03060171 CITY OF CUPEW11NO
BUILDING DIVISION PERMIT �COiyTRACTOR INI3,ORMAT�ION lz^
BUILDING ADDRESS: ELITE ROOFING PERMITNo03060171
r OWNER'S NAME: 477 E EVELYN SUITE F . PERMIT ISSUE DATE
r'l
]NL (408) 749-0242 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELELT PLUMB M[CH
oo LICENSED CONTRACTOR'S DECLARATION CJ O O O
F❑ 1 hereby arum mat 1 sat hccnxd ander ymvddnns or chapter v(eommeremg Job Description �I ��
;�o wlN Section] Bnf Dwisimn Sof me BusmxaandPorca,oats COde.end my liccnx is �8(,'N�[l�q
��? mato torte an rcrt_3g REROOF ►I'E+J Ya
Liccnx Clan Lic.M
RCHITECTS DECDAtXTIO JAN
gk kl
9 C< 1 understand my plans shall he used as public records
>iU
e 0 s Licensed Professional BUILDING
OWNER BUILDER DECLARATION
y n O 1 herebyago affirm mat 1 1. exempt san the Contractor's License Lew for bac
p o following tvasna(Section 7031.5.Business and improve.
dconm h.or Any city or county
i$ which requires•permit m cnnarrw:L alter,improve.demolish,or repair any stmnax
�z i tpoor hat he its issuance,purlsmmquims[be
ovisio s of for such Contra reit micurefile ac Law
(Chapter
thmbcisliccnuJpursmnumthe prnvvmnsnfthcCOnuxwril.iccnxraw(Chapfcr9 Sq. FL Floor Area Valuation
4F$ (cementing with Section 7000)of Division 3 of he B uuncas and Professions Code)or
Net he is exempt therefrom and the basis for Ne alleged exemption.Any violation or 35618049 . 00
Section 7031.5 by Any applicator(Or a Permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not more Nan fire hundred dollars($500). P Y YP
0L.ownero(the properl,a my employees with wagesaz theirsole compensation,
willdo fire work.and the structure is nor intendedormffered arsale(Sce.]044,Business 3 05 _ FRAME
and Pmfrssions Cmdc:The Contractors LicenseLawdoes not apply to in owner of Required Inspections
progeny who builds or imprnvez themmn,and who dwssuch work himselrnrmroughms 307 — INSULATION
Own cmployss.provided mat svchimVrovemenu are not intendedOrodcrcd furxle.E, 601 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,me owner-
builder will have fine burden of proving mal be did not Guild or improve for purpose of 602 - ROOF PLYWOOD NAIL
:am.)' 603 - ROOF BATTENS
❑I.as Owner of the See.70formerly,,B .unc eivdy limitations with licensed contractors t.
more ameproject(Sly.]Ben,Badnessand
ny who Widoor:)The es toncor's Li 6O4 — ROOF IN—PROGRESS
care Uw des not apply to an owner of pr hroo what Wilds or improves Centra,and
whonse La u for such projecu with a confracfor(s)IimnxJ pursuant to the Comranar's
License hue.
❑1 am cxcmpt under Stt. .B&P C for this reazon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
I ban and will maintain a Certificate O(COmacm to self-insure for Worter'sCompen-
satimn,as Provided for by Section 370o Of the labor Code,for the retfonnnt.or the
work for which Cis permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
37M of be Labor Calc,for be pcdmmance mf me work for which this permit is issued.
My Wr' rope salionl mtanm nicr ArtE}lolicyn mbcry pa:
Came ♦ cY No.: /WJ_/9JgB1[a1��3J.fQ o
CER IFICATE OF E). PIION FROM OR ERS'
COMPENSATION INSURANCE
(Thu section need not M completed if the Permit is for one hundred dollars($HXB
or Iw.)
1 cenify that in the performance of the work for which this permit is]awed.I shall not
employ any person in any manner an ah to bebmmc Subject o rhe Workers'Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:If,afar making this CcniOcae of Exemption,you sbnuW
become subject to the Workers Compensation provisions of the Labor Code,you must
., z ronhwith Comply with such provisions or this Permit shall he deemed evoked.
Z 0" CONSTRUCTION LENDING AGENCY
I-. I hereby affirm that there is a eommuctinn lending agency for Its,Performance of
C 7 the.,itfor which this Permit is issued(Sec.3091,Civ.C.)
W Q Lender's Name
W Lender's Addr)agree
U 0 1 cenify Net 1 have read this application and ss¢that Nc above information is
0 U bonding I agree tc comply with all city and county ordinances and cute laws relating pthe CW building consuuclion.and hereby emhonpurposes. i.0 Ol this city lmcnmrupnn rhe
r CL above-mentioned to ny for inspection
mnify an keep h.
CL (We)agree to save,indemnify end hick harmless o City of Cupertino against
,Ui,iZ liabmrsoirtuch Ithecostsr of hot expenses which may inany way accrue againstsaidCiry
V z A APPLICANT
moire Rranll of this Permit.
^-� APPLICANT UNDERS AN AND WILL COMPLY WITH ALL NON- INT Issued by: Dale
U GO 4 TIO ,—A �
f
L17 Re-roofs
gnawrc otic 'Con ,I Da
HAZARDOUS MATERIALS Ocem3DISCLOSURE Type of Roof
Willy the Clieant m future boa]Coe Chart pore or handle Health andmaterialSafety y
az defined by the Cupeninn Munici al Cuda,CM1apmr 9.11,and he Health and Safny
code,sadden zss3za)� All roofs shall be inspected prior to any roofing material being installed.
❑Yea Nu
Will the applicant Or future budding occupant use,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
7d.
t bvardous air chauminanu u defined by the Bay Area Air Quality Management all new materials for ins action.
rlet?
❑Yes
I have read the haaardous materials requlremen¢under Chapter 6.95 Of Ne Califnc
Hca IN&Safety Code.Sccum 255115,15533 and 25534.1 umersaand that if the building
not cameolly hate n a it is myraporuiMlity m notify the i cim n ich mum mnP or RrissuanccoraCcnifica f p cy.�` �� SignatureofApplicant Date
ner IiAmued aF Date All roof coverings to be Class "B" or better
Community Development Department
Building Division
J City of Cupertino
10300 Torre Avenue
4 CITY OF Telephone: (408)777-3228
U P E kT I N O 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) 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: 2 l Z �o ( k ^ `a S
Roofing Company Name:
Ap"cant's/Signature: --� Date: 4 t Le �� 3
\�l/r61AD�X1
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o3
0 6 o / 71
REROOF
CRT OF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
16
Building Address:
216102 �.0�4-��KS ✓e
Owner's Name: C�4— 1 ; _v
FF N (jC
Contractor: l Phon #: License#:
2flo4� `tL {o-j 5 %qrz 657(- _71
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles /K Asphalt Shingles
�— Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs. t
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Descri tiop n: n I
I -. ave_ g �� , wl( ( �.iooeL �� SMc(
Residential Commercial ❑
Fire Zone: 8 No Confirmed with ntn Det. if
there are anstrictions: 1
Cost roject: Type of Construct OccupancjrOuF—
�7^J
Qty. if
Appliq4Le 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