03050017 CITY OF CUPERTINO `"'
BUILDING DIVISION PERMIT CONTRACTpI2fINkURMA.TT�N
BUILDINGADDRESS: ECONOMY ROOFING PmmrrNo03050017
a OWNER'S NAME: 2988 NEAL AVE. �I`gi ffn5/2003
EI-MEI MENG
ONE: (408) 615-7200 SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Q t�
.0 LICENSED CONTRACTOR'S DECLARATION
U I hereby affirm Nal 1 em licensed under provisions of Cbapmr 9(commencing Job Description
^� ' with Swaine 7")of Division 3oflhe Busincssmd ProlessiansCode. Rd myliccnxu ��aa A C
� m fail force andefl REROOF i—INALE®
an z License Cla Lle.g
q�q DaleCHRECI'S DECLARATION 7
I mccomtsnd my plans almll w used"public raonh MAY 2003
C.
Licensed Professional
0 OWNER-BUILDER DECLARATION BUILDING
i�m 1 Mary affirm than I em exempt from dnwnan
m Coart Ltm Law for the
0 0 following meson.(Suction 703 1.5,Business and Pmfamiuna Cale:Any city or county
which requires a permit to Construct,eller,improve,demolish.or repair my swctum
prior an its tssumc.aim requires the applicant for such permit m file a signed em omen
that he is licensed pursuant to the pervisions of Ne Conuactur's License law(Chapter 9 Sq.Ft. Floor Area $5N�"tion
ytt$ (commencing with Section 70)0)of Division 3 of the Business and Pretendns Cnde)ur
3.- Net he is exempt therefrom and the bast for dm alleged exemption.Any violation Of
Section 7031.5 by any applicant for a panels subjects the applicant to a civil penalty of 3 7�BB18aU20B8er0 0 Occupancy Type
not more Nan firm hundred dollen($300).
0 1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and decameters la not intended or offered for sam(Sm.7044,Budnw - Required
and Profesaims Code:The Cournewors License taw does oat apply m an ownar of 307 - INSULATION
Inspections
property who builds orimpmves themen,andwho dM3.Wh work himselfor through his
own employes.provided thatsuch improvements are not Intended oroReind foraok.If. 601 - ROOF TEAR OFF
however,the building or Improvement is mid within one year,ofcompletion,Ne awuer-
Wilder will have the wtdee of proving den he dm not wild or improve for purpose of 602 — ROOF PLYWOOD NAIL
ale') 603 - ROOF BATTENS
0 I,u owner of the property.am exclusively cantraatng with licensed mntnm ea to
comma tha project(See.7014,Business and Prefessiana code:)The Contrmmra U. 604 - ROOF IN-PROGRESS
came Law does not apply m in owns of property want wilds of improves Merton,and,
who conmcur for such projects with a mnowum(O liumed p o wen an tiro Contractors
License law.
❑I am exempt under Sec. .B&P C for this,coon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of The following declarations:
I here and will Munmin•CenlfieomofCmumm or elf-Insum for Workels Compcn.
salon,u provided for by Section 3700 of Ne labor Cade,far tw perfarromce of the
work for which this permit is issued.
have and will mainmtn Worker's Compenaalan Inaunna,u required by Sect;.
3] the labor Code.for dm performance of the work for which this permit is issued.
My Worker0ematlon Imm�mfnni Policy nu �1
Cartier. �omT[ri'l��OYr- ,ry No.: ��00
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(iris section recd not becompleted tf de permit Is forom bundmddollars($IBO)
or leu)
I unify that in the Petfnmaae of me work for which this Permit u issued,I shell not
employ Cy paean) mennpcw 1 Rrm�s che workcrt'Compensetion
/ Laws of Cslifornl .�-
'(-/�\/1 Applicant
NOTICE TO APPLI ,efur axing Mh CIV,
r Ream of Exemption,you should
become mhpa m I orkl Compenmltan provt ions of dee labor Code,you must
0 O fordewith comply wl h wh provisions of this Pemit shell he deemed revoked.
.Zr ► CONSTRUCTION LENDING AGENCY
"r Ihemhy afOm that there lsa canaurection lending agency for me Perfumma of
yv the work for which this Permit is issued(Sec.3097,Civ.C.)
an
aaQ Idehr's Nnnc
Z LendeAddress
U Q 1 certify,that I haw mad this application and sate that the above automation u
Ig.U current.1&&me to comply with all city and county outhouses and sum laws relating m
C) wilding construction,and hereby authorise representatives of this city an cover upon the
4 shove-mentioned property for inspersion Purpasea
(We)agree to ave,indemnify and kap harmless the City of Cupertino against
y liabilities.judgments,costs and expenses which may to my way ambo against aid City
U Z in code roma Of me granting of dein North.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date '
SOURCE REGULATIONS.
Re-roofs
Signewm of AppliaAZARDO Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy t applicant or forum building e,Chapter
erre or handle Health omaverial
a OcRnctl by me Cupertino Municipal Code,ChaPver 9.11.roil the Health and Safety
Cadq Seclim 25532()7 � All roofs shall be inspected prior to any roofing material being installed.
O Yes ONQ
Will the applicant or future wilding oaufa nt ase equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mil haafdom air conmminanu as defined by the Bay Area Air Quality Management all new materials for inspection.
Dmtrict7 \
❑Yes GTJtL
IHave. me hanrdmtsmatedaisre uiremmnaunderCMpmr6.93ofd,c Cslifor.
nim H.M&S c Cade.Ser6.75505,25533u 25534.1uwer thalfft Wilding
Jou not t cum Ili have a venanl.Neit u y mspomibility m mtify the aeupant of he
mCutrtmcnts hie f efbfteamafDCNPNt. Signature App leant Date
Owner or atumme.J agent ate All roof coverings o be Class"B"or better
+!� Community Development Department
I la�j Building Division
t City of Cupertino
• ,,,.. 10300 Torre Avenue
CITY OF
Telephone: (408)777-3228
C U P S kT 1 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. Toreceive 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.
S. 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 Y4" 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: /
r
job Site Address: JO
Roofing Company Name:
A plicanYs Signature: DateSe
• \ANd1J�D�.X1
r
Greg eel
Building Official
Revised 1/30/03 .
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF /
• CUPEI�TINO PERMIT APPLICATION FORM
APN# 2 8 — O O Date:
Building Address
501
Owner's Name: Phone#:
Q ' _ 6t1 Q i"
Contra r: Phone#: 7 License#
Contact: Phone #: Cupertino Business License#:
7tJ -7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shinglesn
�Q Other(Specify) :@,r L(Jr/i 0 0 Other(Specify) CS d�
Number of existing coverings ❑ Provide I.C.B.O.Report# 0.J
• ❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
mjmw Xi -4
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: IJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable 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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