03060177 a CITY OF CUPER FIND
BUILDING DIVISION PERMIT X�ONTRACTOR INF.ORMATIIO
e BU ILDING ADDRESS: WOODS ROOFING PERMIT NU 03060177
OWNFR'S NAME: 2179 STONE AVENUE STE 22 PERMITISSUEDATE
GENE YOUHN(",
ONE: NO.SANITARY N0. ONTROL
(831) 637-5576 C
ARCHITECTIENGINCER: BUILDING PERMIT INFO
BLDG ELER PLUMB MECH
+O0 LICENSED CON-FRACTOR'S DECLARATION
.51
Section
heresy arson that 1 am licensed under provisions or Chapter 9(commencing Job Description
tion Wall))or Division 3 of dm Business and Professions Code.and my Hearst,is
in ruumma 6,deD 3T -2- 1-3 1 REROOF
�_ License Lie.0
ZZ ARCHITECTS DECLARATION IIS B�t 1� y H
K U 1 understandmy plans shall be used as Public records ate/
oe Located Professional JUL 2 4 2003
g OWNER BUILDER DECLARATION
<f 1 hereby affirm that I am exempt from the Contractor's License Law for the
p o following reason.(Section II31.5.Business and Profession Code:Any city or county
5 m which requires a permit m ammnruct.alter,improve,demolish,or repair any nmnure
prior mics issuance.also requires the applicant rot such Permit to rile a signed statement _
ESG thot heislicensed pursuant tothe provisions Ofthe Contootor'sLicense Law(Chapter 9 Sq. Ft. Floor Area aluation
yt- (cont nearing with Section 7000)of Division 3 of the Business and Professions Code)or
y $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of 36923028 , 00
Section7031.5 by any applicantto,.permit subyrw the applicant to a civil penalty,of APN NumberOccu ane T e
not more than fico hundred delta.(S50W. P y YP
❑I,as Owner of Ne property,Or my employees with wages as their sole compenmion,
will do the work,and the structure is not intended or offered for sale(Sea 70aa,Business
and Professions Code:The Connectors License Law docs not apply to in owner of Re wired Inspections
propeny who builds or improv themon,and who doessuch work himselfor duuugh his 307 - INSULAT l-ON
own employers.provided that such improvements arc not intended or offered mrsals.If, 6O1 — ROOF TEAR OFF
howrveq Ne building or improvement is sold within ore year of completion the nwnco-
builder will have the burden of paving that M did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
as owner of the 603 - ROOF BATTENS
❑ (Sec.
ec.7 .B sines and contacting with licensed convenors i-
comma does jot applytooan.ensinwanartywhioruCOorJThemthe on.anLi-d. 604 — ROOF IN—PROGRESS
ewho Law auto not to an owner of papcny who wits or improve thereon.arta
whor contracts for such projects with a comrutor(s)licensed pursuant to the Contractors
Lkc m Law.
Q lam ncmpt underSec. ,B&PC for this resspn
Owner Date
WORKER'S COMPENSATION DECLARATION
I thereby affirm under penalty of perjury mm of the following declarations:
1 have and will maintain a Ccnirinre of Consent to sdf-insum for Worker's Compcn-
motion,as provided for by Section 37M of dm Labor Code,for the performance of the
�wtork for which this permit is issued.
ttl�Lnave and will maintain Worker's Compensation Insurance,m required by Section
7700 of Ne Labor Code,for the performance of de work for which this permit is issued.
My Workers C�ry�-pcnpsation—Ilnsurance articnnd Policy number a¢:
Cartier. �'�la.. T t"'�� Policy Na.:�&S
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section aced not W completed if the Permit is for one hundred dollars IS 100)
Or]a.)
I cendy that in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner in as to become subject to the Wmk(ai Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,alter making this Cri iOcam of Exemption,you should
become subject in the Worker'a Compensation previsions of the Labor Code,you must
.J z forthwith comply with meth rowbinm or this Permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
F IWrehy-Rom Nat there it.construction lending agency far the perfurmarae of
W the work for which this pnmit is issued(Sec.3097.Civ.C.)
W Q lender's Name
7 z 1<nder's Address
V Q 1 certify that 1 have mad this application and show that the above information is
I, P: correct l agme to comply with all city and county ordinances and all laws relalingto
pU building coOSLOOCion.and hereby mthorne mroommativ.-s of his city to enter upon the
W tbove-mciamind Property for iapecuon purposes.
U G.
(We)agree to save,indemnify and keep harmless the City of Cupertino against k—
Signature
IRI liabilities judgmcret.costs and expenses which may in any way accme against said CiqA PLIC NT ofdmgranting Of this Permit.V zSOURCE GULADTIO TANDS AND WILL C MPLY WITH ALLp ON-POINT Issuedby:L/ Date Re-roofs of ApphcanUContnctoJ Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant in future building Occupant store or handle hazardous material
as FZcl by the Cupenino Municipal Code.Chapter 9.11,and the Health and Safety
alc.5[cnon 15531(a u
❑Yea �No All roofs shall be inspected prior to any roofing material being installed.
Will thea scant or future WBdin oma equipment If a roof is installed without first obtaining an inspection,I agree to remove
OP s prem y A a ant or devices which g
it haramous air contaminants ss defined by the Bay Arca Air Quality Management all new materials for inspection.
District? '
Q Yes �61 No
I have mad the WaaNnus materials requirements under Chupmr 6.95 of the Califor- �J
uH.1 ctiSafety Coe,SactOmanth. , imyhand 25534.1 umorytthuifthe Wilding
donsecth&Soot have,tanto Nmms 0, 553 andmibllity unnosfy the p t fine /✓ pj //
nountrcnn which mon met 'onoom n of a Cetufiew Or Op[u nCI� Signature of Appli t Date t
Is 7 g, Q�
Owneroraahorinwdagent D„ All roof coverings to be Class"B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408)777-3333
UPEkTINO
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: cc.
ff
Job Site Address: 1076
/ W
Roofing Company Name: s
�>
A plicant's Signature: 7J ('L�c/ Date: /' o2d 03
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o� G -7 7
- REROOF
CUPER INO PERMIT APPLICATION FORM
APN# 3 (�o 9 ?, 3
g Date: /� L
Building Address:
Owner's Name: Phone#:
Contractor'
ontracto�YL¢
r� 5 Phone#: �O-D803 License#3 -2-5131-2-5 1 3 I
Contact: Phone#: Cupertino Business License#:
_09/0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles `d Asphalt Shingles
'�L Wood Shakes ❑ Wood Shakes
& Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings `L-- ❑ Provide I.C.B.O.Report#
W To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job escript n: f �/� n •T r
O ec>d i oSB, Vl � elO n
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: lJ
Cost of Project:oa Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
H BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
-� BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING