04020136 - CITY OF CUPERTINO '' a = W, A6 = 41
BUILDING DIVISION PERMIT CONTRACTORIIYkORMATIgN�
BUILDING ADDRESS: MARTIN WOODROW PERMIT"04020136
OWNER'S NAMEETT,j(-T4 A177: PERMIT ISSUE DATE
NIA
ONE: SANITARY NO. CONTROL NO.
ARCHITECI'MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 o I1 o
upp LICENSED CONTRACTOR'S DECLARATION
F I hcmby affirm IMt I am Immo d under pmvivans of Chapter 9(commencing Job Description
nzl`uj with Secuon7")of Division Sof she Busineu and Pmfcssass,Code,and my Ikons is
s
fartendcfca
REROOFDicense Class Lic,g
A' atc Contractor
ARCHGL7S DECLARATION
-
Dw U I understood my Ponos dull be used iso public rtcords !� '
w
o G Lwcmsed Professional J
3OWNER-BUILDER DECLARATION
<Y 1 hereby strum that I am exempt from the Contractor's License Lew for the J`
a O following reason.(Sccuon 7031.5.Business and Pmrcesium Cole:Any city or county
$ which rtquires a permit w cnnswct,slur,bnpreve,demobh,fir aped,any awctua
FIy prior to its issuance.also requires the applicant for such Permit to Me a signed statement
< that heialicensed pwNu
anotheproasionaofutecontactorlx<xLaw Sq.Ft. Floor Area Valuation
a (commencing with Section 7")of Division 3 of the Business and Professions Code)or
Wthat he is ezempt therefrom and Bu baso for the alleged exemption.Any violation of
Section T031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3'I0i&Ibet00 Occupancy Type
not mom Than five hundred dollars(BRIO).
❑1,a owner of tion pmpeny,m my wployeh with wage u Their seta comp.wuon.
will do the work,and the he Contra not i Licera or a w do Tortola(Sac.to a4,ewinm
and Professions Cade:The Comadon.License Law tach not apply to an owner of Required Inspections
Progeny who builds or improves thereon,and who docs such wort himself m through his
own employes.provided Wilding
orI Nat such improvements wit art not ear dedofo oroRerW forreadaWe ow.r.
however.the buildingorimprovementis soldwithinet Karofmmpkum.theeoncr-
W ilder will love the burden of proving wt W did net build or improve for puryax of
Ie.).
� as mover of the progeny,em asclusively care ing with licensed consumers w
it
the project ISec771a Business and Poohnsions Code:)The Cmuaclar's LL
nae hw tams at apply u an owner of pmpeny who builds or improves thcaon,and,
who contacts for such pmjects with a commelor(s)licensed Pursuant to the Conuaems
License law.
❑loon.., ..do, .B&P C for this moon
wider Data 011—
L' WORK -SCOMPENSATIONDECLAR'ATION -
1 hereby sOire under pandly of perjury arc of home following elalantions:
I
his
and will mountain•Ccruricau of Cartxm m self-insua for Worker Compen-
tion,u provided far by Section 3700 of We labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maimain Wmker's Compeevat ia.Insurance,as required by Scedim
3700 of the labor Code,for the performance of die work for which his permit is issued.
My Wormi's Compm odan I===carrier and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TMs section need not becomplcmd tithe pemtit is foram hundred dolleran)(0)
or Iess.l
1 acidify than in the Performance of the work for which this permit is issued,I shell not
employ any parson in any manncrso as to Wcomc subject to the Worters'Compensadon
Laws of C.Iromia Data
Applicant
NOTICE TO APPLICANT:If,after making this Car ificate of Exemption,you should
hecome suhjmt to the Worker's Compensation provisions or the Li Wf Code,you a=
.,Z forthwith comply with such provisions or this permil shall be deemed revoked.
zCONSTRUCTION LENDING AGENCY
[-. I hemhy affirm that Wer0 iso construction lending agemy far the pmrmmantt of
C the work for which Nu permit is Wood(Sec.3097.Civ.C.)
f31 Landers Hams
fL Lcnd,es Address
az
V 0 1 modify that 1 have mad his application end sum Nat the shove information is
D. P enamel.I agree m comply with dl city and county ordinances and aus laws alining m
O V building eommuction,and hereby audorim mpmxnutives of this city to curer upon the
above-mcntienu l Propeny far inspection Purposes.
(We)agree w ave,indemnify and keep harmless Ne City of Cupertino against
, Liabilities,judgments.chts and expenses which may in any way accmc against aid City
L)Z me......moor the gr gmf this permit.
�' APP (CANT N ANDS AND WILL COMPLY WITH ALL N N-POINT Issued by: Date
SO E R S. /y, ,,/
/X/0y Re-roofs
uua of Apph anUConuacmr --T Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sure or handle hxvardoua material
as def and by the Cupsnim Municipal Code.Chapter 9.12,and the Health and Safety
"IMLcude,Sccu zss3xdn No All roofs shall be inspected prior to any roofing material being installed.
Will the applicam or�re building occupant uta equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
IV Plant hazardous air contaminants as de0ned by the Bay Arca Air Quality Management all Bew maters Is for' spe tion.
District?
Dyes No
I i&Sof l the havaM, .255(1..25533 mcnts under deme n than f du Calif., ✓/
mini ealth&Bmf tyCaM, ns25505.25537 and 25534.1 understand thaziflM Wilding L/
I
It'urtc ha 4 thm itismyasportsihilityluoou ly tau eupan of Nc
req me a� netpriorwiaaaanacaracmtirmamor ��yo Si atureofApplicant Date
mer m itudmixad e,em Dat, All roof coverings to be Class"B" or better
CITY OF CUPERTINO o a o
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 (�o 0 Date:
Z d
BuildinAddress:
� &el�
Owner's Name i , t p �#; 45
-2
W6�rG�Nb`1J c�
Contracr: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
�❑ 1� Wood Shakes 11 Wood Shakes
7' 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:
Residential IPL
Commercial ❑
Fire Z ne: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: L1
Cost of Project: ` Type of Construction: / Occu)ancy, oup:
Qty. if .
A li a 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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
4 CITY OF Telephone: (408) 777-3228
U P E Ill I N® 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: AdVlllt^'� Uj��r"Vu"`�
st
Job Site Address: /O YJS—�''I AAh�i�'I Ale,
Roofing Company Name:
Applicant's Signature: Date: 41-PO
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper