03100068 CITY OF CUPERTINO s
BuluaNc DIVIs1oN PERMIT CONTRACTOR INFORMATION . '
BUILDING ADDRESS: R E ROOFING & CONSTRUCTION PNDO 3100068
OWNER'S NAME: 15230 CLYDELLE AVENUE PERMIT ISSUE DATE
INGE & LARRY 2003
'NE' (408) 925-9995 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECfi
0 0 0 0
+Op LICENSED CONTRACTOR'S DECLARATION
b Ithereby affirm that 1amtunder provisionsofChapterenJob Descriptiontion
with caion7U7 of DivisionJofhe Business and PmfcssiansCode.and my license is
infmllrmrceand errecL 3 REROOFon Limur.Clasa
Lic:a
,7n DOW Cumraclor
Y ARCHITECTS GECLARAT z^�
>au Iunderstan myplanswhall.\udas'to m V
o G LiccnuJ Pmfcssiunal `—
,g OWNER,BUILDER DECLARATION
CrarrON
00 I mason.
.(Sent that 1 1. cscmpt from dte Cmm�s Co e:Any c Law for the
oO followingrias; OOILnt ]cont. Business and ere.doions Code:Any city or county
O m� which its issuance.
a pemst re etres the alter,improve,h Permit
erm to or repair any structure
°E< that he thither incensed pursuant
thevisiappo antsof for sucContractor's
icensir ae Law
statement
s< (commenhanwith Section 7")the of Divionannhc Comrsemrsnd Profsaw(CbWNof Sq.FL Floor Area Valuation
that he is
(commencing with Section of Division,nRw Busaged iissane PrefAny vi lima, tar
Nm he is scrota thcrtfrom and the basis for me alleged exemption.Any violation or 36911022 . 00
Section 7031.5 by any applicanlfar a permit objects the applicant to a civil Penalty of APN Number
not mom than five hundred dollars SS00s Occupancy Type
❑ I.-owner of the property,or my cmpioycu with wages as their to cma,ma inn,
will do the wart,and the swmum is not entanded.1olPoald for sale(Sec.7814.Businessg��
and Pmfuxions Code:The Conuannrs License Law cars not apply to an owner of 3 0 7 - INSULAT P� d Inspections
property who builds or improves thereon,and who deassuch work himself or through his
Own employees,provided Oat uch improvements are net intended oroffered for sale.It, 601 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the owner-
builder will have me burden of moving that he did not wild or improve fur purpose or 602 - ROOF PLYWOOD NAIL
01, 603 - ROOF BATTENS '
❑1,constas owner of the Seeproperty..Business exdas and contracProfessions
with licensedTheCennuamors t.
"me La does project(See
own owner
property
who Wild or
Contractor's Li 604 - ROOF IN—PROGRESS -
"me law cuts not apply je an owner of property who wilds or improves thereon,and,
who contracts for such projects with a conuamar(s)licensed pursuant m the Convn
eor's
Licencense Law
❑lam exemtt under See. ,B&PC far this reason
Owner Date
AAk WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
1 have and will maintain certificate ofeonunt to welt-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the '
work for which this Permit is issued. -
1 hale and will maintain Worker's Compensation Insurance.as required by Section
BB of We Labor Code,for We performance of We work for which this permit is issued,
My Workers TCo/m�pensat�ioonn Insurance carricrand Policy �w
Canio: SI/sl�' 1A Ik,') Poli,No.: Ila—1 L)
CERTIFICATE OF XEMmON FROM WORKERS'
COMPENSATION INSURANCE
(Thu xenon need not be completed if me Permit u foorke hundred dollars(5100)
e Ices.)
I canary thin in the performance of the work for which this Permit is issued,I shall not
employ any parson in any manner sn as or become subject to me Wormcs Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this CcnlEcas of Exemption,you should
become subject to We Wormria Compensation provisions of the labor Code,you must
�Z rmthwilh comply with such proviainm of this perm it shall be domed revoked.
Z O CONSTRUCTION LENDING AGENCY
1 hereby affom Was then is a constmclion lending agency forme Performance of
x me work fur which this Permit is issued(See.3097.Civ.C.)
1ALender's Name
Z, Z Lender's Address
.J Q 1 certify mat I have read this application and state that the above information is -
y t" torso.I agree to comply with all city and county ordinances and state laws slating to
U building construction.and hereby tribunal represenutiaas of his city to otter upon him
W awvementioned property for inspection purposes.
y
(We)agree h an,indemnify and keep harmless me City or Cupenina against l/v_�as./
h liabilities.judgments,costa and expenses which may in any way accrue against said City r
J,'�• AP cot me gaming of this permit
APPLI NTN AN/SAND WILL COMPLY WITH ALL ON-P INT Issued by: Date
SOURC E6 A t'- s
( l � �0 5 Re-roofs
=igengnn�nfA pl¢anUComncmN 1 �u
\HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We applicant or future building Occupant store or handle hanrdous maunal
as defined by the Cupertino Municipal ode,Chapter 9.13,and me Health and Safety
oda lcclion 355J2(a)?
CD Y. p� All roofs shall be inspected prior to any roofing material being installed.
Will the applicant o future building Occupant use,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
I hazardous airconnminanu as dcfncd by the Bay Arca Air Quality Mmagcmcm �-.all-n w materials for inspection.
strict?
p Y.. /
Ihavcalel thcbmSectons 255rialsre31 andn1m,I u Chatmr695 ofine Cali
nu calIhow booyhe dc.Scctiom25N15,355JJandi553d.lundcrslarWmuifdr ClOing
Ctires n nom. a tenant Nm it is my movability m notify t Amp indoor
mquimma hi must ih pno713 ccofa Ccnl0cote o(Q
I ���y0j\\Signa[ur`eofApp )cant Date
Myer Whoa dagcnt Da1e All roof coverings to be Class "B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
,SMI - 1 CITY OF Telephone: (408)777-3228
OCUPEkTINO 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.
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�AYLYU{ 5 I N( oJ/k R1'i US
Job Site Address: 716 (,r1,0J VI V, AI
Roofing Company—Name: Y / 5 �. S�k Lk
A plicant'Signature:
• Greg Witeel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 6 J 6
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# i -7L__ Date: l R U
Building Address:
I � �� (P 1�1�•�-1Jv1!✓� ��h�ltE
Owner's Name: 'N Phone#:
-1 1
Contractor Phone#: License#:
�\ -12�51`�
Contact: Phone #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ 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 1 ❑ 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: '1),GMM LZ(6&Tl N tf I LAtii� �v� Si+Mte I Nst IJ P :i
As rM Yom, � `�2" CD � �l � UAL"
t�,Zc l,.
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ HConfiarewqrestrictions:
ning De t. if
there
Cost of Project Type of CBnst ton Occu2
Qty. if
Applic4Ke 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
• 2 "
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