03110004 ,'CITY OF CUPERTINO ?'^'s net -' >a r •u
BUILDING DIVISION PERMIT CONTRACTOR INhORM&ION:• _
BUILDING ADDRESS ANTHONY ROOF—g—ERVICE - PERMITNo03110004
10471 HENEY CREEK PL
OWNER'S NAME: 910 5 MCGLINCEY LN PERMIT ISSUE DATE
DICK LEE 11/03/2003
NE: (4U8) 26b—bi,l, SANITARY N0, CONTROL NO.
ARCHITECOENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECII
0 0 0 0
±Ore LICENSED CONTRACTOR'S DECLARATION
2 C I hereby affirm that I am licensed under provisions of Chapter 9(commencing lob Description
U wimsecfnr�f7fJtltyafDiviaou3nfmcBusVnc�.nndPrufcssionsCodc,andmyliccnscis REROOF
in full rnrcc plfJ a ec`.
License I:ns ILot.nM
�r.W Ic Cunt lot - ,(tf N r
RCI{ITECTS DI RAT ON
4 s 1 understand my plans shall be used as public records PR
2004 o ll; Licensed Professional
OWNER-BUILDER DECLARATION
1 botchy affirm that I am cxcmpt from the Contractor's License Law for tW ��'�D1
00 following rc m n.(Section 8131.5.Business and Professions Code:Any city county NG $14154
Sm which requires a permit Or construct,alter,improve,demolish,or repair any structure
-iy
prior Lot its issuance.also mquios the applicant for such Permit o file a signed statement
< that he isl Hectored pursuant o the provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation
Zare-° (commencing with Section 7")of Division 3ofthe Busincatand Professions Cook)ser 34248014 . 00
U R� that he is exempt mcmfrom and the basis for$e alleged exemption.Any violation of
Section'!031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not mane mint hundred dollars(M).
❑I,as owner of the p.,,ty.or my employees with wages sa than role compcosatlrn,
will do the work,and the structure is not intended or offered for sale(Sce.70iq Bonino
and Professions Code:no Conoactors License Law docs nut apply m an owner of Required Inspections
prapeny who builds or improwa income.and who dna inch work himselfor through his
own employees,provided that inch improvements are not intended or offered for I..If.
however,the building or improvement is sold within one oar of completion,the owner.
build.,will have the burden of Proving mut he did net Wild or improve for purpose of
saiC)
❑I,as Owner of the popsny am exclusively contracting with licensed contractors to
construct the project(Sec.70f4.Business and Professions Cade:)The Contractors U. .
ase Law door not apply to an Owner of property who Wilds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant o the C.."itcmr's
License Law.
I am exempt under Sec. B h P C for this morn
wrier One
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty Of perjury one of the following declarations:
I hoc and will maintain a Cerofeam of Consent to self-insum for Worker's Compen-
sation,as provided for by Section POD of the Inbar Code,for me performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3100 of me Labor Cole,for me performance of the work for which this permit is Whom.
My Worker's Compensation In domet cirri r and Policy numMrane n��r�
�arr]e/r / P ey No.:/1C1�DS{Mj2X ] s
.]Ca' CERTIFICATE OF E%FMMN FROM WORKERS'
JJJ COMPENSATION INSURANCE
This section need om W mmpletcd If the fermi,is ormu hundred dollars($lo(l)
m bess)
1 certify mat in the performance of the work for which anis Permit is issued,I shall not
employ any person in any manners as to become mbjecuo the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Eaemption.you should
Weom'subject to the Worker's Compensation provisions of IW Labor Code.you must
�O forthwith comply with such provisions or this perm itshall W deemed revoked.
Z= CONSTRUCTION LENDING AGENCY
I Wrchy a from Out mem iso commuctinn lending agency for the perform cul
X> the work for which anis permit is issmd IS..3W7,Civ.C.)
d1 Q Under's Name
L Lender's Address
� z
0 1 cenify that 1 have mad Nis application and store that the about information is
L E-' correct.l agree to comply with all city and county omimenes and stn¢laws relating to
-�U building construction,and hereby aummrim representatives of mea city to enter upon the
'hovementioned property for inspection purposes.
(We)reg.I.rove,indemnify and keep harmless the City of Cupertino against
Nliabilities.judgments.costs and expenses which may in my way accrue agamit mid City 1
Z in consequence of Use granti ng of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: /ate
SOU EAE J
Re-roofs
sign mofA i CAffmmr Data
A2AB000S MATERIALS DISCLOSURE Type of Roof
Willme plicam Or future building Occupant store or handle humorous material
as defined by the Cupertino Municipal,Code.Chapter 9.11.and the Health and Safety
th]hbSeen..25532001 All roofs shall be inspected prior to any roofing material being installed.
yea [)Ifo
ill the applicant or future building occupant use equipment or devices which
mirIf a roof is installed without first obtaining an inspection,I agree to remove
air Contaminants a defned by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes [bNO
I have Load me honNous materials mquimunts under Chapmr 6.95ofine Calif Or, 5
nia Halm k Safety Code,Sections M%5.15533 and 25534.1 understand then ifthc Wilding
dace not cuocndy have a moan'. t it u my raspmnsih.. m Oouly the ommosm or the J
m rte a which in t mrtniaman=.mraCo!"!i mr0.emPanmy Sign ureof (cant Date
J 1All roof coverings to be Class"B" or better
Owner or authorised tifoill Data
Community Development Department
i Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
ilTYOF Fax: (408)777-3333
CUPERTINO
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 ste CEIVED
required:
1) Pre-inspection and/or tear off approval. N 2 03
2) In-progress inspection approval.
3) Final inspection approval. _ a _-
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is requ' d.
6. Any roofing which is applied without first obtaining spection,
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 LC.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.
Homeowners Name: /J 1 C K/ �0,4
Job Site Address: JC 7ZNQ z ��/� L
Roofing Company Name:
A plicant's Signature: / Date
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
.I
CITY OF CUPERTINO D o D /
REROOF
e CUPEI�TINO PERMIT APPLICATION FORM
APN# `. / Date:
(� Wo '03-0
Building Address: L
e /<
Owner's Name: Phone M.
f</ 4,e 12—`w
Contractor: Phone#k orLicense#:
Contact: _ Phone#: 7Cupertino Business License#:
/y/fi H/ �&& li
Type of Roof Covering:
Existing: Proposed:
Cl Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �d Asphalt Shingles
DWood Shakes Wood Shakes
C3 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: _
,^ / OS 6, � G F-
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed wit .Planning Dept. if
there are restriction` : LJ
t of Project: Type of C struction: Occup cy gr p:
L;Qt i
A licab � Fee ID Fee Descri tion Fee Group
BPERMFEE Bid Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
# 23667
#--;2-o