04050047 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAC�"TOR-INF®ORMATION
BUILDING ADDRESS: WOODS ROOFING PERMIT N64050047
OW NER'S NAME: PERMU MUE DATE
. JIM RALSTON =79-STONE 2004
41 ONE: SANITARY NO. CONTROL NO,
(831) 637-5576
ARCHITEC rENGINEER: BUILDING PERMIT INFO'
BLDG ELECT PLUMB MECH
+p+Op LICENSED CONTRACnOR'SDECLARATION
2�m 1 hereby affirm that 1 am licensed under provisions uof rea Cm ter 9(commencingsI. Job Description
with Section lOW)of Division3af tfe Businw and Praressinnv Crile,and mYli<cnse is
.heyinfill farm and cn s1
q z Licenac Lm.a t 5 3 I REROOF 1 0` AM •C�_S)
z^p Dafe / D Cunlr
ARCHITECTS DECLARA
I understand my plass hall be used a public rttans M^ 2004
DaU
LL tjLicensed Professional
�p j Oat I a.exempt N .de,CoATION �n a
n 0 I hemby.(firm on 1 1. exempt from Ne Contractors License Law her the BUILDING
—p0 which following mason.Permi�1.constr Business and Provee de ov Codcdemolish.
Any city nrcounty
m which its lira a permit m conavud alter,imprtrsu demolish,ar mash any snoctomummer, 9 6 5 0
Uzi
poor in iuiensedpalw re tot he theapplicantor for such Permit ftleasLmdmafemem
< Ihmhcislitt withSemantmthcpmvivision3 ftheB (Chapter 9 Code)
Sq.F[. Floor Area Valuation
a. tha M is ing exempt
Section7000Aand the
Division r duets lied eat and on.Any
Code)or
i�� tiut be u ucmpt thcrtfrom and tbe baso for tiro alleged caetnption.Any violation of
Section T031.5 by any applicant for a permit subjects the.,It ,to a civil penalty of 3 SQIWR 00 Occupancy Type
not more than five hundred dollars(SSW).
❑h u owner of the property,or my employees with wages as their sole cooperation,
will do the work.and the swaum is not immnded or offend fonale(Sm.7 s .Business
and Promotions Code:The Contractor',License Law Goa not apply m an owner of Required Inspections
property who builds orimpmva thereon,and who doessuch work himself ormrovgh his
own employers,provided that auch improvements art not intended oroRered forsade.If.
however,the building ar improvamcnt is sold within one year of completion.the owner
builder will have Ne burden of proving Nat he did not Wild or improve for purpose of
salt.).
I,as owner of de property.am exclusively contracting with licensed contractors to
conswet the pmjen(See.1004,Business and Professions Cade:)The Contractors Li
cave Law docs not apply I.an owner of property who Wilda or improves turm.,and
who coam us for such pmlecu with a eomacmt(s)Iimved pursuant in the Contractors
License law.
❑1 am exempt under Sec. B A P C for this recon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
1 haus and will maintain a Ccmficam of Consent to self-insure for Worloes Compen-
sation,uprovided for by Section 37W of the Taber Code,Tran the par amance of the
work for which this permit is issued.
1 have and will maintain Worker's Covon
mpeauIssuance,o"aired by Section
TW of the labor Code,for me perfatmanee of the work for which this Amis is issued.
My Warkses Compensation Insurance carrier and Policy number am:
Carrier. 3 Policy No.: al"-04-ILf f b
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not becomplcted if the Permit is far one hundred dollars($10d)
of less.)
I certify that in the performance of the work for which this permit is issued.I shell not
employ any parson in any manner w as of become subject to the Worlums Compcvadon
Laws of California.Data
Applicant
NOTPCE TO APPLICANT:If,after mating this Centficam of Exemption,you should
became subject to the Worker a Compensation pmvisions of the tabor Code,you mum
.,Z forthwith comply with such provisions or this Permit shall be deemed rooked.
ZO CONSTRUCTION LENDING AGENCY
(r Ihcrwhichthi Nemcmisarn (Sea.3nknding agency for NC Pcrfurmance of /
14 the work far which Nis permit is issued(Sec.3W7,Civ.C.)
D3 A Lcndcr's Name
'SvLender's Address
VC) 1 certify that 1 have read this applicmim and sum that the above information is
F' coned I agree to comply with all city and county on inames and sum laws relating to
.JU Wilding cmuwction,and hereby sumonee mproeenutiva of this city to offer upon the
0. ,nave-mc e) nedogre property for inspection an keep hs.
We) grom to save,indemnify and keep h y I.atm the City of Cupertino against
F raj) incoitm,waceofth,cauand of this
tmiieh may in anyway came against said City
V Z Acansequenec of the RSTAgrouning of mit Permit.
APPLIC NDERSTANDe AND WILL COMPLY WITH ALLON-POINT Issued by: Date
S EG ATIONS.
ry
Re-roofs
Signature of ppranUConazcmr L Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building oceupmt mom or handle luxurious material
u dertncd by lW Cupertino Municipal Code,Chapter 9.12,and she Health and Safety
ode 0ye.25532(.)? All roofs shall be inspected prior to an roofing material being❑res b� P P Y g g installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it ha,mthm s air contaminants az defied by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Q u
i hava mad the haxamous maferialsmquiremenu under Chapear S95 of me Califon
nia Health&Sdcty Cade,&Cu=u N5.2533and25534.1undcrsuM ifft Wilding ) S ' pa/,
does trot cuncnty a tenant mat it is my mspovihility In mtily the acupam of me T
requ'ancnls IrIh SL be n r. Signature of Applicant Date
S oil
owner auth -ed.ganl Data All roof coverings to be Class "B" or better
o.a vo;�ua� s::of ba b'tld'JYtlY L8G4LI MS INK PAGE 01
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Community Development Department
Building Division
gmang'a City of Cupertino
10300 Torre Avenue
CITY OFTelephone: (408)777-3228
U P E IST I N 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 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: p l I -e,�
Roofing Company Name:
A pIcant's Signature: Date:
Greg teal
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
-a REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # 6 Date:
v J 7 O -4
Building Address:
0 8 OCotNw 4L,-v f\
rLcu�—
Owner's Na � Phone #:
257 - l"73 7
ContractoF: , Pho e#: License#:
60 . 0803 32si3 1
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )!P- Asphalt Shingles
Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Z— ❑ Provide I.C.B.O.Report# '
X, To be Removed ❑ Provide Mfgr.Installation Specs.
v® I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job escription: /
2- l� ''CDS
Residential 1ACommercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are anrestrictions: fi
Cost of Project: Type of Construction: Occupancy group:
9` 6 0 . try
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY EZgy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING