04080113 CITY OFCUPERTINO �'
BUILDING DIVISION PERMIT CONTRACfTOR IRRR�NF�®RMATION
BQILDINC ADDRESS: LEGACY ROOFING & WATERPRO 'VITT'04080113
OWNER'S NAME: PERMIT ISSUE DATE
TOM Pro PAUT TICH QT In
ONE:
SANITARYND.-' 0 OL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
CT PLUMB MECH
0
LO, LICENSED CONTRACTOR'S DECLARATION Job Descri 10
>; C I heroby affirm Out I am Iiceued under M��yaps of Chapter 9(commencing
�Zw with Sectlon)�)ur Division].f the Busine eM9fdkssiva�Code,antl mylicerve ix
;�= In m0 rani1*11terrem' 6 REROOF W/ SHAKES
L.zon,Gf C Lie.. �' z�s� AUG IW 2004
�^O Da¢ Cunuecwr
ARC IIECTS DELLA N� yJ�/I underwnd my plana ilull be uacJ u Public records �—OIt n
G Licensed Professional
3 OWNER-BUILDER DECLARATION
I hereby affirm shot 1 am exempt from thn Cunuanors License Law for the
00 fallowing moon.(Section 7031.5,Business and Professions Code:Any city or county
m which requires a permit to enmwct.Iowa.imlrow,dcmoltsh,ar Clair any source.
Fiy poor to its issuanc,also requires the applicant forsuch Permit to file a signed statement
< thnhckliecasedlursuanuotheprovionunfdo,ConuacmtslicenxLaw(Chapter 9 Sq.Ft. Floor Area Valuation
h (commencing with Section 7")of Division]ofthe Business and Profusions Cndc)m
Wthat he is exempt IMrcfrom and tax buts for the ill,ed exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 MPI M eWr 0 o Occupancy Type
not mom than five hundred dollars(SKID). sus Pb
❑i,uowncr of the property,or my employees with wegesudwir sole compcnudon,
will do OC work and the structure is outranked or ofemd foraal,(Sec.7014.Business
and Profetswas Cox:The Co ursemre Lianxe Law,does,rant apply on an owner of Required Inspections
property who buildscarimpraws them int.dna he doessuch work himaxaorthronigh his
awn employees.provided Out such improvements are notimanded orafrered for sale.If,
however,the building or improvement is said within one year of compledon,the owner,
builder will have the burden of proving that he did not build or improw for purpose of
sale I.
0 1,as owner of the propcny.am exclusively conuaaing with licensed contractors to
comuuct the project(Sea.7044,Business and Profexxiou Cmc:)The Contruwri U. _
Cense Law dao not apply m an owner of poni who builx or improves daemon,and,
who concocts for such pojecu with a conuamC(a)]iceved pursuant on Oe Contractor's
License law.
❑I sin exempt under Sec. .B&P C for this moon
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby aRrres under penalty of perjury orte of the fallowing declaration:
1 have ctfimw nvw caur
and will maintain a Cdof Comment calf-insure for Workerm
Worker's Compc
worn,u provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit is isxaed.
❑I haw and will maintain Worker's Compensation Insurance,u myuired by section
]100 of the Labor Code,for the performance of the work for which this permit is issbetl.
My ants Compensation /a Cartier and Policy number art:
Ca c
17A 7C NNcI Polity No.:V� S S
CERTIFICATE OF EXEMPTION FRO KERS'
COMPENSATION INSURA
(Thnscetion need nopecomplemd irna,Permit is farone hundred dollars($1010)
r less.)
I certify thin in the performance of dm work for which this cemit is issued,I shell not
employ any person in any member so as In become subject In the Workeri Compcnss0on
Uwe of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Connate of Exemption.you should
become subject w the Worker's Compensation provisions of the L dbnr Code,you must
,J,7, fanhwlth comply with such lre,ibinns or this permit shall be deemed mwkcd.
Z•O CONSTRUCTION LENDING AGENCY
(-. I hcwby affirm that there is a Comwction lending agcmy for the lcriann arae of
!Ythe work for which this permit u issued(Sec.3097.Co.C.)
LG 0 fencer's Name
I, Lender's Address
Z)2
U Q I certify that I have read this application and one Oat the above information is
L[ f-� corco.1 agree to comply with all city and county ordinances and state laws relating to
0(.J building consuuction.and hereby auNerimrepmwntatives of this city to enter upon the
above-mcmroncd property for iupcction purposes
F (WC)agree to saw,indemnify and keep h4mlesa do,City of Captain.against
h liebiliues,jud nU us dna expcm....whichmayinanywayacerwagainstaud City
U Z APPLIC NTc N ERSTVDS ANDWILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
SOL GULATI Q _ 13 --/(
}i Re-roofs
Sino
of ApplicardConuse ate
HAZARDOUS MATE RIALSDISCLOSURE Type of Roof
Will the applicant m future building occupant core or handle hnvardous material
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Alkede.
section 21 1? All roofs shall be inspected nor to an roofing material beim installed.
❑Yes N. P P Y g g
Will the.pphttant or mwre uilJing occupant esu cyuiPment or Jcvicu which If a roof is installed without first obtaining an inspection,I agree to remove
In B ha amous air e..ta...... defined by OC Bay Arta Air Quality Managcmcm al materials for inspection.
'I, I
❑Yes Efl. f
I haw mad Oe haaamous materials myuirements under Chapter 6.95 ordte Califnm
ria Health yCodc,"Com 25505.25533 and 25534.1 understand Nmif Ow huildin �f
dins no y hove a tenon,Oar it u my responsibility w notify the aecupant or L s-
myuire utsehichmusr am(prior wissuance ofaC�yt�at�orpttyp %y. "nature ofApplican[ e
�/ Aj l'
Owner or authon,Cd agent DateAll roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEI�TINO
Building Departpient
JOB ADD5FSS: / _ PERMIT #
1(73ZS T/NGS g�-e OSO I/ 3
OWNER'SN 7Ay S ,.,u/ PHONE '/oma y6-7- o, 3-
GENERAL CO CTOR: FAX #
I am not using any subcontractors:
Si ature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
-Stpet Rock
tle
�/3
/Contractor Signature Date
Community Development Department
M/mvBuilding Division
',; City of Cupertino
: 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
OUPEkTINO Fax: (408) 777-3333
Building Department
artment
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:
Job Site Address: /J 3 Z 5—
Roofing
Roofing Company Name:
A plicanfs Signature: Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Lj G C3 Date:
Building Address:
/037-s— . L5 qv-
-q-Owner's Name: Phone#
Contractor: Phone#: License#:
he 9 /\ Ov��S �dfi� F0LC.5Ca
Contact: Q Phone#: Cupertino Business License#:
j/��1'1- �o✓ YZ2- 3S-3-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑/ Asphalt Shingles ❑/Asphalt Shingles
❑ Wood Shakes ; Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description-
.7/0 csxq-,tC.o �, s� 7 22 ' �/r 4A4 C��-,fs 3 5rh4,-e,
Residential 2— Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Wt. if
there are any restricts
Cost of Project: Type of Cons t Occupancy grou .
Qty-
ca le Fee ID Fee Description Fee Group
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