04060100 CITY OF CUPER•FINO
BUILDING DIVISION PERMIT CONTRACTORINF2ORMATION
BU ILDING ADDRESS: TIP—TOP ROOFING PER""04060100
7466 DE FOR DR
OW NER'S NAME: PERMIT ISSUE DATE
ANNA PELUSO 1160 NADINE DR nn4
ONE: SANITARY NO. CONTROL NO.
(408) 370-6425
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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il p C LICENSED CONTRACT'OR'S DECLARATION Job Descri OR' A L n
y w FC I hereby affirm that 1 am licensed under p re ns of Chapter 9(commencing
<iW wish$cction7 )of Division 3af ds Bu4rwssm r fcuiov Code,and yliceuc is
inmemme an cc �$I (- Q REROOF JUN
jv�z Lianx Cl Lic.p 2004
Z F W te Consmmr
ARCHI'TECI'SDEq gATION
cd< I undu
crsnJ my plans shall be used u path t card, BUILDING
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LL l;; Uccvcd Pnsfcssional
OWNER-BUILDER DECLARATION
1 hereby Sir,.'hat 1 am%crept from the Contractor's License Law for the
p O following moon,(Section IIB 1.5.Business and Professions Code:Any city or county
x m which mquims a Permit to Construct,Stan.improve.Cemolksh,or repair any swctum
F_aprior to its issuance,also roquiros the applicant forsuch Permit o rile a Signed statement
Thal M is licensed pursuant to the provisions of the Contracmri License Law(Chapter 9 Sq.FL Floor Area Valua[lon
asFe (commencing with Section 1000)of Division 3 of tM Business and Prefessiosu Cade)or
y $ That M IS esempt therefrom and the Buis for the alleged exemption.Any violation of
Section 703 LS by any applicant for a Permit subjimm the epplicml to a civil penalty of 3SARQOa le100 Occupancy Type
not mom than five hundred dollars($500).
I,as owner of the property,or my employe%with wages as their sole compensation,
will do the work and lM awemre is not intended or offered rental.(Sec.7044,Business Required Inspections
and Pre fessiov Cade:TM Conum
aafs Liarsse law does m e non apply an owner of q P
property who builds or improv%thereon,andwhodoessuch work himself or through his
own employ=%,provided that such improvements ern not intended oruRered formic.If.
however.Ne Wilding or improvement is sold within ore year of completion.the owner.
builder will have the Wrden of proving that he did no,Wild or improve for purpose of
Sale.).
1,as owner of thin property,am exclosiwly contracting wish licensed convectors to
construct the project(Sec.7044.Business and Professlou Code:)The Combustion's U-
cave Law dors not apply in an owner of papa"who builds or improv%thereon,and
who contracts for such projects with a conwac,or(s)licensed pummon to she Contractor's
License law. '
❑Ip em eaema cc. B d:P C far Thi mason
D �f �� c Data ltd
ImIWORKER'S COMPENSATION DECLARATION1 hereby symn under Penalty of perjury am:of the following declarations:1 hale and will maintain a Ccauf®¢of Consent m Self-insum for Warkei pcn-
sComtion,u provided for by Section 3700 of the Labor Cade,for the pcaromiance a(therk for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,u mutational by section
00 of the labor Code,for the performance or ton,work for which this permit is issued.
y Worker's Cn ,a.mi.o Insurance carrier and Policy number art:
G ' SC�aI Pp F
CERTIFlCATE OF E%EMPTIONPORKERS'
COMPENSATION INSb ANCE
fins Section head not M completed if the Permit is fmow hundred dollars($100)
or less.)
I unify Nat in the perfamanec of the work for which this Permit is issued.I shell no, y
employ any person in any manner an u to became=bicm[to IM Worken'Compeuation '
Laws of California.Dae
Applicant
NOTICE TO APPLICANT.Jr.after making this Cm damLa of Eminih;on,you Should
become subject to the Walker's Compensation previsions of Ne IaMr Code,you most
�7, forthwith comply with such provisions or this Pormi"Iall be deemed invoked.
ZO CONSTRUCTION LENDING AGENCY
[-. 1 hereby alarm that then is a eonanstinn lending agency for she terformanec of
(�> the work for which this permit is issued(Sec.W.Civ.C.)
wQ tenders Namc
a Z Lenders Adds%
U Q1 ccnify that 1 has read this application and start that the about information is
(••' correct I agree to comply with all city and county ordinances and sure laws healing to
O V Wilding construction.and hereby mthomarepthemativss of has city to enter upon the
r fel ahove-mentioncd property for inspection purposes.
(We)agme to save,indemnify and keep ha in m tM City of Cupcnst S against
f' v) liabiliu%,judgments.un.indmnifyswMchmay inany way acmuaag Ain Said City
U Z in consequence of the grunting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE R TION //
Re-roofs
tgnewm of AppRC HAZARDOUS MATERIALS DISCLOSURE Da Type of Roof
Will the applicant or ruwm Wilding occupant store or handle haradous material
as dcfincd by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Cade.Scetion 25533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Y% No
Will thm applicant or'fu,urc building Occupant trx equipment ab Jcm¢s which If a roof is installed without first obtaining an inspection,I agree to remove
pp s p quipmen
mit haaambas air concomitants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District? //////��s��S
D Yes #No /�� //l ^ /{`3f•r'
Ihaw
midthehubod ; sanuerChume .95 ooe Cah(oo
.is Hcalh,&Sdels.Secdons25505,25533and 2553,1understand
Oh.ifthe
W;IJing 'Tj\y'"giFtf/b
does nal can,at y lama a tenant that it is my responsibility to amity IM oeeupml of the
require mdortaiaamccoraCmti11 rOcPa �y. gna[ureofApplicant Date
(y /
own thoriacJ agcm/ ,te All roof coverings to be Class "B"or better
Community Development Department
Building Division
-//J;;{{
City of Cupertino
V ✓ 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
SUPEkTINO 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: 1�1744 f zdSo
Job Site Address: X166 At r6oe A4
Roofing Company Name: 2se—
Applicant's
Signature:
, Date: t ,#- I O y
\itla6l�llD�X1 �
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
- CITY OF CUPERTINO 0 to 6 a l
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN#3S-7 2 U —7 ate:
Building Address: }� 6 �
De�'oe. p2.
Owner's Name: Ph o e #:
Aon0. peLuso (og zSS— Z. o9
Contractor: T,P —Top P_mo ,ft Phone# b— License#: C81 Ob-0
�yoe�/�- syZs
Contact: VPhone#: Cupertino Business License#:
� o b n / 4'Pdl 3,;1-d -6 5 2j
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof. ❑ Built-Up roof
❑ Asphalt Shingles 95 Asphalt Shingles
;l Wood Shakes ❑ Wood Shakes
F Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 2. ❑ Provide I.C.B.O.Report#
ja To be Removed ❑ Provide Mfgr.Installation Specs.
OI Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Er
Job Description:
9/cvv
Residential ® Corfimerciitl ❑
Fire Zone: Yes ❑ No\ ? Confirmed tth Plannipg De t. if
there ar an r strictions:
Costo reject: Type of Construe Occu cy up: /
-958°- 00 4 2e1��
Y. i )
is le 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
I l BUSLIC Business License BUILDING
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