03100125 CITY OF CUPERTINO x^" ` n
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
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BUILDING ADDRESS: JNSJ ROOFING INC PERMIT NO.03100125
R'S NAME: (91 W SAN CARLOS ST PERMIT ISSUE DATE
16/2
)NE: 4082796171 SANITARY NO. li� CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELF.Ci PLUMB MECH
His
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100 LICENSED CONTRACTOR'S DECLARATION ��/�+a,�5�
:Cap I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing tl EUD
iiw wilhfcequn 90(Np of Di "onJof NC BuVFp.xand Professions Code,and my license is
in f IJJIf cc andyyr!�(<n�.q p /—
;q? LV«nxGlavaS�Z�Lie.n REROOF OCT 2 9 ZOOS
;;C, Date Cun racmr
ARCHIr le"
RATION
C;C �I node Ice d my plans shall M us Tic recnrJs BUILDING t� (� ���IBI�,�}��I
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401 OWNER BUILDER DECLARATION
1<$ henchy mrirm that an exempt Imre the Contractors License Lew for the
p o to ing reason.(Section 7101.5,Business and Professions Code:Any city or county
j m w im requires a permit to construct,alley improve.demolish,or repair any.arunure
poor In its issuance.alsu requires the applicant forsuch Permit o rile asigned statement
< that he is licensed pursuant to the provisions of the Contractor's License,Law(Chapter 9 Sq. Ft. Floor Area Valuation
sFo (commencing with Section 0!1!10)of Division 3 of the Business and Profcssiem Code)or
s Nat he is tempt thcmfrom and the basis for Ne alleged exemption.Any violation of
Section 703l.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan five handled unit...(S500).
I,ss owner af,hC or my employees wish wages as their sole compensation,
will do she work,and the structure is not intended or offered for sale(Sec.lOaq Business
and Professions Core;The Contractor's License law does not apply to an Owner of Required Inspections
property who builds or improves thereon,and who does such work himself orthmugh his
employees,pmvidcd that such improvements arc not intended oroRemd for sure.If.
however,the building m improvement is sold within one year ofcompletion,Ne Owner
builder will have the burden of proving that he did not build of improve for purpose of
salt.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
answer the project(Sec.RHa,Business and Professions Code:)The Contractor's Li.
arse law docs not apply to as owner of progeny who builds or impmves themed,and
who Contracts for such pmjcca with a contractor(s)licensed pursuant to the Convector.
Liccnu Law.
❑1 am exempt under Sec. .B&P C far this reason
137MDale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury One of the following declarations:
ave and will maintain a Certificate of Consent to self-insum for Worker'sCumpcn-
,n pmvidcd for by Section 37M of the Labor Codc,for the peommon nce of the
for which this permit is issued. ,
have and will maintain Workers Compensation Insurance,az required by Section
of Ne Labor Code,for Ne performance of the work r which this pe.i,.s issued.
alker's Cnm natio tonne earticr and Poh her ase:
r.�Policy e:weYS443
CERTIFICATE OF Mm MON FROM WORKERS'
COMPENSATION INSURANCE ,
fITH scClim aced nm becompleted ifft permil is forode hundred dollars ulfp)
or less.)
1 CCmrY that in the performance of the work for which this permit is issued.l shall not
employ any person in any manner s r as to become subject to she workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.tiler making this CenlOcalC of Exemption,you should
become subject to the Worker's Compensation provisions of the Ltl Cole,you must .
z foMwith comply with such mrosisions Or this Permit shall he dcemc l rovok,d.
Z O CONSTRUCTION LENDING AGENCY
1 hereby affirm that dere is a consvuction lending agency for Ne performance Of
Ld ti the work for which this romir is issued(Sec.30,0.Civ.C.)
+1 Q Lender's Name
Lender's Address
�z
0 1 comfy that 1 have read this application and some that the above information is
E-' correct.I agree to comply with all city and county ordinances and state laws relating to
�U building construction.and hereby amhorive rtpmsencives or this City to enter upon the
C ahave-mentioned property for inspection purposes,
(We)agree to save.indemnify and keep harmless the City of Cupertino against
r fA liabilities,judgments.costs and expenses which may in any way aecsue against said City
J z APPLICANT NDERSTANDSIAND WILL COMPLY WITH AL ON-Po1NT Issued by: Date /
SO CE R ATIONS.
Ills Re-roofs
gnu pplicaH ZARDOUSMATERIALSDISCLOSURE ate Type of Roof
Will applicant or future building Occupant store or handle hatarduus mammal
as fined by the Cupertino Municipal Cook.Chapter 9.12,and de Health and Safely
e, 0 en:ss32(an a.L' All roofs shall be inspected prior to any roofing material being installed.
�YCS I1L nu
Will thea ficadl or future building Occupant use e t or device,which If a roof is installed without first obtaining an inspection,I agree to remove .
pp 6 p yuipmen
I it haiafdnus air contaminants as def cd by the Bay Arca Air Quality Management all new materials for inspection.
v Dourtrr
Yes Nu
I have mad the hvardnus materialsmquirtments under Chapterti.95 ofthe Califm-
mix Heald&Safety Cole.Semon,25505,25533 and 25534.1 understand thatf uh.Mai Wing
docs not currisoy have a Imam,that it is my resporwiml.ty to n IY the tv'cupant of do
Mquircmcn h' hmuslbemetpoormissuanceofaCCNhcat . nor Signat of plicant Dto
ownv eat oracetgent �jp Date All roof coverings to be Class "B" or better
r� Community Development Department
Building Division
({ City of Cupertino
10300 Torre Avenue
� I pCIITY OF A I Telephone: (408)777-3228
C U P S I I V o 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.
P PP
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: �Ve
Job Site Address: (a 880 rrphc0C+.
Roofing Company Name: JNSJ (�o f Y^C•
Applicant's Signatur Date: i �5/03
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
CITY OF CUPERTINO
REROOF 3
CUPERTINO PERMIT APPLICATION FORM
APN # i 0 Date:
Building Address: C W . " H
10 8$0 �aN
Owner's Name: Phone#:
Contractor: Phone#: License#:
T,C. 737980
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Propose
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: g
�Zltibrc CP) YaoT I�hS'h�l �- w�tlnv�r� �i (�
Residential ❑ Commercial
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any r Actions: LI
Cost of Project- ec Type of Con o Occupancy r p:
Qty. if
A 1' able 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
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