03070021 CITY OF CUPEW11NO
BUILDING DIVISION PERMIT CONTRACTORINEORM, N �i
nDILDINGADDRESS: CAL-PAC ROOFING PERMITNo03070021
027F4 CZARI�)RN C-ATR PR_
OW NER'S NAME: PERMIT I55UE DATE
36 RAILWAY AVE
ONL
(408) 874-0784 SANITARY NO. CONTROL N0.
ARCHITEC"DENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
bop LICENSED CONTRACTOR'S DECLARATION L� O O O
fmp 1 berth,sperm that I am Iimemed under Provisions of Chapter 9(commencing Job Description
z with SeC,iqr�]IXkpnp Divixion]uf me Businc, an Prufessinnx Code.andm licenuis
n« in f1lomagrfa erred— 'C 'b2 Gz4 y REROOF
License 6!� C J GI Lic.
F Ow Dam Cubit a
`£7 ARCHITECT'S 9a AT10
C lk I Yn fk1�i my Ian51 bL Y d5 IlllL rt[ 3
u 0'~'t Liccns Pmfcssfly
OWNER9UILDER DECLARAT
a P I hereby alarm that 1 am exempt from the Co aemr' License Law fur the
00 following reason.(Section]131.5,Business and Pmfe inns C e:Any city or county
5 m which requires a permit to consumer.alter,improve, di. or repair any structure
_Ze prior to its issuance.also requires the applicant for such Permit to rile a signed statement
Ea0
that beislicensed pursuant tothe Provisimtsofthe Conlmr:ti sLicense aw(Chapter 9 Sq. FL Floor Area Valuation
eh (commencing with Section 70M)of Division 3 of the Business and Professions Code)or
y that be is exempt therefrom and the basis for the alleged exemption.Any violation of 32630050 . 00
Section 703 LS by My applicant fon permit subjects the applicant o a civil penalty of AIN Number Occu
not more than eane five hundred della..(s50o). P Y Type
❑I.as owne rd'depmpeny,or my emphi with wagmas tneirsolecompenvlion.
will do the work,and Ne mature Is not intended or ORCRd farlalc(Sec.]Bid.Business
and Pronasions Code:The Convectores s License Law donot apply to an owner or — Re uired Inspections
psm,i who builds or improver theon,and who doessuch work himselforthrough his 307 - INSULATION
own employees.provided that such impmvemenla an,not intended oroffemd pourable.If, 601 — ROOF TEAR OFF
however,the building or improve ent is sold within OM your of completion,me owner.
builder will have dic enrolled of proving tat he did not wild or improve for purpose or 602 - ROOF PLYWOOD NAIL
Aide)
.
❑I,as owner of the propeny,am exclusively convecting with licensed Convectors to 603 - ROOF BATTENS
cmuwct the pmjcct(Sec.]IWa,Business and Pmfessions Cade:)The Contractors Li- 604 — ROOF IN-PROGRESS
cereve law docs not apply to an owner or propeny who Wilds or improws lhemon,and
who contracts for such projects with a co ntraetor(s)licensed pursuant to the Committees
License law.
❑I am exempt under Sec. ,B&P C for this mason
13071W
wner Date
WORKER'S COMPENSATION DECLARATION
1 hereby afrvm under penalty of perjury one of the following declarations:
I have and will maintain a CeniGnm of Curator to self-imure for Worker's Compen-
ion.as provided for by Section 37W of the labor Code,for the ormorAnce of the
rk for which this permit is issued.
I have and will maintain Workeee Compensation Insurance,as required by Section
ofthc L aWr Code,for the performance of the work for which this permit is issued.
Work � // tion In'urarme canierandPolicynumberaartier ;+/f (�Ci,t_ polit\yo
CERTIFICATEOFEKEM FROM WORKERS'
COMPENSATION INSURANCE
This action need not W completN if the fermi,is forone hundred dollars(SIM)
ser Icss.)
I candy that in the perromiance OL the work for which this Permit is named.1 shall not
employ any person in any manner An ss to become subject to the Workers Compema,ion
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this CeniEcam of Excmftimi you should
become Subject to the Worker's Compensation provisions of the Labor Code,you must
.JO forthwith comply with Such Prnvilimet or this permit hall W deemed revoked.
Z'rn CONSTRUCTION LENDING AGENCY
F I hereby affirm this mere is a mmuueinn lending agent,for the Performance of
K> the work for which this permit is issued(Sec.XN],Civ.C.)
W 0 lender's Name
Lenders Addreas
fJ Q 1 ttnethat 1 have(cad this application and seam the the above information is
lI. Wilding 1 agree,o comply with all city and county ONiives of and sum laws r upon t e
QU bWw..Lotioncd construction.and for
yamhonp reprmenu,irm orthis city to char upon the
a Wvc(we)are to r nY for inspection keep ha
F y (s ju agree,o cove,indemnify and keep ndrmlcss the y ac ri Cupertino against
h liobilitica,judgmcnts,cousand expenses pe which they in my way secret against said City
f)z A eonuq a of the RSTAtrantirg of this Permit.
SOU EREGULAEONS NDS AND W OMPLY WITH ON-POINT Issued by: Date
tumor plica OMWL Date Re-roofs
AZARD US MA SDISCLOSIfRfi.. Type of Roof
Will the applicant or future doctor cupanlsmre Or handle haaanhna andtenal
As defined by the Cupertino Municipa ode. hapmr 9.12,and the Health and Safety
Cudc,Scniex 25532(a)?. H All roofs shall be inspected prior to any roofing material being installed,
Will the applicant r future but upanl use equipment or devicm which If a roof is installed without first obtaining an inspection,I agree to remove
it navaNnus air conmm ants as defined by the Bay Area Air Quality Management all new materials for inspection.
aurin? �.
❑Yes JC rj Nu
Ihave eou""', ,yi2(/artlnu�smaterials M,quiremenu under Chapter 695 ofine C,IdinI,
iA Health afctyC Sammi55a5.255U anJ 25536.1 senders dthuif the Wilding lVV/
does no,c nay have mnank that it is my pnlglind y m at (be occupant of the
require tswMrnmpubem Lenrace ante to btgna9ji&cofApplicarit .� / e
o net mined tot Da1C All r co rings to be Class "BLr better
Community Development Department
�j Building Division
City of Cupertino
..✓"-: 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
U P E IST I N O
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
rIthe above stated policy on re-roofing.
`T
Homeowner's Name: U&� � VUP ��C. of
Job Site Address:
Roofing Company Name: C rr --Pczc- P4>3�
A plicant'sSignatur . Date: 2�3
Gtteel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o 0 2
k as REROOFCin OF
3 7
CUPERTINO PERMIT APPLICATION FORM
APN# r Date: '` 1
Building Address: I
Com/
'ZD 9-7 �-t.)
0wner's NCe: G r Phone#:
Ei to Chi uI*- U ct r,3 2�Z 3
Contrac r: �_/ Pho e#: License#:
�f}?C , 1J 'l_N1--P� 7'f Sa X(dZ &
Contact: Phone#: Cupertino Business License#:
Lit rUwl 5,. e�Ae_
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles y�
❑ Other(Specify) ❑ Other(Specify)�cr'�
Number of existing covering— ❑ 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: ❑
J Descr ption: WO D- , I '
eCczD 60fC � s Coo+ Ir�h oc)cr�.r- 9,_ S�d ry
Residenti Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with m gDe t. if
there are anestrictions:
Cost of Project: pL Type of Cons ti n: ` Occup �g p:
Qty. .
RIBENERGY
Fee ID Fee Description Fee Grou
BPERMFEE Bld Permit Fees BUII DING
Ener BUILDINGBSEISMICRE Seismic Fee ResBUILDING
SEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
�2� 67