04060138 ' CITY OF CUPERTINO �* "� -'"'"�'"I'll - � ;'+-A
BUILDING DIVISION PERMIT I CONTR'ACTR,OINE RMATION �r
BUILDING ADDRESS: STATEWIDE ROOFING INC - PERMIT NC04060138
' 110991 N A DE ANZA BLVD
OW NEWS NAME: PERMIT ISSUE DATE
SARATOGA MANAGEMENT 5542 MONTEREY RD 06/16/2004
ONE: SANITARY NO, CONTROL NO.
(408) 288-8680
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
�oo LICENSED CONTRACTOR'S DECLARATION O O O O
I ManRestated!by afn at I am Ikenunder provisions Or Chapter 9(commencing Job Description
wish Sec1I 79M)of Divuian 3 often Busimu stns Profculons Code.and my mecnc is
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n'�zppp lora oC�derr cn� G REROOF W/ (BUILT`U-P fit F
an Caul he used
�D ,RATION n�
I understand my plana Nall he used u public record,
c Licensed Professional
u OWNER-BUILDER DECLARATION
i I hereby a1Rrm that 1 am mmorpl from the Contractors License Law for the ----
0 o following reason.(Section 7031.5,Business and Professions Code:Any city or county
S which requires a permit to construct,eller,improve,demolish,or repair any structure yS`2 7 375
t-Z N„ n
prios its issuance,alao requires the applicant(orsuch permit to file a signed statement
g that W is licensed pursuant to the provisions of the Contractor',License Law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commencing wish Section 7000)of Division 3 of the Business And Professions Cnde)or
that het,exempt therefrom and den but,for the alleged eumption.Any violation of
Section 7031.5 by any applicant for A Parmit subjects she apple.,to A civil penalty of 3 2/14;nmelu U Occupancy Type
not mo¢than five hundred dollars($500).
❑I.uovmec of the PmpatY.or mY employees wish w{mulheit sole mmpensation,
will dothewars.Caere:
he Cmisures undedm Loath tomt.pply.]fist, wnma
and Pty.h.W :The Conor ora ndwho Law dao m,apply lf an ovmar is Required Inspections
mancenwho Wilxvided rat Nimon.andmUmnatimm�dkhim,elf for Weugh his
ownemployees,pmvixd Natsuchemprowm withdraw
t art not intendedmpletirn.Tor We.or.
builder,Nc Wilding orimptowmenlissold edidoneyear orcompvfrsheowmr-
.[A.).rwill have du burden of proving Nn W did ml Wild or Improve for purpor of
ark.).
❑1,a owner of the property,am imitatively coursening with licensed contractors to
construct the project(Sec.70",Business and Profauiom Code:)The Conmcmt's Li.
cense law does not pply to an owner of property who Wilds or Improve thereon,and
who contracts for such projects with a eontnctor(s)licensed pursuant o the Contractor's
Lkensa Law.
❑1 am exempt under Sec. .B&P C for this noon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of One following declarations: '
❑I haw And will mainssin a Ceeificam of Comets to self-insun for Workers Compen. ,
urian,As provided for by Section 3700 of the labor Cox.for the performance of the
work for which this permit is issued.
❑1 Mw and will maintain Workers Compensation Insurance.As Iequired by Section
)]00 of the Labor Cox.for the performance of the work for which Nis permit is lured. -
My Workers ore tion Ins a carrier and Policy num r
Treryler. Poli >
CERTIFIC OF EKEMPION M ORKERS'
0 PENSATION IN RANCE
(This section deed not W completed if the Permit is Its,am hundred dollen(SIM)
or Ina)
1 certify that in the performance of the work for which this Permit is Issued.l shall not
employ any person in any manmran As to become subject to the Workeri Compemadan .
Low of California.Data
Applicant
NOTICE TO APPLICANT:IL arm,making this Cenifrcam of Exemption,you should
become subject to the Wohars Compensation provisions of the Labor Code.you must
,J O foMwith comply with such provisions or this permit shall bo deemed moked.
'�y CONSTRUCTION LENDING AGENCY
[+ I hereby Affirm that then is a construction lending gency fm the Performance of
CYi > the work for which this permit is issued(Sec.3097,Civ.C.)
QLenders Name
Z)z Lender's Add.
fJ Q 1 certify that I haw read this application and sum Net the above information is
E' correct.I agme to empty with all city and county aWinances and amus laws Mining to
0 building construction,and hereby authorize represenutiwa of this city to enter upon the
W above-mentione4 Property for inspection purposes
IV) (We)dime to save,indemnify and hmempick hay in m w Glly m Cupertino against
Z liabilin
lac mofth,cmuand ofpcmu which may in my way aecme against said City
fJZ in comegmna of she granting of this Permit
APPLICANT UNDERSTANDS D W L CO LY WITH ALL NON-POINT Issued by: Date
SOURC EGULATIONS, 6 L G
U Re-roofs
Si t or ApplicanUContnctor am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WI1 sho applicant ur future building occupant store or handle hanrdom material
u defined by the Cupertino Municipal Code,Chapter 9,17,and the Health and Safety
coda,SCAtianYm Iyy Nu 35534007 All roofs shall be inspected prior to any roofing material being installed.
�
Will Ne applicant or future Wilding Occupant iso equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emh hamrdnu,Ai,mnumina ns u de0nad by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yee /yyNu /
I have read Nua
ehrdirramrials nquitcmcnuunxr Chmmr 05af Ne Califar
nu Has"Safety Cox.Secdmu25505,25533 and 23534.1 understand thnif in Wilding
docs sol Monctly how•. t,dot' ' my ponsihiliryano.. the aecupart fNe
require Is hichmonIV ' ma araC, mnmafGecnpxtu G If Si atureofApplicant Date
wne authmoecd agent Dam All roof coverings to be Class"B"or better
Community Development Department
f Building Division
,let
j> City of Cupertino
10300 Torre Avenue
OpC[ITY�F A Telephone: (408)777-3228
Ur C kT I l i 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 obtainingsn 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 SC✓l ��� ��l t l _
Job Site Address':' /Q T
Roofing Company Na*: f
Applicant's Signature: Date:
Greg Iteel
Building Official
Revised 1/30/03
Printed on Recycled Paper
X'or-
am CITY OF CUPERTINO
, REROOF
CUPEIkiINO PERMIT APPLICATION FORM
APN# 3 2 6 Date:
Building Address: (�
Owner's Name: Phone#:
S 0
Contract r• License
Contact: Cupertino Business License #:
Q" 02
Type of Roof Covering:
Existing: Proposed:
b( Built-Up Roof ,K Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
Cl To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
-� Job Description: �X .
Residential ❑ C6mmercial
Fire Zone: Yes ❑ No ❑ Confinned with Planning Dept. if
there are an restrictions: u
Cost f Project: Type of Constructs n: Occupancy group-
7
roup:
-z737S G
Q . if1
A li b e 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