03050054 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON TR"ACTURINk'ORIVIATION �
BUILDINGADDRESS: DAN ELLIOTT' S ROOFING CO PERMIT"°03050054
7604 ELDERWOOT) (-T
OWNER'S NAME: 2669 COIT DR PLTIMITISgISBDNT 3/2003
U HA X ET AL 7 1
"E: (408) 559-7327 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
upp LICENSED CONTRACTOR'S DECLARATION -
mp I hereby affirm that T am licensed under provisions of Chapter 9(commencing Job Description
IW wish Section 7ol10)ofDoudion 3 ofthc Budncas and Profcssiom Code,and my license is
„ in fullfosaan Ree ,C Lt..N + 3 -� REROOF
Dg(Z License Clu _r
G care CUnuxmr f. i tt' SIJ�'ti41 tC
F4 ARCHITECTS DECLARATI 'N
shy C� 1 understand my plans shall be uxtl as public meet&
;LLt; LicensedPmfcssianal JUN 0 9 2003
'O:I OWNER-BUILDER DECLARATION
I oroby alarm Nat I am exempt from the Convectors Liecnx Law for thc
00 following rtawn.(Section 7031.5.Business and Pmfcssiom Crum:Any city or county B�'
y w fi which requires a permit to construct, re
ct,alter,improve,demolish, pan
air y structure LDING
Fi< poor in its issuance,also requires the applicant for such permit to file a signed statement
wt he is licensed pursu.mm she pmvismm of me Contmcmla leen,Law(Chapter 9 Sq. FL Floor Area $6Y��Ijtion
(commencing with Section 7000)of Division 3 of me Business and Professions Code)or
i $ that he s exempt therefrom and IW bass for the alleged exemption.My viobgnm or
Section 7031.5 by any applicant fm a permit subjects tbe applicant to a civil penalty of 3_9&X ftuUer0 0 Occu ane Type
em more man five hundred delta.(MM).
P y YP
❑I.as owner°fide propcnY•mmy cmploym wish wagmatheir sole tompensadon,
will do the &-..d mesbUcmte is s mmu ided moUesed fonale(Sec.7044,Business Re��
and Profession Cade:The ConvenMs Lwensc Law don Inst apply m sn owner or 3 0 7 - I NSULAT I'OVd Inspections
property who builds at improves thereon,and who doessuchwork himself orthrou ph his
own employees,provided that such improvements ma not intendee or offered for sale U. 601 — ROOF TEAR OFF
however,the building or impmvemcnt is veld within ons year of completion,to owner-
builder will have the burden of proving Nat M did not Wild or improve fur purpose of 602 - ROOF PLYWOOD NAIL
iile')' 603 - ROOF BATTENS
❑I,u owner of the property,am exclmiwly convecting with licensed coomcbrs m
construct the project(See 7046,Business and Rofassidns cede:)The Connac ars U. 604 - ROOF IN-PROGRESS
came,law does not apply to an owner of property who Wilds or improves thereon,and
who contracts for such project,wit a eamramor(s)licensed pursuant in the Conuam x`3
License law.
❑ I am cxcirpt under Sec. B k P C for this rtuan
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affum under penalty of perjury one of the following declarations:
I law sod will maintain eCutifiote ofComxm Code.
le fm Performance
a ce of the
cation,as provided for by Section 3]00 of Ne tabor Code.fm the performance of the
work,for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
37W of Oc labor Code,for the performance Of the work for which this permit s issued.
My Work5el CompemNon Insurance cannot and Policy number are:
Cartier. .1F%!A Policy No._5n3x =Z
CE IIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mos section need not be completed if she permit Is forone hundred dnlhn(SIM)
or mss)
I emir,Nat in thn perfnrmsncc of to work for which this permit is issued,I shall nut
employ any Pilsen in any manner an u to become mbjces to the WortrKCompemation
Laws of Califomia.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Cenifmare of Exemption,you should
become subject in the Worker's Compensation previsions of the Labor Code,you most
.JO forthwith comply with such provisions or this permit shall be,deemed rewked.
'z CONSTRUCTION LENDING AGENCY
-(-+ I omby allirm Nat More is a comuuchon lending agency for me licrfunnamc of
61: me work for which this permit is issued(Sec.3097,Civ.C.)
Tondo's Namc
= z Lenders Address
U C) 1 certify that 1 have lead this application and stem that to move information Is
L. Pcorrect.I agree to comply with all city and county ordinances and sure laws totaling to
OU Wilding convection,and hereby aumorim representatives of mil city to enter upon me
N L27 move-mention°property fordnspection a.,.purposewhich ms
F y We)agree to aave,indemnify and keep hmrmiess me City or Cupertino against
h Iiebilisopmoc of s.tho g.ti.osts d es penvcomit. very in any way attrx against said City
U z mcoa¢qubIT ofthe Reaming sNis permis.
^ APPLICANT UNDERSTAND AND WI L COMPLY WITH ALL NON-POINT Issued by: Date
REGULATIONS. Re-roofs;CE
le ofApplicanuConuacmr DateHAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wilt Ne applicantm future Wilding occuparoumm or handle harardous material
ed by me Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
ection 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yns �NoWill me applicant or future Wilding occupant use equipment or devices whichIf a roof is installed without firs[obtaining an inspection,I agree to remove
rzrdous air contaminants as defined by the Bay Area Air Quality Maim,ermin all new materials for inspection.
? 1
❑Yes 'YpI Nu
I have read the Wom!cos mvcri ds requirements under Chapter 6.95 of the Cilifor-
'a Hcaim h Safety CUde,Sections 25th)5,25533 and 35534.t understood Ou it Oa Wilding
d of cu Oy W ¢nam,Nat'l s my responsibility m notify IW..pant of die
minists m intpn issuance or aCcmncamafoceapaney. ignature of Applicant Date
cr or auth9sircd egcm D,m All roof coverings to be Class"B"or better
Community Development Department
Building Division
r a'. City of Cupertino
` -a 10300 Torre Avenue
('� CIT. ,Y OF Telephone: (408)777-3228
C i t P E kT 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: �/ ,, UDC/ /�/yyL �-y ,L, �_
job Site Address: 7�'�7 �lCfi�/� �{C4
Roofing Company N e: id g aC ` iro
A plicant s Signatur ate:J� 3
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
NITIY REROOF$CUPRTINO PERMIT APPLICATION FORM
APN # � q7, Date:
r- D j
Building Address:
Owner's Name: one #:
SSLk \ gid
Contractor: Pho #:
l,o s n� L� e5 a -1
Contact: Phone#: Cupertino Business License#:
G.v1 0 C Ly u uNe
Type of Roof Covering:
Existing: Proposed:
O Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Rr Asphalt Shingles
0 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings O t e. O Provide I.C.B.O. Rep( k
0— To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: �q
Job Description:
lrk�\4S �r�l�-�_�(tt�a� LI Yz N spy , t11L (40 --
Residential ® Commercial ❑
Fire Zone: Yes ❑ No [ Confirmed witl anning- t. if
--4heW are an restricf s:
Cost of Pro$ct Type of Construction: cupanc group:
( �
Qty. i '
A a Fee ID Fee Description I ce Group _
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BULLDWG
BSEISMICOM Seismic Cormmercial BUILDING
13PLANCHK Plan Check Fee BUILDING _
BUSLIC Business License BUILDING
2IJ3 3
f Z �. 7