Date
UR ULATIO S. C, b�0
Re-roofs
ore o! pplicuVCr
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wilkie applicantmniton WiltlCgoccupant noma handle Health and
u refined by dm Cupertino Munici CMA.ChaPmr 9.13.aM th Health and Saicry
.StcOm 25532(e7? All roofs shall be inspected prior to any roofing material being installed.
Dy.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Mail harardnus air centaminents u fled by the Bay Area Air Quality Management all new materials for inspection.
District,
DYcs a
Ihave&Safet Cork,Oe Sdous ecant.
25505lsnquirtmumur c5534,1rChaperd.m of the Caldart
nae.nelthde Safety CM a ran t,s73N)3,353JJ and 23374.1 undenwtd Not ifDm Wilding
des not curmntiy how a Aman Not itis Y nubility m nod tbe oceup 1 of a
n =menu muatbema b,mi orace. eamaf0a a `C >..Signatureof pplicant Date
Sl ` C�7 D'J All roof coverings to be Class"B"or better
eroreuthoudagent Dae
' Community Development Department
Building Division
City of Cupertino
.. 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPERTINO
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.
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:
job Site Address: o5ZO.3S g G L t f V
Roofing Company Name: o —
A vhcanfs Signatu
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
�j
p3o�looq�
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# b Date:
py o5 03
Building Addres :
a o3 gg c t_ 1 F fl w Pt �
Owner's ame: hone
LA, 1 P.�{{j� as -/o +3
Contractor, Phone# "9-U%
ce se#: a`
Contact: I Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles pe�Asphalt Shingles
✓Wood Shakes ❑ Wood Shakes
Cl Wood Shingles ❑ Wood Shingles
❑ Other(Specify)—�� ❑ Other(Specify)
Number of existing coverings UNC ❑ Provide I.C.B.O.Report#
q/`fo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply Wit Cu ertino's Tear Off Polic
Job Description: TE-TE --O 0 IR-� TED Sb` -�
IasTP«� sbt_tD 5gj�:A N� �Au- 30 GD
Residential Commercial ❑
Fire No ❑ Confirmed with Plannin f
there are any restric ' ns:
C st of q6 Type of Const Occupancy grou
Qty. if
A li ab 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