03070004 CITY OF CUPERTINO
BUILDING DIVISION PERMITMq „
BU ILDING ADDRESS: R E ROOFING & CONSTRUCTION IM�ND03070004
2223 21-IRERTINQ R.;)
OWNER'S NAME: 15230 CLYDELLE AVENUE, PERMIT ISSUE DATE
DNE: (408) 925-9995 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
±00 LICENSED CONTRACTOR'S DECLARATION ?� m O
0r 1 hereby+form that I am li"Am” under p viaiona of chapter v(commencing Job DeSCrlp[I 0
w with Sec tion 70M) !DiylPio Sof Nonni. Proreasions Code dflylicenscis
inrolmmean e. �L)K ?x 5j°("� REROOF JUL 3 Q ZOOS
g i LiPense elasa ase.a
Curer wr
e7
CHITECI'S D RA I
t I understand my plana shall lose acd hlic records
BUILDING
fp e ' !�'e DIpg/'��A
5 G Licenee Proralaomat {V
OWNER-BUILDER DECLARATION
O1 hereby affirm that 11. exempt Gum the Cssion&o License Law for lW
OO following reason.(Severn 7031.5,Bnlms,iand Pmlesdoli Code:Any city at county
$m which requires a pertnil m ennsruc6 elks improve,Jemnlixh,m repair any xuucom
bus prior to its icmance,also requires the applicant rormchperniuorlesigned stalemcnt
< that ho is licensed pursuant to the provisions nfthe Common's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
O (commencing with Section 7")of Dwain.3 of OW Basin asand Profession Code)or
y dust he Is exempt therefrom and the basis for the alleged exemption.Any violation of 32616082 . 00
Section 7031.5 by any spplicanifor a permit subjects the applicant to civil Penally of APN Number Occupancy Type
not more Nan five hundred dolhn
L o owner Of the pnany.ar UTO is not intended
tende woo wa{es as sla((Sec.
camomiless will dothewod,Coda:shC The
ommunes Liamdnawdos offered otapply 7l W4,mani,of — Re aired Inspections
and Profusion Cada:The Genu¢ton. ndwho Law dna not apply to an owner 307 - I NSU- IE P
property who bol Ids or ire proses Merton.a nd who does such work h imml f or Cross{h his
Own employees,provided that such lmprowmenu Are not intended oroffered foraate.If. 601 — ROOF TEAR OFF
however,she building or impm numml Is sold within one year of completion.me owner-
budder will have dte burden of Proving mat he did not loved or improv,for purpose or 602 — ROOF PLYWOOD NAIL
tele')' 603 - ROOF BATTENS
❑I.a owner of set Amar(,am a imee; ad Profession,with:)The Cmucammmn m
Contrast doesnonpplytoinOwnerofprodPronasionsCodepmeCanuacon.U.and 604 — ROOF IN-PROGRESS
came Law coca not la ts owns of proper(who Wilda or impmvas Centro.and .
who Contacts La"for such gvKCLL with+crntncmr(q licensed pursuant w the,Contractor's
License Law.
❑lam exempt antler goo. ,B&PCfor Nle
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby&Tran under Nuctry of perjury,oro of the following declaration:
1 haw and will maintain a CeAfrcam of Commu
� o self-Ivum for Worker'aCompen-
astion,as provided for by Section 37110 of me labor Code,for the Performance of the
work for which this permit is issued. nu
❑1 haw and will maintain Worker's Compensation Iuunce, required by Section
3700 of me rCw0.for the Performance or Also work for which this permit is Issued.
(keriCan scan in nna cartiar and Policy number am:
ca ' '1 qNa.: —lU
CERTIFICATE OF NFROM WORKERS'
COMPENS TION INSURANCE
(This section need not W completed if the permit is for one hundred dollats(Sire)
or less)
1 certify Mas in Ne performance of she work for which this Permit is issued.I shall not
employ any porson In any manner an as m become subject to IW Worker'Compensation
Laws of California.Dam
Apple:=
NOTICE TO APPLICANT:Ir.after making this Cer ificam of Exemption,you should
become subject he the Workeri Crmamsation provisions of she taloa Code.you muss
Oforthwith comply wish such provision or this Permit hall he deemed revoked.
'Z' " CONSTRUCTION LENDING AGENCY
1hereby&from Net Nem its contraction lcndin{agency for dm Performance or
CNe work tour which this permit is issued(Sce.3097,Civ.C.)
�W Q Lender's Name
C z LendersAldw
U Q I artily Nat 1 Mw mad this application and sum that the&W w information is
Y. corect.I agree m comply wish all city and county ordinances and sate laws mating to
U building convection,and hereby aumorire repwmatiws of Nis city to enter upon tint
417 abon-menconed property far inspection purposes.
(We)agree to save.indcmntry and kap harmless the City of Cupertino against
liabilities,judgments,Cosa and experua which may in any way area Against said City /
U7 Aconsequence
UND {STANDSthis
ce WILL COMPLY WITH A N-POINT Issued by: Date
N;
(/
�i ; tau ps_ 0'r' Re-roofs
Sig plicandCon or Due
RDOUS MATERIALS DISCLOSU RE Type of Roof
Will Use applicant or future building occupant store or handle havArdoua material
As
de0ned by the Cupertino Manic' Lude,Chapter 9.11,and Ne Health And Safety
ewe,section zssu(+n - All roofs shall be inspected prior to an roofing material beim Installed.
ra Nu P P Y g g
Will me aPplwanl or future b ng occupant tax equipment tar devises which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air Commons. cfmcJ by Nc Bay Area Air Quality Management all new materials for inspection.
4iet?
❑Ya No
Lisawmw NownlsrcyuimmcnuundcrC dt.9 ardor .Gelding �'
IniaHea�Mh]&Safe,yCok.Sw�ons25505.25533md25534.lun&m=dth undth ifmc Wildon{tcunan0yhewa moan,Net II u my inecasibiliry mr ntify Nc upset f Ne
ul na sl r iasis ceofaC.rulie maroccu Igna ant Date
fauthorizwa Dam All roof coverings to be Class „B"Or better
Community Development Department
Building Division
s " City of Cupertino
10300 Torre Avenue
" Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
4UPEkTINO
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: Dc, /G11n'D�A cy,
Job Site Address: 2-
Roofing
Roofing C Name:
A p ants Signa e: � Date: I I U
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
CITY OF CUPERTINO
1 REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# �7 � Date:
Building Address:
2,232� C,IUPeRTI�lo
Owner's Name: Phone#: 2_03 — (;712- .
�KRI� Nl'R
Contractor: R6 USN e Phone#: LFt�s_g2s- License#: '72. 75
�. Inc:
Contact: Phone#: Cupertino Business License#:
p G I5
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles G, ��—��
❑ Other(Specify) �(Other(Specify) a klo� SPLIT_Yl
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:,7,el wvt �ISKf1N t, L{qy� 0 yvo oq t�Nict«1 IdsSTAtn 2" CDX i
.3 aAsrK Flan ktoW� .SPLA SNM<L"_ L W zr
Residential Cominercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with P i g Dept. if
there are any i ctions•. LJ
Cost of Project: I U v O1 Jt1 Type of Construction: Occupancy oup�
Qty. if
ApplicabFee 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
Z23 3