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CITY OF CUPERTINO'''
INF'OXiMATIO
BUILDING DIVISION PERMIT
C,OIVTRACTOR
BullADDRESS:
A0290
ADVANCED ROOFING TECHNIQUE
ERMR NO.
P1.
OWNER'S NAME:
1179 MYRTLE DR
APPLICATI A
Q'I
NE:
(408) 249-493,%
SANITARY NO. CONTROLNO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hcreby affirm Nn 1 am licensed under provisions of Chapter 9 (commencing
p
with Soction 7,10)nf IvlAlon 3aftheB in end Professions Cade, andmylicemeis
in full farce a er
Ltcensc Cleo .g
REROOF
Da - eonRE
ARCHITECTS DEC ATION
{T �XTTT. E PLA E COMP. SHINGLE
/
nd m plans shell be used a uM1lic ucnrds
Lldrd Professional
OWNER -BUILDER DECLARATION
1 hereby .(Sure I sere exempt from the Contns law for the
Any
Co : Any city vet county
(Section 8131.5, Professions c
following Maso on Business and
_
demolish. or:
eonnrthe pWn Improve, sig any citure
which mquime A pmmh t, improve.
requires a
h permit1or e a umment
o the for such permit lafileaeLaw chapter t
priorly its issuance, elmnt
Ft. Floor Area
Valuation
he ecingwiit pursuant to the isionao
to of the ContractorsBusiness
Sq.
Code) or
(commDivision3ofthe essand Professions Crede)o
(commencing with Section of Division
eged
Nat W H exempt therefrom and the bu0 for du alleged csemptlon. Any violation of
and the
APN Number
Occupancy Type
Section 7031.5 by u0' Applicant fan permit subjects the applicant to a civil penalty of
not mon than fin hundred dollen (5500).
01.eownerfthepmpeny.mmycmployeeswithwgesud i mleampenutlan,
34248035.00
Required Inspections
willdo the wart, and the structure is not intended ooRered forsale (Sec. 7044. Business
dots
And Professor. Cade: The Ci mrutofs Lt.. law col Apply n An owner of
progeny who builds or improves thereon. and whodoessuchwark himselforlluough his
305 — FRAME
own employers, provided Net such improvements Arent Intended orotfood(anal&If,
307 — INSULATIONhowever,
the building or improvement is old within oro year ofcampledon, the owner
builder will haw: the burden of proving Nal W did nm build tor Wprove fee purpose of
601 - ROOF TEAR OFF
vele.).
602 - ROOF PLYWOOD NAIL
0 I, As owner of the property, am exclusively contracting with licenxd euouaesen m
comtmct the project (Sec. 7044, Business and professions Cade:) The ComrAetors Lt.
603 — ROOF BATTENS.
ocnae Law does not apply in an owner of property who Wilds or improve thereon. and,
604 — ROOF IN -PROGRESS
who conocts iteration pmjec%with a conuanortU licensed pursuant u the Conumuseg
License Law.
0 I am eacmpt under Sec. . B k P C for this moon
Owner Dem
WORKER'S COMPENSATION DECLARATION
1 hereby a1Drm under penally of perJury one of the following declanllons
then and will maintain.eCcnl37M of ConntoCode self -insure far Worked Compcm
ss0an, u provided for by Section 7]00 of Ne Lehor Cada for the performance of the
work for which this permit la issued.
❑ 1 have and will maintain Worker's Compensation Insurance, As myviretl by Section
3700 of Ne labor Coda for Ne peRormance of Ne wet for wide h Ihia permit is issued.
�--�
My W i mpemnlon himunn c certicc and Policy nu r au:
<cYe.
Policy
CERTIFI TEOF EXEMPTION FIRWORKERS'
COMPENSATION INSURANCE
1
(7Th account need not W completed If the Permit n (oaahundred dollars ($101)
/
or Ices.)
I marry Net in the Performance of the work for which this permit is issued, I shell not
employ any person in any manner m As in become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL After making NH Cenificam of Eacmption, you should
become subject in the Workeh Compensation provisions of the Labor Code. you most
forthwith comply with such provisions or this Perrot shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 Wilby &M m Net there in conswcdon lending el'cnry for the performance of
the work for which this permit is issued (See. 3097, Co. C.)
Lender's Name
- -
LentRe.Adduas
I Nu I Mn read Nit end rete est the aWve rela0un is
and coon laws
bonding 1 agree to comply withal) dry and county end cult laws
agreecity
e
ntatnanas
r upon t
building construction,roend hereby Authorize of this tlry m enter upon Nc
prepresentatives
an purposes.
ehovc (we) - ed propene for Indemnify the City ose Morino l$id inst
(We)ague to un, indemnifyand keep harmless
City
and e"his a whtch may in ane way acne Againel sold City
Ilae,jed may
consequence of thebosu
APLICATof the gro of "hispermit.
APPLICANT UNDE DS AND WILL COMPLY WITH ALL NON -POINT
Issued by: D to
OURC E L I
Re -roofs
Type of Roof
`I -
S at= plican roomier
HAZARDOUS MATERIALS DISCLOSURE
th applicant or future building occupant atom m handle haurdova meurial
M dcfin d by the Cupertino Municipal Code, Chapter 9. 12, and the Health and Safety
do, Secinn25532(a?
0 Yes pa
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fuwu Wilding occupant use equipment or devices which
I, Wurdnu sit romam mets a defmcd by the Bay AMA Air Quality Management
all new materials for inspection.
trict?
CYe �u
Ii.O.Wicumemly
IhavemW the WwaNtws memsialsmyuimments un rChepter6.95 of the Glifro-
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Hulth a Safety Cade, Sodom 25505.23533and 25534.1 dereundthuirdm Wilding
ha�e vet. that it u my uspomihility ro otlfy 1M aceupml of Ne
✓/\V/
uumcnu Which c el pnormissuance cafe Ccrulka afOc ipanee.
Signora of Applicant are
—03
All roof coverings to be Class "B" or better
O r mA,,ed agent Dam
CITY OF
ICUPEkTINO
•
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 stated policy on re -roofing.
Homeowner's Name: $a ,d .d Ls "Y)
Job Site Address: 10,3'75 d&6!f4 Cr�c
Roofing Company Name: AA , e9A�W n:Q% ono,. T� �s t, o s
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date: _2�- 3