03080009 a CITY OF CUPERTINO - t`. +> -77
BUILDING DIVISION PERMIT $CONTRACTORINFORMA50.N:,,
Bu1LONGADDRESS: PRESTIGE ROOFING PERMIT NCO 3080009
701 T-TATT7. PT,
OWNER'S NAME: 725 MIRAMAR PERMITIBSOE DAT(i
KANN
NE: (408) 268-8003 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: UILDING PERMIT INFO
BLDG ELECT PLUMB MECH
106 LICENSED CONTRACTOR'S DECLARATION JobDescri non
1 hereby affirm Ihm rare liumseciunder provisions of Chaplor 9(commencing P
;" with Section 70M)of Division 3 of the Business and Prefusames Code.and my license is
y Lieuseclaandoffec CeIC(®� REROOF
nv�Z Liccnu Clus r—�q Lk.N
�I„p
DOW
ConlrIDbr
f q❑W ARCHITECTS DECLARATION
w U l un send my plans shall W used u public records
6
c Licensed Professional
�q
OWNER-BUILDER DECLARATION
d m 1 hereby of Orn that 1 em exempt from the Contractor's License Law ror the
apeO following...a.(Section 7031.5,Bu,irku end Profession,Code:Any city.,county
5 q which requires a Permit to construct,altar,improve,demolish,or repair any structure
prior it)its issuance.else requires the applicant for such Permit to File a signed statement
< rhelhcislkensedpursuanuodmpmvisionsoftheComracmraLiaenmlaw(CM,M,9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Professions Codc)or 32640008 . 00
Nat he is exempt therefrom and the buts far the allcgcd exemption.Any violation Of
Section 7031.5 by any applicant for a Permit subjects the applicant m a civil penally of APN Number Occupancy Type
not marc than f hundred dollars(5500)..
❑I,as owner of the property.Or my employees with wages as their sole compensation,
will do the work and the account,is not intended or offered fo...1.(S .70,14,Business – YXAMEeC1100S d ITIS
and Professions Code:The C.rometar's Lt..Law does not apply to m Owner or 307 – IN SULA�
NSULA� 8 p
pmKny who build,orimproves thereon,and who doeuuch work himself or through his
own employces,provided that such improvements tie not intended or Offered for sale.If. 601 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.). 6'
❑I,as owner of the property,am exclusively contracting wide licensed canbacto to 6�0 4 – ' R'OF 'I -PROGRESS
construct the project(Sec.lOd4,Busincsa and Pmfwions Cade:)The Contsactot Li.
cense law tlus not app1Y loan owner of property who W ilds or improves coma,.and; / t
who eammcu for such propels wit a eonvactor(+)licensed punuant to dee Coram ort"' /7 r
so La
01 aus
exempt under See ,B&PC for this he L/ MLJI
Ir—
ner Data
ORKER'S COMPENSATION DECLARATION
by oRimt under penalty or perjury one o(the following declarations:
nd will maintain•Cenifrcare ofConsentto self-insure for WorkebCompen-
rovided for by Section 3700 of the L aW,Code,fm the perfarmeme ofthe
hich Nis permit is issued.
1 have and will maintain Worker's Compensation Insurance,u required by Section
0e 4WfuNepWorkeM1ComPewtica Imm�ncecartiuand Policynumberam:
rver. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W compleval if Ne Permit is rormm hundred dollen(SIM)
anus)
1 unify that in the perfommnee of the work for which this Permit is lamed.I shell not
am nypermg inanymanu,mukbccomembpcstolkworkeri Compenedon
or Calif tli,n•
P TICS _ c/
NOTICE TO APPL. eMr making this visimm of of Exemption,you u Weak.
,Z illaccone,compy it Woheka Compensationpmvitshall fNe IceWr Code,you muse
foMwiN comply with such prmi+ions or Ni,Permit be dccmrA revered.
ti O CONSTRUCTION LENDING AGENCY
I hereby affirm that there is construction lending agency for the Performance of
x> Ne work fur which this permit is issued(Sec.3097.Civ.C.)
yQ leadch Name
z Iendn's Address
J O 1 certify that I h.ve red Nis application and+ark Our the above infmmni m is
y — context.I agree to comply with all city and county oNinancennd,tire laws relating m
building eommuction.and hereby announce mpresenulive+of this city to enter upon the
C .hove-mentioned property for inspection purpoms.
(We)agree to eve.indemnify and keep lurmku Ile City of Cupertino against
'–'In liabilit ,judS=nu.cmuuderperuuwhichmayinanyw.y...ag.i.ta dCity
J Z in, sequcexeoflbegranling Of this permit 1, l'
^ A LICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date v
URCERE ATIONS.
Re-roofs
i sere of App Dote/ / Dak
Namorr = MATERIALSDISCLOSURE Type of Roof
Will dk a Cu ent ne future Wilding auupaptnore or addle h eaNau,makri,l
u defused by the Cupertino Municipal Calc.Chapter 9.12,and die Health and Safety
ode.sextion35532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ON.
Will the applicant or future Wilding occupam use trial em or device which If a roof is installed without first obtaining an inspection,I agree to remove
11 horardnus air coouminums u defined by the Bay Arta Air Quality M....came, all n materials for inspection.
vier?
❑Yen ON.
I hew mal the hamrO.1makriats rtquirc nems umkr Chapter 6.95Ofthe Cxlifor. h [
.Health&SafetyCode.Sul.25505,25533 and 25534.IundcrurW lhslifthe Wilding ilk\
dura not currently hew a timer Lha ilk my responsibility k notify the occupant of the
iremcma k muatx met prior kissuanuaf a Ceneirseate or occupancy. Signature of App(cant Date
Ower or,uth. m agent oak All roof coverings to be Class"B.' or better
Community Development Department
Building Division
1a 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
eypolicy on re-roofing.
Homeowner's Name: (m Wylf 1� pf
job Site Address:
Roofing Company Name:
A plicanYs Signature: Date: G`� 3
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
�ICITY OF CUPERTINO 3 ,
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# fo� C(O 00 c6 Date:
Building Address: �
l0(011l e ,
Owner's Name: Phone#:
,'nftr L,00Lee , K@Utj
Contractor: "C-P ne#: . �� License#: �6 to
Contact: C C Phone#: Cupertino Business License#:
i °`rJ
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles R Asphalt Shingles
)11. Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number 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:
ve CAS Qvit ;1k"o to to
Residential E4 Commercial ❑ —36L,9. 85T14 a6 v e��y- 2evpeQ t„[ Elk Sera,
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction• Occupancy group:
K.e
Qty. if
A 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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