03050011 CITYOFCUPERTINO A'� "°'� `' �'
a BUILDING DIVISION PERMIT CONTRACTURNF'ORMATIQN .
BUILDING ADDRESS: TALBOY ALAN R PERMIT %3 0 5 0 011
UgD $
OWNER'S NAME: PERMT (J '82/2003
ONE: SANITARY NO. CONTROL NO.
f
ARCHITECV(INGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+ro z LICENSED CONTRACTOR'S DECLARATION Job Description
F I hereby affirm Nal 1 am thorned under provisions or Chapter 9(commencing P A�
with Sion 11")of Division 3 of the Business and Professions Code,and my license is ��I tl�l✓�I�
in full mree and effwL REROOF V�
j n Z License Class Lic,N
nJF DBto Commoner '
,eQQ ARCHITECTS DECLARATION MAY 2 7 2003
y a 1 understand my plana shall w used u public records
OdU
Sot, Licensed Proromional
5 the OWNER'BUIIDERDECLARATION BUILDING
I 1 hereby M.that I em exempt from Conlractufs License Law for the
00 following memo.(Section 703 1.5.Business and Prefrssium Code:Any city or county
$ which requires a permit in construct.alter,improve,demolish,or repair any structure
f prior m its issuance.also requires the applicant for such permit to rile asigned statement
F mho that he is licensed pursuant in 0te previsions or the Contractor's Limnse Law(Chapter 9 Sq.Ft. Floor Area $516fttion
yF$ (commencing with section 7000)or Division 3 ofthe Business and Proressions Code)or
Net he is exempt thenufmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 54iff240*8berO 0 Occupancy Type
m
no ore than five hundred dollars(5500).
1,as owner of the property,w my employees with"Jim a their role mmpensaldn.
IB do she wort,.and the swmu,is not intended orofrered formic(See 70th,Business — FRAME Required Inspections
and Professions Code:The o ntracmla
r's License w does not apply m an owner of 307 — I NSULAT IUN P
property who builds m improm thereon,and who does suc h work h imm1l or through his
own employees,provided mat such improvements are notimmakul breached for sale.If. 601 — ROOF TEAR OFF
however.the building or improvement is sold within oro year of oompledon.the owar-
builder MR have the burden of proving mal he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.). 603 - ROOF BATTENS
0 L as owner of the pmpeny,am exclusively contracting with limned contractors to 604 - ROOF IN-PROGRESS
construct the project(Sec,7W,Business and Professions Cade:)The Comrscmri Lt
arse Law does not apply to an owner of Drepeny who builds or improves thereon,and
who contracts for such projems with a co un cmr(s)licensed pursuant no the Commeloes
License Law. '
❑ lamsmmytundersee. .B&PCforthismason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 threby affirm under penally of perjury one of the following declarations:
I have and will maintain a Certificate of Conant rose r-insure for Worker's Compere
.,on,as provided for by Section 37011 of the labor Code,for the performance of me
1M31,00
rk for which this permit is issued.
1 have and will maintain Workers Compensation Insursom,as required by Section
of the labor Code.for the Performance of me work for which this permit is issued.
y Worker's Comp enation Insurance carrier and Policy number sm:
rrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectiw wed not W completed truths Permit is rrrow hundreddollars(510()
or to..)
1 certify that in the performance of the work for which this permit is Issued,l shall not
employ any Person in any manner se u to become subject to the Workers'Compensmon
Laws of Cali(o .gam
APPlicam 6a (�
NOTICE TO APPLICANT:If,afar mating this Cod inns of Eaemptian,you should
became subject to dw Worker's Compensation previsions of the tawr Code,you most
�z foonwith comply who such pmvisinru or this Permit shall w deemed molted. .
ZO CONSTRUCTION LENDING AGENCY
F I hammy al that them its construction lending agency or the performance of
rl F�-m the work fur which this Permit is Wood(Sm.3097,Civ.C.)
W Q Lender's Name
D
z Lender's Address
U Q 1 certify that I have read this application and sum that the metro information is
W L✓ correct.T agree to comply with all city and county ordinances and stale laws totting to
0 U building construction,and hereby auhodre representatives of this city to enter upon due
r W above-mentioned properly for inspection purposes
04 (We)agree to save.Indemnify and kap harmless the City of Cupertino against
Uzee in consegwwe of the granting of this permit.
,o) liabilities,judgmants,mmi and as,.which may in soy way a.against aid City
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: Date
SOURCE REGULATIONS.
f fu,.—, R 1-6L4hwt( S- 2•n� Re-roofs" Signal..of ApplicanVComratm Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle halamous material
as defined by me Cupenino Municipal Code.Chapter 9.12,and the Health and Safety
COJa,Sccuon 255324)? All roofs shall be inspected prior to an roofing material beim installed.
El yes r-1 No
P P Y 8 g
Will the applicant or rumure Wilding=upon,use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Ir hnardous air mourn.anta as defiwd by the Bay Area Air Quality Management all new materials for inspection.
Disuin7
❑Yes ON.
I haw mad the hanrdtusmateri5,25533remc 5534.1rChapterd.95e(thc Calding n _��v.w
rias not �entlyCodc.how4 Would,that
res andbilq.1 understand to nourftoccucwifihe r!V L`l S
Jots not currently has a tenmcl mu it u my resp.f.c ni c w oro cc panty. of me
roquirt cru which muslwmm pdorwissuanm ofa Ccni(ream of Occupancy. nature of Applicant Date
caner nrantherlSd agent - Dale All roof coverings to be Class "B"or better
Community Development Department
� Building Division
+5 �tiI City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPS TING
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 A" 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: A /atv ^�� I
Job Site Address: `t`? U�w�ccJ Y
Roofing Company Name: owk e P`
A plicanYs Signature: Ta1L6O', Date:S-2-63
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF o3 °s-°
• CUPEII`TINO PERMIT APPLICATION FORM
APN# C p 2 L Date: L C�
Building Address: JG
-7 L/ d Zk) tv 5 C)
Owner's Name: 4L ¢c)� q Phone #: / _ 3 L'
Contractor: ,T J Phone#: License#: `7 tP
Contact: l Phone#: ^ 3 y y Cupertino Business License#:
N Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ ilt-Up roof
❑ Asphalt Shingles ®' Asphalt Shingles
❑ Wood Shakes E3Wood Shakes
p Wood Shingles ❑ Wood Shingles
❑ . 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 Polic
Job Description: n/, ` C
Residential (�'l`n 1Commercial` ❑
Fire Zone: . Yes ❑ No ❑ Confirmed with Planning D,_ept. if
there are an restrictions: u
Cost of Project �v OU Type of Construction: Occupancy group:
C.0 c)LS�
Qty. if
RBENERGY
Fee ID Fee Description Fee Group
BPERMFEE TEner
rmit Fees BUILDING
BUILDING
BSEISMICRE Fee Res BUILDING
BSEISMICOM Commercial BUILDING
BPLANCHKeck Fee BUILDING
BUSLIC usness License BUILDING
4 ar76 �
$-/ o7.