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TY OF CUPERTINO"°'""—"'
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BUILDING DIVISION PERMIT
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BQ�gE�S: DE ANZA BLVD
PLATINUM ROOFING INC
PERMIT N0.
03040036
JRL�y RI0 ROBERT L AND ILDA
RUS1853 S 7TH ST
PERMIT ISSUE DATE
04/07/2003
SANITARY NO. CONTROL NO.
.
(408)280-5028
ARCHITECf/eNOINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB McCH
LICENSED CONIRACIDR'S DECLARATION
Job Description.—, —"-�
mby annum at I are Eced under provisions of Chapter 9 (commencing
1 Mthat ns
r
MlhSwdon70(10)of Division3ofthe Buaineua ft[essiov Code.mder Scenwu
in Lull tome end IT —
fr
�y t.Is9Rr'r'�
Lit Clata Ic.11REROOF
te Com or
1 understand my Puns shall W used As pE c records
11'
IIJt .
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby ARirm that I eco ,scope from the Crnwc9eats n Law for tW
e: A c county
(Sedan 711313. Business and Professions Cade: Any city
whichmason.
s
which mquira a permit u, com slur, improve, demolish. m wpolr any atwdum
$ Ft. Floor Area
9•
Valuation
do I
! pdorwnsluuanco.duantno
epownsn"ofMrmchpctor'MNualaw(Chumwt
' that helaB¢nwitpursoemM0MOfDis of Me
1
of
$56200
of lE of the BusloorlIAenscLaw(Code)
and PrInficaston.
Sectionfrom
(commencingaisexempt
exe
basis or Alleged mya'lt&"
thatheu 31.5 b thorefwm and the Aute Tea tbl sllegd euIMAAR M Any violation at
. pt and
it wbjuv the applWntw&cMl)emlty of
�DDI� r Occupancy Type
out more N.n raw hundreddl d.11.(($50001
3V�1�U UI . 0 0
❑(.uownmofthepropeny,mmyemployeuwlNwaguuNelrsolewmpensedon,
wmdo the work and the structure hoot intended oroffemd tmwe(See. Tobe, Bud•...
Required Inspections
305 - FRAME 9 P
And Proreadom Cade: Tie Conuacwes License Law dons net apply M an manor of
pmperty who builds orimpuosestharcumand whadoes,welt khlmmlfw through his
307 - INSULATION
ownemployces. pmvwed Nuauch tmprovemants arenea unloaded moaned wverfor Sale.IL
ho, the building m Improvement 1. sold within one year oteomPtetiw. de owner
601 — ROOF TEAR OFF
W iwer ME haw the harden of ProHng dist he did nes build ea Improve for purpose of
602 - ROOF PLYWOOD NAIL
Mw.).
❑ 1, as Owner of the property, am aeiuively contracting with licensed eontranwa to
603 - ROOF BATTENS
construct to pm)ccl(Sec.TOM, Business and Prorrasions Cie:) The Cwtrwwr's LI-
604 — ROOF IN -PROGRESS
cense law door not apply M an rower or property who Wilda or Improve demon. and
who contracts per such projects with A eanuactOds) licensed purausto M the Cleo amoes
License law.
❑ l atn exempt underSec. . B @ P C for thi reuua
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pe4ary one of the following decluatiuns:
have and will maintain a CeNfiww or Camara lis self-Insum for Worker's Compen-
An, u pwwidcd far by Section 3700 of the Labor Cade, for W Performa of the
weak for which this permit is issued
❑ 1 had an will maintain Workers Compensation Insurance. u required by Section
3700 of the Labor Code, fm the performance of the work forwhich this permit is issued.
M Worker oro enu0unl ante ea Icr an one, number are:
g ' • 1 ey No.:
aria:
CE FICATE OF UKEI. ON FROM WORKERS'
COMPENSATION INSURANCE
'
(Thu mcdon need not becomplemi Etat 1.11 is foronehundemdellam (SIM)
or her)
I certify that In the perform.= of the work for which this permit is Issued, I .hall not
employ any person in any manner a u M become subject w the Worketa' Comp n saalon
Laws of CNfomlA. Dau
Applicant
NOTICE TO APPLICANT: if. after making this Certificate of Exemption, you should
bcwme subject M the Worker's Campmtati0a pmvuions of LM labra Code. yw must
F forthwith comply with such proMsinns or this permit.lull be dared rnmkd.
CONSTRUCTION LENDING AGENCY
Ihereby Amro that them Is a cumbuclion tending agency for the PURAM IMO n(
> the work for which this permit is ISawd (Sec. 3097. Civ. C.)
Lcnear's Name
Lenders Add=
1 certify that I Mw mad this application and rote seat the abase MinstraUon u
wrme, I agree to comply with at city and county ominsncend sou law mhtine M
jbuilding construction , and hereby authodx nepnewntatim of this city Mumu upon the
&hove-memtond property for lnspecdon Punewa
17
y (We) agree to Save. indemnify and keep harmless the City of Cupertino Against
A Ilabllida,)udgmenu,cmuand expense. which may in try wry acme aSawstuid City
TIn consegnenee or dee crating of thiA per sit.�&L
PPLICANr UNDERS"rA AN ILL COMPLY WITH ALL NON -POINT
Issued by:S Date
S CE ULATIONS
� . --
)'
.,Re -roofs
Signatu or Appllc uC �'��,/ Date
" MATERIALBvy7yavSURB
e Of Roof
Type
HAZARDOUS
will the applicant or future building Occupant seem or handle handout material
As donned by the Cupertino Municipal Code, Chapter 9.12, and tits Health and Safety
Cie, Section i5533(e)7
All roofs shall be inspected prior to any roofing material being installed.
❑Ya r
If a roof is installed without first obtaining an inspection, I agree to remove
Will flu sppllcantar fuwm Wlldingaccupent taw dqulpmanl m devirea avhlCh
it hound.., air cwtsminanu u deMcd by the Bay Arca Air Quality Management
all new materials for inspection.
nric@
.YenNu
tawhauommueddsrequlmmenuundcrCMptr6.95ofw Califw.
IIInredrd
2M5.25533u 25534.1mbcmanddwuthc building
eD
n1&Hul"SefnyCodc,gwdm
dm not currently haw a tenant that is u my tupamiblity M notify the occupant nt the
`Date
hlchmunW ria Liss cool; ni8ceuafOccupancy.�
yulmme
)gnatureofApplican
jrirA&\i aQ
All roof coverings to be Cl " or better
Owner or Authorized a ent Date
Community Development Department
Building Division
j City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF DT]NO N Fax: (408) 777-3333
C U PE
El
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 Y4 " 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 abover stated policy on re -roofing.
Homeownerp
Homeowner's Name: >6
Job Site Address:
Roofing Company Name:
Greg C4teel
Building Official
Revised 1/30/03
Printed on Recvdad PaD8r
Date: 4- v? C) j
Ll
9
DT
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
o30`fa-v _?(�
APN #
Bldg Permit Fees
BUILDING
Date:
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
Buildin d ess:
Seismic Commercial
) 2,oa - 3 .J
Owner's M,
Plan Check Fee
BUILDING
Phone it:
1 1�`
BUILDING
Co tor:
Vic
Phone #:
WOO
&J -S
License, tD
`jj
A:11' t ✓
.1
2 o
12>9
Contact:
hone #:
Cupertino Business License #:
Type of Roof Covering:
Existing:
Proposed:
t< Built -Up Roof
Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Wood Shingles
nq Other (Specify) &s r- 2 p'% a cA P -
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: ..
cAP
Residential ❑ Comme
ial
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Det. if
there are anv restrictions: LLJJ
osst of Project: T e of Construction: Occupancy group:
e
Qty. if
ADDIicable.
Fee TD
FPA nPCI`P.TYalfl
T.PP rTllll Tl
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
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