03040113 OARCHI��/ENGINEER
OF CUPErrTINO r ' ' - ^� '� ltf •- " a ��' °x"'
UILDING DIVISION PERMIT CO NTIUOT�OWINFORMATION
c2y6DT":ESTATES DR SAHLIT ROOFING PERMIT N0.03040113
NffDE T L AND ETHEL B 10481 DAVISON AVE PERMITISS6a)22/2003
SANRARY NU0.4 CONTROL NO.
(408) 255-5094
ECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O D
LICENSED CONTRACTOR'S DECLARATION
uMreby of oro mat 1 am Lcamcd under pmvi.smns of Chapter 9(commencing Job Description
< ion 70(Xq of DivieionJof the Businvy(and Pmfcssinna Codc,end lee and rrr/ REROOFj� l s .Contract S
If AR llboxce DEC oc /
w U I undersand my Plans shall M used v uMic records t/
6
.perLucnxd Professional O
5 OWNER-BUILDER DECLARATION "J
a y 1 hereby affirm that I Out exempt from the Contractor's License Law for the \7
o O following mann.(Section 7031.5.Business and PrOPesshms Cott:Any city or county
i w E which requires a permit to construct,alma improve,demolish,or repair any structure
prior osis issuance.also requires the applicant for such remit o file a signed sammem
coo that he is licensed pursuant to the provisions of the ComnctudLicense Law(Chapter 9 Sq. Ft. Floor Area $-albi6ion
2�- (commencing with Section TlW)of Division J of the B urine and Proreatnm Code)or
$ mat he u cacmpt therefrom and the basis for the aIIc1td rMnaption.Any violation of
Section 7031.5 by any applicant for a Permit ubjecu the applicant to a civil Penalty of
not mom than fisc hundred dollars($500), 38DN Y0rPhef 00 Occupancy Type
❑I,aa owner of the propcny,or my employees with wages M their sole compensation,
will do the work.and the structure is not inrcnded or offered for sale(Sol.7014,Business 305 - FRAME
and Professions Code:The Convector's License Law does net apply m an conn,of Required Inspections
property who builds or improves Bittern,and who doesauch work himaefor through his 307 - INSULATION
Own employees.prodded the such improvemena arc not intended or offered for sale.If,
h601 — ROOF 'TEAR OFF
however,the building or improvement is sold within on year of completion,me Owner-
Wilder will bare the human arproving that he did not Wild or improve for propose of 602 - ROOF PLYWOOD NAIL
sale.).
Q I.as owner of me property,am eaclumnly convecting with licc=d conn cora to 603 - ROOF BATTENS
construct the Project(Sec.7pC4,Business and Professions Cade:)The Convacmr's Li. 604 — ROOF IN-PROGRESS
arae law does not apply to an owner of propeny who builds or improver Ihemer,and
who contracts for such projects with a contncmr(s)licensed pursuant o the Contractors
License Law.
am cacmpt under Sec. ,B It P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby,Alrirm under Penalty of perjury arc of the following declarations:
I base and will maintain a Certificate of Consent to aelemwm for Worlateseanopen-
Miian,u provided for by Section 37W of the labor Code,far the performanm of the
work for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,M required by Section
37W of the Labor Code,for me performance or the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier Policy Na.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not be completed if the permit is for one hundred dollars(5100)
Ices.)
1 artiry that in the ",rtp nee of L.�arYfm whicM1 this permit is issuetl.1 shall nut
employ that Person A�rmdrnt�as ser hccomc subject m the Workcri Compensation
Laws of Ca irorni
ApPlic I _
NOTIC APP ICANr:Jr.afar making this Ccnificatc of Exemption,you should
bttoto a jeer to Be Work,,A Compensation provisions of the La,,Code,you muse
D z foNi
to
comply with such on,
or this Permit shall be deemed mmkcd.
Z O CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is•con ton ino lending agency I'or the performance of
X the work for which this permit is issued(Scc.3097.Civ.C.)
YLender's Name
Z Lcndcr's Addrosa
Q 1 codify that 1 have read Nis application sad All that be above information H
y H correct.1 agree to comply with all city ad county ordinances and slate laws relating to
0U building conswction,and herebyauthorix mprescrufloes of his City tp enter upon the
LQ aw.e-m,judgad ma.Propertycosts
for inspection purposes.
y (We)agree to sacs,indemnify and keep harmless the City of Cupcnimo against
i,Iz liabilities,judgmentse grading expenses which may in anyway accrue against aid City
J z in consequence of the granting of this permitAPPLICA .
.. SOURCE NT UNTA
AERSN S AN L OMPLY WITH ALL NON-POINT Issued by: 6� Date
uLm of Applicant/Contractor �"�. Date Re-roofs
HAZARDOUS MATERIALS DISCLOSUR4 / Type of Roof
Will the applicant serfutum building Occupant smrcorhandlAA ,ardour material -
as def nod by"o CupeninA Municipal Code.Chapter 9.12.and me Health and Safety
ewe.Scwan zs531(a)7 164. All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will me applicant nr faux building occupant Rae equipment or devices w6xh If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants m defined by the Bay Arca Air Quality Management all new materials far inspection.
vicR
❑Yesan r
Ih&Safet CodOur e,SrdrmsmavrlalsmquimmCn 53a.1 oChapmr6.950fthc Calder, E4� ��
nits HcalNH SafctyCwc,Sauuru 25NIS.Z55J3aw 25534.1 undersand thatifde building
docs am cunondy ban a�pant A it A y resp risibility m n lily tM rccuPant of
xquiremenaw ' a et flour fa Cenifn:me (C y.
are o Applicant Date
Or udit.n,.edagenlD„e All roof coverings to be Class "B”or better
e!� Community Development Department
l Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPS T]NO
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: �& e_ LDS_
Job Site Address: /Z�' 6 e20 6_45-T — ST/4T-S' Alf__
Roofing Company Name: _54#z- c)
A plicant s Signa _ Date:
Greg teel
Building Official
Revised 1/30/03
- - - - _ Printed on Remied Paper
J CITY OF CUPERTINO
REROOF
CUPEf�TiNO PERMIT APPLICATION FORM
APN# Date:- b
Building Address:
�-5 �s �S
Owne ' Name: QLD Pone #:
Contrac r: ` / ` hone License#:
oor
Contact Phone#: Cupertino 7Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles JL Asphalt Shingles
OWood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles t
Cl Other(Specify) Ll Other(Specify) ;�F.-51,OC TML�
Number of existing coverings wb ❑ Provide I.C.B.O.Report#
• I- To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description-
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: 15
Cost of Pro' c 7 oD� Type of Construction: Occupancy roup:
D ,tea F/tea TL
Qty. if
A I• a Fee ID Fee Description Fee Group
EBSEISMICOM
FEE BldgPermit Fees BUILDING
GY Ener =LING
ICRE Seismic Fee Res BUILDING
Seismic Commercial BUILDING
HK Plan Check Fee BUILDING
BUSLIC Business License BUILDING