03090198 :1 CITY OF CUPER'1'INO °^'. > + ` ? `
BUILDING DIVISION PERMIT *CONTRi1C COR INFORMATION•"`
RU ILDING ADDRESS: Y FIVE STAR ROOFING PERMIT NOO 3090198
If
WNER'S NAME: 387—A UMBARGER RD PERMIT ISSUE DATE
—..Q2/24/2003
NE: (408) 972-7855 SANITARY NO. CONTROL NO,
AR CHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION
m❑ I bereby arfirm that 1 am Berard under provisions of Chapter 9(commencing Job Description
�<W with Section lLYkO of DivisionJof NC Businetypmi Prufessinne Code.end my license is
rc/� / REROOF
Corer or 2
yy"} ARCHIECTS DE ATION ^ a ■
E C l u d my plans shall he used uhlic records II �II V lr"'Y'SII�®
le. w
oGLicensed Professional
g OWNER-BUILDER DECLARATION
<7 1 hereby affirm that 1 am exempt from do Contractor's License Law fur the
HMAR 2 6 2004
O O following reason.(Section 103 1.5.Business and Professions Code:Any city car county
`c m which aquina a permil to contract,tra ,alcor.improve,demolish.or repair any aloacmre $16000
u2M pdorto its issuance.also requires lhcapplieam roraoch permilm file a signed alalemcm
mal he is licensed pursuant the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
sF0 (commencing wire Section]Uf,()"f Division J of the B usiness and Professions Code)or UILDING
,u,�S that he is exempt Therefrom and the basis for the alleged exemption.Any violation of 3 691 1028 . 00
Section 7031.5 by any applicant for a Permit subjects the applicator to a civil Penalty of .APNNumber Occupancy Type
not more man five hundred delta.(SSW). -' "'-
0 1,as owner of the pmperty,or my employees with wages As their sole compensation,
will do Base work,and the someone is not intended or offend for sale(Sec.9044,Business — p,.,,
and Professions Code:no Contractor's License Law does not apply to in owner of 3 O 7 — IN.S•j.JLA}Tk,y}�t1Cd IDSpeCIIOn$
property who builds or improves thereon,and whodocs such work himself or through his 1 1 vLV
own employes,provided that such improvements ate nut intended or offered for sale.It. 601 — ROOF TEAR OFF
however,me building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that M did not Mdd or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale'' 603 - ROOF BATTENS
❑ I,as owner of the property,am exclusively contracting with licensed contractors to
construct he project(Sec.]04C,Business and Profusions Code:)The Contractor's Li. 604 — ROOF IN—PROGRESS
cense Law docs not apply to an owner of propeny who builds or improves lhemon,and,
who contracts for such projects with a conmctor(s)licensed Pursuant to the Contractor's
License Law,
1 Am eaempl under Sec. .B&P C for this meson
IL
Acr DateWORKERS COMPENSATION DECLARATION
1 hereby affirm under penally or perjury one of the following deelantimrs:
I have and will maintain a Certificate ofConsent to self-insure fur WorkersCompcm
a provided for by Seclien]100 of the ISM,Code,for me pnrmomare of Ne
k for which this permit is issued.
1 hale and will maintain Worker's Compensation Insurance,As required by Sectio of me Labor CodC,for me pc rmmancc of the work for which this pemnil is issued.
Workees Cnmpcmation Insurance carrier and Policy numhcr am:mer:STATE T.. Qt Pn'yNA.: 53 94
CERTIFICATE OFEX NFROM WORKERS'
COMPENSATION INSURANCE
(This section need not becomplemd if the Macon is for ons,hundred dollars(SIO)
or less.)
I certify that in the perfmmarec of be work for which this permit is isued,I shall not
employ any peswo in any manner An As as become subject to the Workers Compensation
laws of California.Dale
Applicant
NOTICE TO APPLICANT:If.after making this Cenifcao of Exemption,you should
become subject to the Worker Compensation previsions of the Labor Code,you most
Z forthwith comply with such pmviaima or this permit shall be deemed revoked.
z O CON SrRUC ION LENDING AGENCY
I berehy,affirm that mem is a construction lending agency for the perfurmana of
Z me work for which this perm's is issued(See.JWt,ON.C.)
Y1 Q Lcndcr's Namc
Z Lender's Add.
J Q I certify that I have read this application and sure that me above information is
y f' cone,.1 agree to comply with atl city and county ordina em and Adds,laws relating to
�U building Construction.and hereby Ammon mprescmadves of this city to enter upon the
L57 ahovnmerifmned pmpeny Tor inspection Purposes.
(We)agree to save,indemnify and keep bannless the City of Cuperlino against
r N liabilities,judgmcnu.costs and expenses which may in any way accrue against mid City
J Z in consequence of the grants ng of this perm it.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 22
SOURCE REGULATIONS.
n l�qt 9 03 Re-roofs
nature of Appli<anUConmcmr D tc
NAIARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant tarfoot.building occupantstore or handle Im dims malarial �
a defined by the CupeNoo Municipal Code,Chaplet 9.13,and the Health and Safety
c, 1`1 Yes 255.)]1x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will thc applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
h hvardous air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection.
trier?
❑Yes �No�
I bans-mad NC MaaNnusmas,rials requirements under Chapter 6,95 onhc Calilnr,
nix HcalN&Safely Code.sections 35SI5,355JJ and 355Jd.l understand mal if Be building
dLCt not LYRCnIIy IIaC a iendnl Blal it is my rtipaNihilily tel mlti]mC MYupNt of 11M
reyuines�mc�am.which must he mel d�orso-isslmnnL^eora cemB<am pr0.<ppancy. �Srignatu�re of Applicant Date
Gi.Cs�� L�a Z G
aalhmiI d ag<nl .Do,,.' All roof coverings to be Class "B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
SUPEkTINO 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: E
Job Site Address: 1 O � S Irl l 1�1 V_ -U r
Roofing Company Name: EL) r—
A plicant's Signature: 1 d 1 ` c—�� Date: 2Z>3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
I,
CITY OF CUPERTINO b 3 9&
40 REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# J O Date:
zy o 3
Building Address: O
JC"' C'G,
Owner's Name: Phone#s
Contractor: Phone#: License#:
f�71 U Cc51 h�'2 t20 iY1 408 e??Z-98SS 4 1 -7 ❑ 1 'f
Contact: Phone#: Cupertino Business License#:
AL NZISO NJ civ 8 ':�-7 z--r�&S
Type of Roof Covering:
Existing: Proposed:
O Built-Up Roof ❑ Built-Up roof
o Asphalt Shingles oto Asphalt Shingles
=5K Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
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:
Job Description:
�Q✓tc t7 1�b1X� -,ka&e — t�2 " OS(13 �{1l c� � y� 3D c8 -Cl f.
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of roject: �-T of Construe ion ccupancy group:
( oce> iE_ LTD St
Qty. if
AppligAfle , 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