03120097 ICITY OF CUPERTINO r
BUILDING DIVISION PERMIT CONT.RAGTORINFORMATION
,a9UILDING ADDRESS: _ TOM MCAURTHER CONSTRUCION Pr"MRNO03120097
187 nRRRNWQnr) TIP
OWNER'S NAME: PERMITISSUEDATE
TIERN Y
ONE: SANITARY N0, CONTROL NO.
(408) 509-1671
ARCHITEC IENGMEER: BUILDING PERMIT INTO
BLDGELECT PLUMB MECH
0 o t� o
X00 LICENSED CONTRACTOR'S DECLARATION'
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
mm with Senian70fU)af Divhion 3 ofhc Buti�",rid P ufeui... Je yIt,..is
in'
` REROOF
g qFLicense Clm Lk.g
Dale ' Cunu tar
eO
CHITELTS IS R 10
y 1 0,129gland my plan shall he used as public records
�aU
G Licensed Professional '
Lvr OWNER-BUILDER DECLARATION
t a C I hereby maxo .('firm that 11. exempt from the Camns Co License taw for the
my
O O which
mama.(Section]11715.Business and improve.
di Professions Code:Any city m county
$ which rcyuires a permit m nnswcL atter,imprnw,dcmnliit t fie.sir any etreclum
Pon,to pursueanion.,ttoMapplicaor forouch Cont etor's ik,eLaw(stammem
£ <
that heencinnWJpuntion7 00)ofDiviomnfththeBuutessandenulaCo(Chapter Sq. Ft. Floor Area Valuation
Y,x❑� tham a is
(commencing exempt
Section]and the
basis
r of das al aged exempt on.ProfessionsnCade)of
Inst he is exempt Ncmfram and Ne bu4 for Ne alleged exemption.Any vinladon of
Section 7071,5 by any applicant for permit subjects the applicant l0•civil penalty of 3WZ14t"er00 Occupancy Type
not mom Nan Rw hundred dollar($M
❑1,as owner of the pmpeny,or my employees with wages u their cele compensation,
will do the work.and me,wnuse I.nut intended or offered finitude(Sec. Business Required Inspections
and Profession.Code:The Conuact.e.Liave Law does not apply to&n owner or q p
pmpcny who mild,or improvss theman,end who donuuch work himself orNrou{h his ,
Own employees,provided Nat such improvements son not intended or.neral forms.If.
however,one building of improvement is sold within one year of completion.the owner.
builder will haw the burden of proving that M did not build or improv for purpose of
sale.). a.r I.�..- r. f-•-•� r [z.'.\.
❑I,ruOwner ofci Sm.704,manessad Prnbad..with licensed W
construct du projen(SecJ044,Business and Professlov Cwe:)lTe Canusemrl I•
come law drca r such inot apply to an owner of protons who builds or improv thereon. d;
who contracts such projeN with acomndarp)IiunuO pursaanl mthe Canton
rise
Law.
un exempt under Sm. .B k P C for Nis
Owner 0a
WORKER'S COMPENSATION DECLARATION
I hereby aRilm under penally of perjury,one of the following declantlons:
I haw and will maintain a Cenifcate of Covent to self-mom,for Wmtr!&Compen.
cation,as provided for by Section 3700 of the labor Code,ror the performance of the
work far which this permit is issued.
❑I hew and will maintain Workcfs Compensation Insurance,as required by Section
7700of the labor Code,for the performmec COW wart for which Ni,permit is issued.
My Wodce.Compensation Nuance crier and Policy number art:
C Me
CERTIFICATE OFEKFM FROM WORKERS'
COMPENSATION INSURANCE
(Mas sectionreed not Moseeplemd if rte Permit H two=hundremdoltan(SItlB
or lett)
I cenify that in the perrmmmec of the work for which this permit is Issued,1 Nell no,
empI oy any pen min any manncrsnumMemo aubjectmade Workuri Campcmehlon
Lw,arcn i..D,n,
Applicant_
N C ANT: ,afar n i, C ¢ f•i{emption,you Nnu1J '
hero mbjen m the nud , tai bar Code,you must
.JO !a th complywiadsueh rovi&lov or this permit shall he deemed revoked.
Z M CONSTRUCTION LENDING AGENCY
F k for which
Wl adertiucoMvn 3097,Civ.
.) l'af the perfuementt of
fY adc work for which this permit is issued(Sec.7097,Civ.CJ
W Q Under'.Name
=,z Lcnder's Address -
U O I cenify that 1 haw read this application and sista that the,how admiration i,
W F CmrleCL.I&glee in Comply with all city and county oNlnaatts and shin,laws misting to
O U building Conswction,and hereby authorize representatives of this city to enter upon the
IT1 above-menlidnedprop oat furin.pensepurposes.
0. (We)agree to saw,indemnify and keep harmless the City of Cupertino against
fq liabilities,judgments.cont and expenses which may in any way acme against mid City
U z APPS ANTe11NDERSTTn
AngOStn,s Drmi PLY WITH ALL NON-POINT Issued by: Date
ONS.
Re-roofs
al ApplicantlCanvaclor vl Date
HAZARDOUS MATER: DISCLOSURE Type of Roof
Will one applicant or future building occupant rare or handle barudous materia(
as dented by the Cupenino Municipal Code,Chapter 9.12.and an,Health and Safety
ewe,odes 25532(.)7
r No All roofs shall be inspected prior to any roofing material being installed.
Will the applinm or umrc building arupom use cyvipmcm dr Jcvias which If a roof is Installed without firs[obtaining an inspection,I agree to remove
ill havaNnm air comemina m defined by the Bay Arca Air Quality Management all new materials for inspection.
isuict7
n.
❑Yes
Ihrvcmedthehoaanbus ateria4reyuimmc5534.irCheptcdhuiffcCalding ✓ )���
ria Hcoiad Safcty11h Sccdans 550 25577 sour const Chip.dadatifadc building
/dura not matlyh au Nal' is res nsibi' nntl('y tM mRupanh of adc
ants wn u top re w' o of OCC amay. Signature of pplicant e
r as orixed agent Da All roof coverings to be Class"B" or better
Community Development Department
Wit ,
Building Division
:• r City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
qUPEkTINO
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:
Job Site Address: / 9397 6 rte.,vi w o b J 0-(1 CV PErJ1nU
Roofing Company Name: M LIoirAtr con J
A plicant's Signature: Date: Z_ T
\�l/r6WOLX1
Greg teel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF O� 2
CUPERTiNO PERMIT APPLICATION FORM
APN# 3 5 Q Date: /.Z _ b— V
Building Address:
Owner's Name: Phone#:
cointractoPhW#b: o - � License#:: a,X. b mo
Contact:AL Phone#: Cupertino Business License#:
S001_10 I.
Typi
0 -
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles p Asphalt Shingles
Wood Shakes 13 Wood Shakes O �
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 11ng ❑ Provide I.C.B.O.Report#
A To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
cl Me
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with P ning Dept. if
there are any r trictions: u
Cost of Pro'e t T e, o stnactio Occupancy otl�
/5 > '� '�&- vo�
Qt ,
A lic le- __ 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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7 /