03100118 CITY OF CUPER•I'INO + , "»* tisrax Y•1.mi xf-a' z;yr a'^k
BUILDING DIVISION PERMIT =CONTRACTOR INFORMATION >-
BUILDING ADDRESS: JNSJ ROOFING INC PERMIT No.03100118
2RRO RR-ANC-9 GT BLD G
OWNER'S NAME: 691 W SAN CARLOS ST PER.MTISSUEDATE
NE: 4082796171 SANITARY CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
100 LICENSED CONTRACTOR'S DECLARATION
%roF I hereby Fri.that I am licensed under previsions of Chapmr 9(commencing Job Description
i2with Sccd ] )of vN,o9,d of the Busine a Profcuium Codc.old myliccnsc is
red in Tull fo effe� J t
'q= uanaecin Lk.g REROOF
IF pj Date— eJOlydelnnf
• �\ / A HITECI'S
imp ticrsanJ my plans shall hcuse
>ar V
'0� Licensed Professional
3 OWNER-BUILDER DECLARATION
aY I hereby affirm that 1 am exempt from the Contractor's License Low for the
00 following moon.(Section 703 L5,Easiness and Professions Codc:Any city at court,
f m which requires a permit to cnnslael,altep improve,demolish.or repair any structure
priorm is issuance,also regorms the applicant of such permit to file a signed statement
?So that be is licensed Pursuanutthe provisions oftoContmcloriLimnuLaw(Chapter 9 Sq. Ft.Floor Area Valuation
2t- (commencing wi th Section 90100 of Division 3 or the B acuo,s and Prorcssions Cele)OI 3261 onc;9 o r)
Nat k is exempt therafrom and be bazu for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects be applicant to a civil Nearly of APN NumberOccu ane T e
not mom than Eve hundred dollars(5500). p Y YP
0 I,as owner orthe property.army employees with wages as their sole compensation,
will do the work and the swnure is not intended or offered for sale(Sec,70aa,Business
and Professions Code:The Contactors License Law does nut apply to as owner of Required Inspections
pmpcny who builds Cr improves Neuron,and who doessuch work himself or through his
own employees,provided that such impmvereems are not intended Connected for sale.If.
however,the building Cr improvement is Said within one year of completion.be owner.
builder will have the burden of proving that he did not build or happen for purpose or
sale.). ..
0 1,as owner of the property,am aelus;vcly contracting with licensed contractors to
construct the project(Sec.9D1a,Business and Professions Code:)The Contractor's Li-
cense law does not apply on an owner of property who builds or impmru theman.and
who Cii for such projects with a contractors)licensed pursuant to the Comeactori
License law.
0 I.cacmpt under Site. ,B&P C for this .an
O..C, Date
WORKER'S COMPENSATION DCCLARATION
I hereby from under penalty of perjury ane Of the following declarations:
I have and will maimain a Ceadicam Of Consent o self-insure for WmlCompcn-
udan.a provided fm by Section 3700 of the Labor Code,for the performance of the
work fof which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,u required by Section
37W of rite lalwr Code,for the performance of the work for which this permit is issued.
My worke Cgmpewtion nsunnce carrier and Policy number
Ca cr. �'1�-1— ^ Pn_�hc,•ff��o1�: I'l am;`i.� 9— -
CoKjifICATEOFEXEM4,-E5>WI0 WORKERS'
COMPENSATION IIR7SURANCE
(Thu section need not Wcomplefed if the permit is for one hundred dollars(SUKB
or less.)
1 ccnlry that in thc pcanrm itme of the work for which this proof is issued.I shall at
employ any person in any manner so res to heeome subject o the Workera'Compensalien
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL arter making this Coal fcate of Eaemp,ion,you Should
become subject to the Worker's Compensation provisions of the Iahm Code,you must
.z fonhvi th comply with such provisions or this Permit shall od deemed mvnkcd.
ZO CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for be performance of
L' the walk fof which this permit is issued(Sec.3097,Civ,C.)
Q Lender's Name
lender's Add.
;J C) 1 emit,that I have read this aplAirinam and Sam that the Shore information is
y F correct.1 agree m comply with all city and county oNin<s and state laws relating to
building connmetion,and hereby nmhorim representatives of this city to enter upon the
N a aboac-mcntidned pmpc ret(an imtccuepurposes.
(We)agree to Save,indemnify and kap harmless the City of Cu,ma.agaimt
N liabilities,judgmcns,toss and expenses which may in any way awac against said City
;J Z MAPPLICUN
of this permit /
ND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date I G
umrRe-roofs
DO MATER S DISCLOSURE Type of Roof
teappcantorfuture W occupant slam m handle haraNuus material
ss rmublsy-0na.puparurp- rental Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Ye
B
withea licam or future building Occupant use equipment If a roof is installed without first obtainingan inspection,I agree to remove
pp P y proem or device which p
it ha.ardnus air comaminans.d recd by the Bay Arca Air Quality Management all new materials for inspection.
,let?
C Yes
I have mad the harndous materials mijammentS under Chapwr6.95 Critic Calirm-
doesnW S�f�lyCodc,Scctrum 25505.255JJ and 2553x.1 untMrstand that if NC FuilJing �O /��/?�
dots not c am.Nal u¢m naibility m nodly de occupant nnf the U
no which muss me riot m issuance !71,11 actor Occupancy nat Applical t e
ner or au .,ied agent p„e erings to be Class "B”or better
Community Development Department
t f� Building Division
r
i City of Cupertino
�4 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
qUPEkTINO
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.
J 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: ctir { no S--46r- 2L2it
Job Site Address: M$p F.zac 0
Roofing CaSignature,
: J�SJ °71 YKr
A phcant' Date: la ISQ 3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
CITY OF CUPERTINO
REROOF
CUPEkTiNO PERMIT APPLICATION FORM
APN # , O .� /'�'� Date:
Building Address: ,� �t
0880 aNc-o �,-f, gld (,
Owner's Name:
C,ti 1� Si''C2 �or
Contractor: P ne#: License#:
J7�sj poc. cJ;.C. `toe zxi—GI7 73 ?980
Contact: VPhone#: Cupertino Business License#:
t�
Type of Roof Covering:
Existing: Proposed:
D"Built-Up Roof ir-'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: a-
Job Description: pp�
1"c«O�c (e) Voo�j' it�S�pl vw J 4Pk w kw�1 — SHv�2cecl $ Ll�
Residential ❑ Commercial 0�
Fire Zone: Yes ❑ No ❑ Confirmed with anning De Cif
there are an estrict* ns: u
Cost of Project: Type of C in Occupancy roup:
;kBPLANCHK
Fee ID Fee Descri tion Fee GrouBPERMFEE Bld Permit Fees BUILDINGBENERGY Ener ILDINGBSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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