03070072 CITY OF CUPEWI'INO t'
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: CROWN ROOFING INC PERMIT NO 03070072
OWNERSNAME: 3535 KIFER RD PERMUISSUEDATE
ARTHUR RAMOq
"E (408) 874-0784 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION
w❑ ns
I hereby affirm that I am licensed under provisiom
ns of Chapter 9(commencing Job Description
�z with Scction70)(0)ufDivision 3ofthe Bus ss d csmdOCode, dmyliwnrcis
m�rdn Lfull forcca cf t Xj� L �®
i�? ucasx class `�3_�ue.:»n �^ ��`�O REROOF IFQ�
=h,0 Datc - Carl...tor r4-_r)W d i°w'
ARCHITECTS DECLARATION
f m1 understand my plans shall be used as public mcnfN JUL
' y 5 L.SOO�
>yU JU _
e o Licem ad Professional
OWNER-BUILDER DECLARATION
2 1 hereby affirm that 1 am exempt from this,Contractor's License Law for the B 1 U'�D���
i.00 following reason.(Section 7101.5,Business and Professions Code:Any city or county
<m K' which requires a permit to carriu e,aIle[,mpmve,demolish,m repair any structure
prior it)its issuance.also requires the applicant for such permiuo Glc a signed stammcm
yegi that he is licensed Pursuont1.the Provisions ofthe ContmctufiLicenuLaw(Charter 9 Sq. Ft. Floor Area Valuation
a (commencing with SCLtion 7(Xxd of Division 3 of the B usinesi and Professions Coda)at
u5§ that he is exempt domfmm and the basis for the alleged exemption.Any violation of 32608056 . 00
Section 7031.5by.a,applicant for.permit sebjecu Ne applicant la is ave penaltyof - APN Number Occupancy
our mom Than rave hundmd dollars(5500). P Y Type
O I,u owner of me property,or my employees with wages as their sole compensation,
willdothewois.and Ne stmemm is not intended of offered for sale(See.7061,Business — R
and Pmfeasmna code:The canuumrs License Law aoa not apply m.n owner ar 3 0 7 - INSULATeIgp d Inspections
Predacity
who builds orimproves thereon.and who doessuchwork himselfor through his 1 N
own employees,provided that such improvements ere not intended or offered formic.If, 601 ROOF TEAR OFF
however.the building or improvement is sold within mm year of completion.the owner-
buildm will have she burden of proving that be did not build or improve fur purpose of 602 — ROOF PLYWOOD NAIL
sal..).1603 — ROOF BATTENS
I,ru owner or the progeny,,Business exclusively confessions with licensed canhactors to
cense La the pmject pply totwn,weorand property
Professions Cade:)The Co thersi 's u. 604 — ROOF IN—PROGRESS
cane Law dos not apply m in owner of property who sed p or improves demon,and.
whocontractsLac6 for such projects with a conuactor(s)licensed pursuant dr,Contractor's
0 1 am Law.
❑I am exempt under Scc. ,B&P C for his reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 busby aff rte under Penalty of perjury ow of the fallowing declarations:
7371M
I have and will maintain a Certificate of Consent to wif-houmfor WorkcisCompcn-
am,as provided for by Section 3700 of rite labor Cndc,for the performance of the -
rk for which this permit is issued.
1 hale and will maintain Woraefs Compensation Insurance,m required by Section
of NC Lahor Code.for Ne performance of the work for which Nis permit is issued.
W kee C[p,mw adonl tett ca dPolicy numberam:�'� policy No.;
CERTIRC OFEXEM ONFROMWORKERS'
COMPENSATION INSURANCE
(Thu auction wed not w completed if the Fermi,is for one hundred dollars(B10B)
or less.)
I candy Nat in the performance of the work for which this Permit is issued,l shall not
employ any person in any manner so as in became subject m the Workeri Com ransaion
Laws of California.Date
APPlicant
NOTICE TO APPLICANT:If,after making this Candicate of Exemption,you should
become subject to the Worker's Compensation provisions of Ne Lxwr Cade,you must
.J ,Z forthwith comply with such provisions of this permit shall be deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
r I bemby affum that Nene is a consuuetion lending agency for the performance of
01 Nc work fur which this permit is issued(Sm.3097.Co.C.)
W) Lender's Name
= Z Under's Address
U Q 1 ccnify Net 1 have read this application sad stare that thc above admonition is
I,H corms.l agree to comply with all city and county ordinances and state laws relating to
0 building contraction.and hereby auddhim represenletives of this city to enter upon the
above-me judgments.
a prep costs
for inspection Purposes.
4 (Ws,)agme m save,indemnify and keeP harmless Ne City of Cupenino against
h ineilisecticeaofth.c trading of this permit, may in any way accmc against Coy
(„) ,Z in eonsegwnce of Ns,Braining of this permit, t
'^ SPPLCER ULDEIRST WILL COMPLY WITH ALL NON.POINT Issued by: Date
grarcafApplicenVCunua r 03 Re-roofs /
Date
HAZARDOUS MATERIALS DISCL URE Type of Roof
Will Ns,applicant or future building occupant Store ea handle h mAhatis material
as defined by the Cupertino Municipal,Code.Chapter 9.12,and the Health and Safety
Cow.Section 25532(a)? 1
❑Ya ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hneNaua air moodramn,e-dcfned by Ne Bay Ams Air Quality Managemem all new materials for inspection.
isria?
O Yea D"15
Ihaw&SdaINIh,SNrmsm55i5.255uiremenuunder Charter ti.95of Ne Cadinr ��
ria HcalN 53afcty Gtdc,Sccuons 25N)5.25533 and 255}s.l undcrstane thaifNc huilJing giv
/O O
d cu I hone a tenant, at it is my rexponsihility m nnGly the wcupap of Ne
re uircman hich ustb met dose 'ssuanec of a cefdfcate of Ocg�m y.
�a gnat re of Applicant ate
n a sumoriamageml Data All roof coverings to be Class "B"or better
� I
Community Development Department
flY Building Division
City of Cupertino
C i• 10300 Torre Avenue
Clll OF Telephone: (408)777-3228
Fax: (408)777-3333
U w E�,�,'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 LC.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: /L(.�-, /62 /J, f�y�
Job Site Address:
Roofing Company Name: 1 Lt1
4'AIiant
sSignature: Date:Je'
el
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF Q 3b 7 o 0 7 Z
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN # 2- Date:
�
Building Address:
Owner's Name: S Phone M -
- 3 0
Contractor: Phone#: License#: G
Contact: U Phone#: Cupertino Business License#:
sv q
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles L3Wood Shingles
I� Other(Specify) }-C— r� ❑ Other(Specify)
N tuber 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:
ZZ
Residential 7 Commercial ❑
Fire Zone: Yes ❑ N Confirmed with Plannin a t. if
there are an restrict' ns:
Cos of ro'ect: Type of Co struction• �� Occupancy group:
7 U V
Qty. i
A li ]e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees =BUI]LDING
BENERGY Ener
BSEISMICRE Seismic Fee Res
BSEISMICOM Seismic Commercial BPLANCHK Plan Check Fee BUSLIC Business License
• /
zs17,
CITY OF CUPEWI'INO t'
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: CROWN ROOFING INC PERMIT NO 03070072
OWNERSNAME: 3535 KIFER RD PERMUISSUEDATE
ARTHUR RAMOq
"E (408) 874-0784 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION
w❑ ns
I hereby affirm that I am licensed under provisiom
ns of Chapter 9(commencing Job Description
�z with Scction70)(0)ufDivision 3ofthe Bus ss d csmdOCode, dmyliwnrcis
m�rdn Lfull forcca cf t Xj� L �®
i�? ucasx class `�3_�ue.:»n �^ ��`�O REROOF IFQ�
=h,0 Datc - Carl...tor r4-_r)W d i°w'
ARCHITECTS DECLARATION
f m1 understand my plans shall be used as public mcnfN JUL
' y 5 L.SOO�
>yU JU _
e o Licem ad Professional
OWNER-BUILDER DECLARATION
2 1 hereby affirm that 1 am exempt from this,Contractor's License Law for the B 1 U'�D���
i.00 following reason.(Section 7101.5,Business and Professions Code:Any city or county
<m K' which requires a permit to carriu e,aIle[,mpmve,demolish,m repair any structure
prior it)its issuance.also requires the applicant for such permiuo Glc a signed stammcm
yegi that he is licensed Pursuont1.the Provisions ofthe ContmctufiLicenuLaw(Charter 9 Sq. Ft. Floor Area Valuation
a (commencing with SCLtion 7(Xxd of Division 3 of the B usinesi and Professions Coda)at
u5§ that he is exempt domfmm and the basis for the alleged exemption.Any violation of 32608056 . 00
Section 7031.5by.a,applicant for.permit sebjecu Ne applicant la is ave penaltyof - APN Number Occupancy
our mom Than rave hundmd dollars(5500). P Y Type
O I,u owner of me property,or my employees with wages as their sole compensation,
willdothewois.and Ne stmemm is not intended of offered for sale(See.7061,Business — R
and Pmfeasmna code:The canuumrs License Law aoa not apply m.n owner ar 3 0 7 - INSULATeIgp d Inspections
Predacity
who builds orimproves thereon.and who doessuchwork himselfor through his 1 N
own employees,provided that such improvements ere not intended or offered formic.If, 601 ROOF TEAR OFF
however.the building or improvement is sold within mm year of completion.the owner-
buildm will have she burden of proving that be did not build or improve fur purpose of 602 — ROOF PLYWOOD NAIL
sal..).1603 — ROOF BATTENS
I,ru owner or the progeny,,Business exclusively confessions with licensed canhactors to
cense La the pmject pply totwn,weorand property
Professions Cade:)The Co thersi 's u. 604 — ROOF IN—PROGRESS
cane Law dos not apply m in owner of property who sed p or improves demon,and.
whocontractsLac6 for such projects with a conuactor(s)licensed pursuant dr,Contractor's
0 1 am Law.
❑I am exempt under Scc. ,B&P C for his reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 busby aff rte under Penalty of perjury ow of the fallowing declarations:
7371M
I have and will maintain a Certificate of Consent to wif-houmfor WorkcisCompcn-
am,as provided for by Section 3700 of rite labor Cndc,for the performance of the -
rk for which this permit is issued.
1 hale and will maintain Woraefs Compensation Insurance,m required by Section
of NC Lahor Code.for Ne performance of the work for which Nis permit is issued.
W kee C[p,mw adonl tett ca dPolicy numberam:�'� policy No.;
CERTIRC OFEXEM ONFROMWORKERS'
COMPENSATION INSURANCE
(Thu auction wed not w completed if the Fermi,is for one hundred dollars(B10B)
or less.)
I candy Nat in the performance of the work for which this Permit is issued,l shall not
employ any person in any manner so as in became subject m the Workeri Com ransaion
Laws of California.Date
APPlicant
NOTICE TO APPLICANT:If,after making this Candicate of Exemption,you should
become subject to the Worker's Compensation provisions of Ne Lxwr Cade,you must
.J ,Z forthwith comply with such provisions of this permit shall be deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
r I bemby affum that Nene is a consuuetion lending agency for the performance of
01 Nc work fur which this permit is issued(Sm.3097.Co.C.)
W) Lender's Name
= Z Under's Address
U Q 1 ccnify Net 1 have read this application sad stare that thc above admonition is
I,H corms.l agree to comply with all city and county ordinances and state laws relating to
0 building contraction.and hereby auddhim represenletives of this city to enter upon the
above-me judgments.
a prep costs
for inspection Purposes.
4 (Ws,)agme m save,indemnify and keeP harmless Ne City of Cupenino against
h ineilisecticeaofth.c trading of this permit, may in any way accmc against Coy
(„) ,Z in eonsegwnce of Ns,Braining of this permit, t
'^ SPPLCER ULDEIRST WILL COMPLY WITH ALL NON.POINT Issued by: Date
grarcafApplicenVCunua r 03 Re-roofs /
Date
HAZARDOUS MATERIALS DISCL URE Type of Roof
Will Ns,applicant or future building occupant Store ea handle h mAhatis material
as defined by the Cupertino Municipal,Code.Chapter 9.12,and the Health and Safety
Cow.Section 25532(a)? 1
❑Ya ON. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hneNaua air moodramn,e-dcfned by Ne Bay Ams Air Quality Managemem all new materials for inspection.
isria?
O Yea D"15
Ihaw&SdaINIh,SNrmsm55i5.255uiremenuunder Charter ti.95of Ne Cadinr ��
ria HcalN 53afcty Gtdc,Sccuons 25N)5.25533 and 255}s.l undcrstane thaifNc huilJing giv
/O O
d cu I hone a tenant, at it is my rexponsihility m nnGly the wcupap of Ne
re uircman hich ustb met dose 'ssuanec of a cefdfcate of Ocg�m y.
�a gnat re of Applicant ate
n a sumoriamageml Data All roof coverings to be Class "B"or better
� I
Community Development Department
flY Building Division
City of Cupertino
C i• 10300 Torre Avenue
Clll OF Telephone: (408)777-3228
Fax: (408)777-3333
U w E�,�,'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 LC.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: /L(.�-, /62 /J, f�y�
Job Site Address:
Roofing Company Name: 1 Lt1
4'AIiant
sSignature: Date:Je'
el
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF Q 3b 7 o 0 7 Z
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN # 2- Date:
�
Building Address:
Owner's Name: S Phone M -
- 3 0
Contractor: Phone#: License#: G
Contact: U Phone#: Cupertino Business License#:
sv q
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles L3Wood Shingles
I� Other(Specify) }-C— r� ❑ Other(Specify)
N tuber 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:
ZZ
Residential 7 Commercial ❑
Fire Zone: Yes ❑ N Confirmed with Plannin a t. if
there are an restrict' ns:
Cos of ro'ect: Type of Co struction• �� Occupancy group:
7 U V
Qty. i
A li ]e Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees =BUI]LDING
BENERGY Ener
BSEISMICRE Seismic Fee Res
BSEISMICOM Seismic Commercial BPLANCHK Plan Check Fee BUSLIC Business License
• /
zs17,