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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
OWNER'S NAME:
-
APPLICATIO
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,NE:
SANITARY N . ONTROLNO.
ARCHTIECTrENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby .Elan Nn 1 Am licensed m rovisians of Chapter 9 (cammeming
with Section] )af Dlvialon3 otrial) um a o"n" onw Code.aM mylicenm is
mmlua deIT 0
Licenm Lic.g
30YR. SHINGLE OVERLAY
CONTRACTOR: JONUTZ ROOFING
Data c°"
ARC S D U ION
I undo nd my pl.... hall bo used a public reenrtis
License Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from Ne Contractor', License Law for the
following season. (Section 703 L5, Business and Professions Code: Any city or county
which requims a Permit to construct. alter. Improve, demolish, or repair any svuctore
poor to its issuance, also mquires the applicant forsuch permit to file a signed statemem
Nal he is licensed pursuant the provisionsofthc Common's Limns Law (Chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7011) of Division 7 of the Business and Professions Code) or
Nat he is exempt thcmfrom and the basis fm the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to s civil penalty of
not mora than five hundred dollars
❑hu owner oflhe property, or my employees with wages u their sole compensaflon,
32630059.00
Required Inspections
q P
will do the work, and theebuctute is nolmnded oroffenul for sale( Sec. 7014, Business
and Profesdom Cade: The Conusstofs License Law does not apply to an owner of
property who builds or Improves thereon, and who doessuch work himselforthrough his
305 - FRAME
own employees, provided thatsuch improvements ere not Intended oroacred for sale. If,
307 — INSULATION
however. the building at Improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not Wild m Improve for purpose of
601 - ROOF TEAR OFF
sale.).
602 - ROOF PLYWOOD NAIL
El 1. aOwner of the property, amexclusively contractingwith licensed convectorsto
construct dire project (Sec. 7(44, Business end Profml Code:) The C.Amactera Li-
603 — ROOF BATTENS
const law does not apply to in owner of property who Wilds or Improves thereon,entl
604 - ROOF IN -PROGRESS
who contracts for such projects with a cormou r(s) licensed pursue to the Contractor's
4' Law
1 ren site under Sec. . B & P C for this reason
D 0
WOR 'S SA DECLARATION
I hereby aRmt under penalty of perj w of the fallowing dcclAraOons:
_
and will
In
or Consent to wdc,
1
foreforWmtrM1Ce of the
prion, u provided for by Stttian 7700 of the Labor Code, for the performwm of the
As for by
wok for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Seniors
3700 of 0te Labor Code. for the performance of the work for which this Permit is issued.
My Worker's Campenutlon Insurance Cartier and Policy number am:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisswtlon wed not he completed If the Permit Is intone hundred dollen (SIM)
Car loss.)
i cenlfy, the, In the inteno-of the work for which this Per it is Wood, I shall at
employ anype a mpner., asm !care eta �eS si lis orkcrf Compeasadon
Isweaf Cell te_-—
Iqqp1majjI
N(g1Q� TOA WCANT- . e( making Irks mric4te of Exemption. you should
,.V
e subject m the Worked Compcnptinn y ?visions of the labor Code. you must
forthwith comply with such provisions raids permit shell le deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby AMOCO that there its construction lending agency for the performance of
the work fur which this permit is Issued (Sec. 3097. Civ. C.)
'
Name
Lender's Add.
I certify that I have read this application end tote that do, above infuriation is
I agree to comply with all city and county ordinances and state laws mount; to
Wilding construction, and hereby eUthOHM rep SOMAL es of this city to enter upon dic
above-mentioned property far impection purposes.
(We) ,gust to ansa. indemnify and keep harmless the City of Cupenina Against
liabilities, judgmenu. cam and expenses which may in any way emu, against said City
di
in consegueme of Ne graming of this permit.
APPLjPANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SO R�`0 21-1-115 �
Re -roofs
Type of Roof
S un of Applic Co mr Data,=,I
OSMA-RIALSDISCLOSURE
Will the applicant or future bulldin oceuppl Co. or handle hasamous material
As defined by the Cupertino Monicipe ode. LTaPter 9.13, end the Health end Safety
coda. Sccuon 35533(.)7
All roofs shall be inspected prior to any roofing material being installed.
❑ Yes
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or dcvima which
11uit hazamnos air contaminants ens freed by the Bey Area Air Quality Management
all new materials for inspection.
stne,?
❑ year a
I havemad the haranlnm materials requirements under Chapter 6.95 of the Celifor.
Cala Hca N&Salc"Csra Sections 25505,25533 and 35534.1 understand Nmifthc Wilding
duce currently have s tenmt, that it is my reaponsihilily In notify the occupant of the
1
nu which o t W met nor m issusncc n e Ceni ca¢ of Dec.tic .
P F y
_
1 attire of Applicant Date
ec
All roof coverings to be Class "B" or better
at aan silted ant Dale
i Community Development Department
f� Building Division
f §� r�`'t City of Cupertino
A(,
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
CUPEDT1N0 Fax: (408)7773333
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 r/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: nn� i�� %�' ✓�—%�
Job Site Address:
Roofing Company
A plicant'srS(i�g^nature:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
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