03030045 CITY OF CUPERTINO ' +'- '
BUILDING DIVISION PERMIT OIVT RAC�`TaR IINFORMMM",
BUILDING ADDRESS: T D ROOFING PERMITNO.
10329 R 29TAT-99 PR
r OWNER'S NAME: 3540 MARGATE AVE. PER FarM%s e A
WE: (408) 892-8872 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
186 LICENSED CONTRACTOR'S DECLARATION O O O O
V 1 hcrcby affirm that I am licensed under provisions of Chapter 9(cnmmencing Job Description
E W with Seadon]000)of Division Sof dee Busnew.ad Prefcuiou Code,and any Became is
?p In full to.and effam. C
,qz Leraccika �- 3 l see.« ��`- REROOF
o DAm�I l o t can a or T/O. 2 LAYERS OF �'O P. /411TSfAA73 W/40YR. COMP.
lq- ARCHIT'F.CrS DECLARATION
l 2 1 understand my plena Shall W aced as public Ron',
)e
`oVff
Licensed Pm(nsional MAR_ 2 7 2003
m Oat I am exempt
from
DECLARATION
<Y 1 hereby.(Sere on 1 am,Business
from Om Comrmroh License taw for the
pofollowing
urresa(SwoonRI31.5,Businessmprve.deinuCode:Any city ofcounty BUILDING
5$[vi which its isu n permit to construct,aalmr.pplicant
Improve,demolish,or repair any swetom
doortoiuiensedp rtu rt to be prevision o for each Conmcmil tofleasigned
aw(Chmment
frommincingwiit purwanuo the of Division
of the Contramar's Llcenussim Chaprer9 Sq.Ft.Floor Area Valuation
sjF (commas exemithscctiorear, it the
basiiofrnftMBusinusmton.A.,uCode)or
��$ thel he b exempt therefrom and Ilm bila for the Alleged exemption.Any violation of
Section 7031.5 by airy applicant for a permlt subjects the applicant Io a civil penalty of APN Number
oat mare than five hundred deltas IS500). - Occupancy Type
0I.umnmofthepropeny,mmyemptoyccswlthwagmutheirmlcwmpeus0on, 36908001 . 00
will do thewmk and theswctum is ret intended or offered forgets(Sea]061,Business
and Pro(estmns Cade:The Cancer;umme Law dun not apply to an owner of Required Inspections
property who builds.,impro adiarwn,andwbodoeeaaehwmk himself.,through his 305 — FRAME
owocmployecs,provided thatmch improvemenmafc not intended reoffered fmwk.If, 307 — INSULATION
however,the building or improvement Is sold within me,year of mmpledon,the owner
builder wise have the human of proving that M did not wild or Improve for purpose of 601 — ROOF TEAR OFF
01.as owner of the prapcny,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
construct tam pmject(sec.7064.Business and Professions Code:)The Coma ers u. 603 — ROOF BATTENS.
cense law dose not apply to an owner of property who wilds or improves themen.and 604 - ROOF IN-PROGRESS
who contracts for such projects with a matractor(a)licensed pursuant o the,Contramem
Lkenu law.
❑I am exempt under Sec. ,B&P C for this Mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby grim under penalty of perjury ow of the following dealuauons:
I hese end will mm nti
eintsin a Ccruficaof Commao self-insure for Workers Compen.
action,u provided for by Section 3]00 of Ne later Code,far the parformance of the
weak for which this Permit is issued.
I have and will maintain Worker's Compensation Insurance,As required by Section
W of the labor Code.far the performam,of Ne work for which this Permit is issued,
My Workers gorepenntion Insurance carrier and Policy number art:
Cartier. S «� tssslek Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(]blsaceflon readout beeompimed iOhe permit is for...hundred dollars(SI(Kh
or leu)
1 cenify that in the Performance of the work for which this permit is uo md,I shell not
employ any person in my manmr An As to become subjectto the Wohers'Compensedun
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificem of Exemption,you should
become subject to the Worker's Compensation provisions of the tabm Code,you mon
D fuMwith comply wit such provisions or this permiuhall he deemr4 meted.
Z O CONSTRUCTION LENDING AGENCY
1 wmhy arum that then is a construction lending agency for the Performance of
x r thc work fur which Nis permit is issued(Sec.3W],Civ.C.) .
4 lender's Name
5 z, Unita'.Add.
J Q 1 unify that 1 have read this application and sum Nn the Above information is
i F
corneal.1 Agree to comply with all City and county ordinances and atom laws Rlating m
"JU building construction,and hcrcby auRtortm representatives of this city in enter upon the
W above-mentioned property for impaction purposes.
,r W (We)agree to save.indemnify and keep harmless the City of Cupertino against
14 Ilabilities,judgmcats,costs and expenses which may in any way acerae against said City
J z in consequence of the grmling of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b
SOURCG y: Date 3 (( I 03
E qRfEEATIONS.
lA, d6'a 3/it Io3 Re-roofs
Srgoanor of AppIMmn antrum,G-,` Data
HAZARDOJBAATERIALS DISCLOSURE Type of Roof
Will the applicem ser future building occupant seam orhandle hastrdous material
AS defined by the Cosentino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(q]
pYn , All roofs shall be inspected prior to any roofing material being installed.
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 h4mdous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
Wrier? Asn
❑Yes NV 6
lhave rod the hauNous maOrialsmquimmcnuunder Ch,p 6.95of Ove Califm- I 1 1
nufmalth&SafetyCadc.SenioMM505,25533 and 25534.1 undermad Ilan lithe wilding I��l—X^j(p /; 3 / (( I J
Jon not currently haw a mnan4 Nur it u my msp osibility a madly the mcapanl of two �/ t UGLVV
mquimmcnu a mustwmetpoortoiuummar&cmuOnmor0c n. Signature of Applicant Date
r G Lti9_9 37I l .s
Owner orauthonmd agent Date All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C U PE 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: i C\ W e.1l ko
Job Site Address: I 2 C) 1E_
Roofing Company Name: f t D 91
Alicant's Signature: X Date; / / I �3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper