03110092CITY OF CUPERTINO
BUILDING DIVISION PERMIT
K-ONTRACTOR INFORMATION
-,
BUILDINGADDRESS:
FIVE STAR ROOFING
PERMIT NOO 3110092
2 7
OWNER'S NAME:
PERMITISSUEDATE
ENTRAL PROPERTY MANAGEMENT
387-A UMBAR ER RD
11/18/2003
NE:
SANITARY NO. CONTROL NO.
(408)972-7855
ARCHITECT/ENGINEER:.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
LICENSED CONTRACT'OR'S DECLARATION
Ib Description
OESCrIp
I hereby affirm thin I am lofianad under p nvisinna of Chapter 9 (commencing
c,and
with Section 7") of Division SNa BusinessdPodessiansC dmy lice.. is
�Cj'
m lull fare of L
REROOF
e Lie .
DolCunuvcmr
Dole
do rihnd my plasusA.l heUsedO.11 bliimmer°d
MAY 11 2004
Llccnsed Professional
DECLARATION
OWNER DECLARATION
BUILDING
I hereby affirm that I um cacmpt from the License Law fur the
m exempt
following reason. (Section 7031.5. Business and Professions Cotte: Any city or county
Which requirea permit to construct. alter, improve, demolish, or repair any slruclure$6260
prior m its issuance. also requires the applicant for such permit to file a signed.oarement
Sq. Ft. Floor Area
Valuation
thathe is licensed pursuant o the provisions of the Contractor's License Law (Charter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Cade) or
that he is exempt therefrom and de, basis for Ne alleged exemption. Any violation of
Mer 0 0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
Out more than five hundred dollars ($500).
❑ I, as owner of the pro,zall, or my employees with wages as their sole compensation,
Required Inspections
will do the work, and Ne suuctum is not intended or offered for sale (Sec. 7060. Business
and Professions Code: The Contrumr's Liame law docs not apply to an owner of
property who builds or improves thereon, and who does such work himselfor through his
own cmployacs. provided that such improvements ore not intended oroffered for sale. If,
however, the building or improvement is mid within one year of completion, Inc owner,
builder will have the burden of proving that he did not build or improve for purpose of
ale.).
O 1, as owner of the property, am exclusively contracting with licensed emoomlots m
conswet the project (Sec. 7044, Business and Professions Code:) The Contractors Li
rise law docs not apply to an owner of popery who Wilds or improves Merton, and
who contracts for such projects with a contractor(s) licen¢d pursuant to the Contractor's
License Taw.
I am cacmpt under Sec. B & PC for this reran
Ow Date
'S COMPENSION DECLARATION
WORKERAT
WORKERS
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insum for Worker's Camper.
anon, as provided for by Section 37M of Ne labor Code, for the performanu of the
work for which this permit is issued.
,
I have and will maintain Workers Compensation Insurance, as required by Section
3700 of N W bar Code, for the performance or Ne work for which this Permit is issued.
ce rti and lacy number art:
My Wor r :s Cnm n�sation r
C s'eC Polic N
CERTIFIC TE OF E%EM FROMWORKERS'
COMPENSATION SURANCE
(This section need not hecamplaed if the Permit is for one hundred dollars (SIIX)
or less.)
I Unity that in the performance of the work for which this permit is issued. l shall not
employ any permp in any manner so as to become subject to the Workers Compensation
Laws a( California. Dale
Applicant
NOTICE TO APPLICANT: If, after making this Certificate, or Exemption, you should
become subject to the Worker's Compensation provisions of In, labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm Nat there is a construction lending agency for the performance of
Ne work for which this permit is issued (Sec. 3097, Co, C.)
Lender's Name,
Lender's Address
I minify that 1 have rend this application and suite that the above information is
correct 1 agree to comply with all city and county ordinmas and state laws relating to
building construction, and hereby authorise mproenmivos of this city to enter upon the
shove -mentioned property for inspection purposes.
Cupertinoagainst
m indemnify and keep harmless the City of Cupertino against
(We,) agree ave,
j liobilitiae)greto case, and capcnmswhich mayinanyeCityf
City
in consequence of Ne gaming of this permit.
APPLICANT UND RSTA A WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SO�URCE��U� ION
Re -roofs
S tum of ApphmUWConlmctor Da¢
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant w future building Occupant store or handle hazardous material
as defined by the Copeman Municipal Code. Chapter 9.12. and the Health and Safety
.ode. Section 25532(.)?
All roofs shall be inspected prior to any roofing material being installed.
o Yea
I(aroofisinstalledwithou[first obtaining an inspec[ion,lagreetoremove
Will the applicant or future building Occupant use equipment ordcvienswhich
it hazardous airconmminants fined by the Bay Area Air Quality Management
list
all new materials for inspection.
rict?
p Yes No
Ihave fraud the haallousm 55(15.smquimmcntsuntksdepagadhourf the Califon
.is Hcatcg:Safety Cab, Scats 25Xtism73and 25534.1 undcrmndeoccthehuilding
/� /`%y/<?T!%'a�V✓ r/� 1
dao not currently haw a tcryrM1 that it is my nndty the t of Ne
- / !/
v�
nee 0nAlcaroo a plocy.
mgn�top�wnje{t mace& iaean��eert;Beammazta3,pr�
Signature of Applicant Date
' //
All roof coverings to be Class "B" or better
Owner r authorized agent Datc
�CITY OF
UPEt�TINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408) 777-3333
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 statedpolicyon re -roofing.
Homeowner's Name: (f P� I { r c / Pr Q yi/P� �� We /" (tea z- �
Job Site Address: a (/(/� V �/� h �� w /� r
Roofing Company Name: r r p 5 fU r 0 P- 1
A plican' Signature:
• Greg teal
Building Official
A(// Date: l( O 03
Revised 1/30/03
Printed on Recycled Paper
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CUPEkTINO
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CITY OF CUPERTINO 03
�/ 0 D 7 Z
REROOF
PERMIT APPLICATION FORM
APN #
L7 —� 0 Z 2,,-`
BUILDING
Date:
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
Build'Ad ress:
BSEISMICOM
Seismic Commercial
TO
✓
Plan Check Fee
Owner's Name:Phone
BUSLIC
Business License
#:
—
?47
C� IVB
rD P M A�
q-7 (
Contractor:
pPhone #.
License #:
V o�✓
100 1 r n �_
— S
Contact:
Phone #:
4367
Cupertino Business License #:
Mal
5ql-
Type of Roof Covering:
Existing:
Prop sed:
,/ 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
❑ Provide I.C.B.O. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cupertino's Teaz Off Policr,
Job Descripti
�
C �{0
T U -
Is Solo")fila
Residential
Commercial ❑
Fire Zon • Yes
No ❑
Confirmed with PlanninpsD_pt ifs
there are an restri ' ns: LJ
Cost
if Pro'ect:
Type of Construction:
Occupancy gro
0.
Ie root—
Qty. if
Annlica c, 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
22 00 254
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