03090111 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � CONTRACTnRyINFQRMATION �,".
BUILDING ADDRESS: ABOVE ALL }ROOFING PERMIT"°03090111
OWNER'S NAME: 700 NORTHRUP ST PERMIT ISSUE DATE
ONE:
(408) 292-4188 SANITARY
ACHITECIyENGINEER: NO. .11 CON ROLNO.
RBUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION ]Ob Description
(� O O
U C 1 hereby affirm that l am licensed under provisions of Chapter 9(commencing p
n with Scmio ]OfN f n3of Ne Bovi�,)EqM.in con ter « I�V�?IREROOF;�� 1L /
l iU l understand my plans shall he used as public records
t � Licensed Professional v
'0,5 OWNER-BUILDER DECLARATION ,
<I I hasty affirm that I am othipt fromtheContractors License Law for the
o O following reason.(Section 7131.5,Business and Professions Cale:Any city ser county
$Ewhich myuires a permit m cahsaun,alter,improve,demolish,or repair any saucmrs
^iy prior In its issuance,also requires the applicant forxach permit to rile aligned stammer
-za thatWislicensedpursuanttotheprovisionsoftheContractor'sLicenselaw(Chapter9 S Ft. Floor Area
1210 (commencing with Section 7000)of Division 3ofthe Business and ProfessionsCadt)or q' Valuation
y$ Not he is exempt therefrom and the basis(an he alleged exemption.Any violation a( 34216068 . 00
Section 7071.5 by a"applicant for a permit subjects he applicant to a civil penalty of .AEN Number
not more man fin hundred dollars($500). - - - - - Occupancy Type . _,. .
D I.as owner of the pmperty,in my employees with wages as their sole compensation,
will do the work,and the sessions is not intended or offered for sale(Sec.706),Business
and Profmions Code:The Contractor's License law docs oat apply to an owner or - Required Inspections
property who builds orimproes menton,and who does such work himselfar through his 307 - INSULATION
own employees,provided that such improvements are not intended oroRered for sale.If, 6O1 — ROOF TEAR OFF
bovion,the building or improvement is sold within one year of completion,the awncr-
builder will baro use mourn of proving that he did not nand or improve far purpose of 602 — ROOF PLYWOOD NAIL
:se,). 603 - ROOF BATTENS
co 1,a mvner of ct Sec.70 am exclusively contractingness and fesss with licensed contractors,on'sm
onsvuct doesojmpplyto1anownerofprosaywhobuidsoriThevesdomor'sLi 604 — ROOF IN-PROGRESS
cense Wwdoesnot shptr can ownerofpmperly who buildsorant improves hereon,and
who contracts for such projects with a contractor(s)licensed pursuant m he Conuacmra
Lienee taw.
❑I am cxcmpoender Scc. ,B&P C fonhix reassert
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pe jury one of the following declarations:
I ban and will maintain a Certificate or consent to sal Mutate for Worker's Compere
avian,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which oris permit is issued.
❑I ban and will maintain Worker's Compensation Insurance,as required by Scetion
J70o of he labor Code,for the performance of he work for which this parmit is issued.
My Workcr's n casvf n[[.so rtmsimicf a/d Policy nin�k . , _
Carries lity No.: //-0
RT1Fi AT-O EXEMPr10NFROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the factors'is farone hundred dollars(S JOB
on Less)
I certify that in the brhom once of the work for which this permit is issued.I shall nut
employ any person in any manner so as to become subjecuo the Workers Compensation
Laws of California.Dam
Applicam
NOTICE TO APPLICANT:If,after making his Cet iBeata of Exemption,you should
became subject to the Worker's Compewtion Provisions of the labor Cade,you most
z forthwith comply with such provisions or his permit shall M deemed invoked.
z2 - CONSTRUCTION LENDING AGENCY
— Ihereby affi,m hat here is a construction Ismdingagemy fm the performance of
35the work fon which this permit is issued(Sec.)(197,Civ.C.)
.y Lender's Name
Z) z Lender's Address
J Q I certify that 1 have mad this application and sum that flue above information is
.L COMM 1 Agree to comply with all city and cpuntY mi inv¢o and slam laws relating to
Z)U Wilding combustion,and hereby arhrriat representatives of this city 10 thus,upon aus
ti dalcove-mentioned property fon inspection purposes,
(We)same m save,indemnify and keep han ness the City of Cupertino against
Z in
equnce Of ti.the costs and cxptnscsmit. they in anyway accmc against mid City
Jz in consequence of the gmnf !this permit.
^ APPLICANT UND DS AND WILL COMPLY WITH ALL NO -P INT Issued by: Date
SOU E REG S.
Si mureofApplicanbConaamorRe Data -roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cul ci or(Muni Wilding occupant sum or handle Health and
as defined io the Cupertino Municipal Cada Chapter 9.12,and the Health and Safety
Cede,Section 25532(a)?
❑Yea .�Svn, All roofs shall be inspected prior to any roofing material being installed.
Will me applicant o fuWre Euildmg impact ase equipment Ordlvxo which If a roof is installed without first obtaining an inspection,I agree to remove
it Wrardnm air contaminants as defined by he Bay Arca Air Quality Management all new materials for inspection.
stria?
DYcs
l baro mad the Wsasl m orshiequimmenu undcrCWpmr6.YS of the Calm
ma Hcahh6S Coda ScctiomnM5,25537am1255Ja.luW n=dthalifthc Wilding
not y have a mnamL that n a any maposs iliry m mNfy ha a pant of dm T
id n which must m met prior w issuance of a Pica¢of cy.
�. Si atureofApplicant Date
Owner or auhoraccd agent Data All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
4 r 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
CUPS TINO
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 o�C�h fQp K
Job Site Address: `8 1 uC{
Roofing Company Name: Ariyyc /qt k gzd(�,!Y So)U-�r t, X
hpliatl sSignature: Date: 9/laps
eel
Building Official
. Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO q
� . REROOF °
CUPERTINO PERMIT APPLICATION FORM
APN# Date:.
Building Address
Owner's Name: Phone
#•
1<0.\0� 1 \
lc�bCoo k ou 2 7 q- z
Contractor:AbaU Phone License :
X41 (ZCdk,� au 2 Y �13s
Contact: Phone Cupertino Business License#:
Type of Roof Covering:
_ _Existing: Proposed:
❑ 'Built-UpRoof - --- -
❑ Built-Up roof
.&b Asphalt Shingles -b Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Xb Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 2 ❑ 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: -k�
Jo4 Desc 'ptio
IVIS
k n L I 4,4-- 0SY3, n tti ll CGvv,
LO
ResidentiaLU Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed wit fining De t. if
there are a restrictions:
Cost of Project: SU6 Type ction: Occupa cy grou
oaf�ff
li bl Fee ID Fee Description Fee Grou
BPERMFEE BldgPermit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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