03080171 CITY OF CUPERTINO
BUILDING DIVISION PT;RMIT CQNTRACTrOR INFORMATI0N:,:
� '.„r .sero';t 'five ;,'-'s54ctc.xk
e ILDINGADDRESS: CAL/WEST ROOFING COMPANY PERMITN 03080171
a WER'S AME: RD PERMITISSUEDATE
3508 CUESTA COURT
ONE: (408) 531-1961 SANITARY O. C Ol,NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+Or, LICENSED CONTRACTOR'S DECLARATION JobDescri tion
E u I bcroby affirm that I am lieemcd under provisions of Chapter 9(commencing P
With Section 7”)of Division 3 of the BusinryuM Professions Code.and my license is FINAL
�®
]�n� in(tell fn std off t. ✓ ��.>- -56 r `
Is LicenseclG°. C Lic.4 :4y�a REROOF .
sF Da Cumractar rs Wro 5
s ARGHITECrSIYgARATION SEP 1.0 2003
1 understand my plana shall be used as public records
)BU
�qems] Located Professional
OWNER-BUILDER DECLARATION BUILDING
A i I I hereby affirm that I am exempt from the Contractors License Law for the
00 following mmew.(Section 71131.5,Business and Professions Cade:Any city or county
$ which reyulres a permit m cmasmcL alter,improve,demolish,or repair any slmclum
-Z< prior W its issuance,also requires the applicant Roston permit to Ric a signed statement
ss that he is licensed pursuant to the provisions of the Commown's Liable Law(Chapter 9 Sq. Ft.Floor Area Valuators
�F0 (commencing with Section 7")of Division 3 of the B winesa and Professions Code)or
Net he Is exempt dtemfrom and the basis for thin alleged exemption.Any violation of ';2rlc;124 nn
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type_.
not more than Eve hundred dollars
❑1,as owner of the property in my employee,with wages an Weir sole compensation,
Will do the work and destruction is not intended or offered forsale(Sec.70",Business 305 FRAME Required Inspections
and Profession,Code:The Contractor,License law docs mat apply in in owner of q P
pmpenywho Wildsor orNaws themon,and whodoes suchwork himselfor through his 307 INSULATION
own employ=,provided that such improvements arc not intended meatied for sale.If, 6O1 - ROOF TEAR OFF
however,We Wilding or improvement i,Mid within ane yeas of completion,the owner.
builder will have the burden of proving that he did not Wild or Improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.).
0 I.as owner of the pmpeny,am exclusively contracting with licensed anuanors W 603 - ROOF BATTENS
construct the project(Saw.Iliad.Business and Professions Code:)The Contractors LI' 604 - ROOF IN-PROGRESS
cense law does not pply to an owner of property who Wiids or improves themon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractees
License Law.
❑I am exempt under See. .B k P C for this mason ..
Owner Dau
WORKER'S COMPENSATION DECLARATION _
Ihercby affirm
in fllhimimsdeclasalioos:
I have and will meinuin•CerdRau of Cenxnuo xlFlosum fwworkeri Compcm
sation.as provided for by Section 3700 of the labor Cade,for the performance of We '-
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,ns tequircd by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
My Worker's Cnmpsmatian lnsusan arties and Policy numberem:
Ca 'er: P a.:�e4en
CERTIF KATE OFF WORKERS'
COMPENSAnONNNNNN111711NNNNNNSURANCE
mils motion wood not be completed if the Permit is fm one hunJrcddollismail 0)
lir lest.)
1 certify that in the Performance of the work for which this Permit is issued,I shall not
employ any person in any manners,as W become subject to the WMIZol'ComPeesadom
Laws of California.Dat
Applicant
NOTICE TO APPLICANT:IL after making this Ccnificat of Exemption,you should
become subject m the Wortch Compensation provisions of the Lehr Code,you must
z forthwith comply with such provisions in this permit shaft be deemed invoked.
ZO CONSTRUCTION LENDING AGENCY
1 hereby affirm Wu there is a cowstruelinn lending agency for tbe performance of
Y. r>-t the wart for which this pemtit is issued(Sac.3497,Civ,C.)
11 Q Lender's Name
z Lcndcrl Addreu
J 1 cinify that I haw read Wis application and sue Oat We eWw information in
L correct.I agree to comply with all city and county ordinances and tut laws miming Int
Wilding constructor,and hereby authorise opmsenutiwa of this city wiener upon the
show-mentionW PMPerty for inspection Purposes.
ti (We)agree to saw,indemnify ry and keep harmless w City of scenic
against mid
against
Z in
nsequede of the coast and espcnsc,mit. may inany way acme agalnnmid Cily
J,'� A APPLICANT
of the UNDERSTANDS
of this permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO CE REGU
— 8L7-5 - �c Re-roofs
nuurc of ApplicutUCanract� /r D�—
HAZARDOUSMATERIALSDISCLOSURE Type of Roof
Will We
:'Pip
forum Wilding aecupsmamm ar handle hseade esmatflal
sa W Oned by the Cupertino Municipal Code.Chapter 9.13,and the Hcallh anJ Safety
Code.Section 25532(x)? -/ All roofs shall be inspected prior to any roofing material being installed.
rlYes JNu
Will the applicant or future Wilding occupant sax mild Ment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it Immolwu
s air conmina n;u defined by he Bay Area Air Quality Management all new materials for inspection.
Idoet
❑Yes KNN
I have maJ the hanardnusmaterisurequimments under Chaptr6.95 ofthe Califor.
Hex]"Safely Code,Sections 25N15,25533 and 25534.1undersund dstilOe Wilding T n0 not currently haw a tnant.u,it u my responsibility W nodly the wcupant of the v L6-16
u'mmentNv IpdortuonaofaCcnifreatefOcgupeRsyr. Signature fApplicant a
net or authoniod agent �,//'s. All roof coverings to be Class"B"or better
Community Development Department
Building Division
Sul CCity of Cupertino
10300 Torre Avenue
* CITY OF Telephone: (408)777-3228
UPEkTINO 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: Z2��/s L✓1� b
Roofing Company Name: p -s.,(
A plicant' � 15s Signature: �� Date: 03
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
r
CITY OF CUPERTINO
REROOF `� 6
CUPER INO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name: Phone#:
Contractor: Phone#: License#:
efA E (D
Contact: Phone#: Cupertino Business License#:
5b5–z
Type of Roof Covering:
Existing: Proposed:
J:1- Built-Up Roof Q- Built-Up roof
❑ Asphalt Shingles --er'Asphalt Shingles
,a–Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
O Other(Specify) ❑ Other(Specify)
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:
c� Il 3
Residential E] C ercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: IJ
Cost of Project: a- Type of Cods_ do Occupancy group'.'—
Qty. if
A 1' a Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener_gy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
/ , �' 7