03010207 CITY OF CUPEwrINO
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' BUILDING DIVISION PERMIT CONTR'ACTOR4NFC1RMATION•
1 °d. f' [• ,
BDILDINc noDlxrssADVANCED ROOFING TECHNIQUE PERMIT NO.
7519 DUMAS DR 03010207
OWNER'S NAME: 1179 MYRTLE DR APPLICATION SUB DATE
MR & MRS HOLB 01/31/2003
ZONE: (408) 249-4937 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING P17RMU INPO
BLDG ELECT' PLUMB MEGA
0 0 o
eX00 Lm that I CONTRACTOWS DECLARATION
F e hereby affirm that 1 am licensed under provisions or Chapter 9 s,ficencing Job Description
with el ]g10)of UivisiunJof NC Busin sant Professions Cole,unJ mylicense is
moo. mlul and effect REROOF
ZC na L' nae I �q Lic. 9 S
F_�� a I".— —Com &'ossa p� T/O WOOD SHINGLES, INSTALL COMP. 30 YR. SHINGLE
ARCHUTICT'S .ARATION
aSy ie< 1 undemanU pl{pq ons shall ba used as public records
d\1GQ�-
3u.� Lice�nscdBPnmfcssinnal
OWNER-BUILDER DECLARATION
fy. I 1 hereby affirm that I am exempt from the Contractor's License Law for the
4100 following reason,(Section 7031.5.Business and Professions Code:Any city or county
ad m which requires a Permit to consumer,alter,improve,demolish,or repair any structure
Fiveprior to its issuance,also requires the applicant for such Korea to rile a signeJnamment
Nat he is licensed pursuant in the pmvisioruofThe Cnni=ti)rkLice use Law lChapter9 Sq. Ft. Floor Area Valuation
Ho (commencing with Section 7000)of Division 3ofthe Business and PnslcasiunsCode)or $7000
Out he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fur a permit subjects the applicant Ina civil penalty of APN Number Occupancy Type
not mom than Five hundred dollars P$500). 35924046 . 00 P Y YP
C]1,as owner of the property,or my employees with wages as their sole compensation.
will do Ne work,and the swaum is not intended or offered for sale(Sec.70,14,Business
and Professions Code:The Contractor's License Law does not apply In an owner of 305 - FRAME Required Inspections
property who builds or improves thereon,and who docs such work himself or through his
man employees.provided Nat such improvements we not intended or offered for eslc.If, 307 — INSULATION
however,Ne building or improvement is sold within one year of completion,the owner-
builJer will have the burden of proving Nat he did not build or improve for purpose of 601 — ROOF TEAR OFF
salt,1 602 - ROOF PLYWOOD NAIL
lkf ❑I,as owner of the property,am exclusively contacting with licensed contractors In 603 ROOF BATTENS
conmct mthe project(Sec.7(144,Business and Professions Code:)'Ihe Contractor's Li
cense law does not apply to an owner of property who builds or improves thereon,and 604 ROOF IN-PROGRESS
m who compacts forsuch projects with a conlractons)licensed pursuant to the Contractor's
License Lew.
❑1 am exempt unJer Site B&P C for this reason � p
Owner Dam 0=9IM 006%LED
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: JUL 2��3
1 have and will maintain a Certificate of CnnNmI In self-insom for Worker's Compere
sation,as provided for by Section 376(1 of the labor Code,for the Performance of the
work for which this Permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance,as required by SCCLRm BUILDING
3700 of me Labor Code,for the performance of the work for which this Permit is issued.
My Worker's Compensation l sumnce rn.,and Policy ny"h�er inc:
Cch 5.114 UNe� policy
Pin:Sd]_'IQ_���
7` CERTIFICATE OF F.%EM Pr10N FROM WOR KERS'
COMPENSATION INSURANCE
(Dissection n need no be completed iRM permit is fornne hundred dullam o 0fl)
or less.)
I ccniry that audit,sero mance of Ne work for which this Permit is issued,1 shall not
employ any Person in any manner so a to become subject o the Workeri Compensation
Laws of California.Dale
Applicant
NOfICETO APPLICANT:If,after making this Cceiricau of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor CnJe,you must
O z forhwith comply with such provisions or this permit shall he deemed revoked.
z 0 CONSTRUCTION LENDING AGENCY
[-� I hereby affirm that there is a conswction lending agency l of the performance of
C' Ne work fur whichmis permit is issued(Sec.3197,Civ.C.)
{al Q Lender's Name
C Lender's Address
� z
U 0 1 certify Nat I have read this application and sure that the alwve information is
LL F. correct.l agree to comply with all city and county ordinances and sWm laws relating to
0 U building construction,and berchy authorim representatives or Nis city In enter upon the
W4 above-mcnfioned property for inspection purposes.
IWe)agree to save,indemnify and keep harmless the City of Cupcmav,against
FF-I h liabilities,judgments,costs and expenses which may in any way accrue against said City
U z in consequence of the graining of this permit.
PPLICANT UNDERSTANDS AND WILL COMPLYITH ALL NON POINT Issued by: Date
UR REGULATI
9 V 3l^o? Re-roofs
Signature nr Appheanvenntmem,r Date
HAZARDOUS MA7'1?RIALS DISCLOSURE 1�pC Of ROOF
Will Ne applicant of future building occupant store or handle hamadnus material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
nue,section 35532m)] 1 All roofs shall be inspected prior to any roofing material being Installed.❑Yes *o
3 Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
it hazardous aircnnmmivants as dclined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No
1 have read Thu hamrdnus mamrial.s requirements under Chapter 6.9.5 of Be Caplin-
due,aal emSolelydhaveca Luar ,that it
my 3 and255341 understood that o of the
due,nfla& ndy haveatenant that is553 and 2553 it 1 umomit'dt tit Le, tdding
regmmmems whit must et prior loismomero actaireatemam:aP Signature of Applicant v Date
obo07r authorized agent Bate 0 All roof coverings to be Class "B" or better
1
Community Development Department
Building Division
�� =6 City of Cupertino
ter" 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkT1NO
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: M (Z VA R S 4 O � h
Job Site Address: S' 19 -1) y m !4S �Q
Roofing Company Name: 41 V�ANrep R w T t Kq
A plicanYsSignature:
\�lR6USLXXI -
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper