03070196 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �CONTIUCTOR INFORMATION N
EU TIDING ADDRESS: WOODS ROOFING PERMITN003070196
OWNER'S NAME: 2179 STONE AVENUE STE 22 PERMRISSUEDATE
JANE TV SON 03
"E' (831) 637-5576 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+Op LICENSED CONTRACTORS
sedundrp DECLARATION lob Description
�z❑ I ionhereby70 affirm that 1 am licensed under provisions on Chapter 9(commencing p
iW with Section 701g)mfDivision Soffa Business and Professions Code.and my is
'o. infull tome and c.
Leen pro t2�, `� ti.to ARCHITE . REROOF
to Daa / tl� um r a FINALE®
4 re u 1 understand my plans shall w u ed as public reenrJa
. Licensed Professional. SEP 15 2003
=ms0s OWNER-BUILDER DECLARATION -
y1 hereby affrm that 1 am exempt from the Contractor's License Law for tax py��{�ye
O O following reason.(Section)1131.5,Business and Professions Code:Any city or county �I�I�/�
Sie� which requires a Permit m construct,alter,improve,demolish,or repair any structure tris
_Zy prior us i.issuance.also rechims the applicant for such Permit to File a signed stammem
�< that he is licensed puruanttathe previsions orthe Contractor's License aw(Chapter 9 Sq. Ft, Floor Area Valuation
cj l-ta (commencing with Section 7")of Division 3 of the B usiocss and Professions Chute)or
i that W is exempt donations and the basis for the alleged exemption.Any violation of 36222029 . 00
Section 7031.5 by any applicant fora permit o bjems the applicant o a civil Penalty of ane ApN Number Occupancy
not more than five hundred dollars(5500). p y Type
❑I.as owner orthe property,or my employees with wage¢as do4mlc compensation,
will do the work,and me structure is not intended or offered for sale(Sec.704,1,Business RR
and Professions Th
sions Cade: e Commaims License law does nut apply m an owner of 3 O 7 — INSULATeftOtirgd Inspections
property who builds or improves thereon,and who does such work himself or through his
Own employees,provided that such improvements are not intended uroRered for sale,It. 6O1 — ROOF TEAR OFF
however,she building or improvement is sold within one you of completion,the owner.
builder will haw the burden of proving that he did not wild or improve for purpose of 6 02 - ROOF PLYWOOD NAIL
sale,), 603 - ROOF BATTENS
0 1,as Owner of she property,am exclusively contracting with licensed Contractors to
construct the pmjcct(sec.7044.Business and Professions Code:)The Contractor's Li 6 04 — ROOF IN-PROGRESS
rue Law does not apply to an owner of property who wilds or improves do moo,and
who contracts for such pmjecu wits a cantractorls)licensed puts....tbo COntnaora
License La-
0 .C..pt.ndr,Stc.
aw.0lamex.pt.ndr,Stc. ,B&PCfm m..a m
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ooe of she following declarations
1 have and will maintain a Cenifeme of Consent to self-insure for Worker's Compen-
smion.as provided for by Section 3700 of do labor Code,for the perfovnance of me
wmk for which oris Permit is issued.
have and will maintain Worker's Compensation Insurance,u a iumcd by Section
3700 of me labor Codc.for the performance of the work for which this permit is issued. -
MyWork ns nlnsunrgce carrier and Policy numwr am:s
Carrie (,V Policy Na.:,"`p5 03 —/q1
CERTIFICATE OF EXEMPTION FAO w RM 0 KERS'
COMPENSATION INSURANCE
(This section need not w completed if tk permit is for one hundred dollars(SIM)
,it Icss.)
I certify that in the performance of me work for which this Permit is issued.I stall not
employ any Person in any manner m as to weome subject o the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:if,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
,Z forthwith comply with such Provisions or this permit shall he deemed nemkm.
Z� CONSTRUCTION LENDING AGENCY
1 wreby affrm that there is a commuminn lending agency for tw Performance of
Y me work for which this permit is issued(Sec.3097,Civ.C.)
1.1 Q Lender's Name
Z Lcndef's Address
J 0 I certify that 1 have read this application and state that me above information is
y f correct.l agree to comply with all city and county initiatives and sum laws relating m
Jbuilding construction,and hereby uthorine rcpresentxtivee of this city mentor upon the
U about-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
V/ liebilitla,judgmen.,c.a.and exioneas which may in any way seem,against said City
of
U,z in consequence gij m rmi� �� J
.. SOURCE NT LATiRSTA S WILL 1PLYaW'ITH A L ON- OINT Issued by: Date
Signature of AppiaanUComgamrDare Re-roofs
HAZARDOUS MATERIALS DISCLOSURE r Type of Roof
Will the applicant or future building occupant more of handle h aland
fin
as deed by me Cupertino Municipal Cade.Chapter 9.11.and the Health ts and Safay
COJc.Section 25332(¢)7 B'1� All roofs shall be inspected prior to any roofing material being installed.
' ❑vcs
Will mea leant or future building Occupant use a If a roof is installed without first obtaining an inspection,I agree to remove
PP g p a Air Quality
lity Management nt g P
it haeardnus air contaminants as Jcfned'by me Bay Arca Air Quality Managcmcnt all new materials for inspection.
isuia?
by.. Q¢�
1 have mail the haraNtms mmerials¢yuircmcnu under Chapterti.95 of the Califon /�pJ.��JG'/saw+.•Q�
nia Hcalm&SarCoCua Sections 25M5.25533and 25534.1 understand muff the wilding q
Jes oat currently anahl t i responsih' Y ld mply the mmu t of me �/ 1)Y'S
43
rcyvi¢mc w mM mi e ,r rtifi m ai , Signature of Applicant Date O
Owner or amhorircJ agcm �pas� All roof coverings to be Class "B" or better .
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N® Fax: (408)777-3333
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 complywiththe above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: ll—"-L9
Roofing Company Name:
Applicant's Signature: Date:? �� 03
Greg teel
Building Official
Revised 1/30/03 ,
Printed on Recycled Paper i
07/'25/2003 12: 45 51053E32E2 LEGALITIES INK PAGE 01
CITY OF CUPERTINO
'
ezr�c. REROOF 3 o6
& CITY 0
UPEkTINO PERMIT APPLICATION FORM
APN# �-- Date:
30- 22 v 5 0
Building Address: 11-20
Owner's Name } Phone #:
_
C :ontracto Phone#: License #:
s oL,� G oto - 0803 . 3 ,?-si3 1
Contact: Phone#: Cupertino'Business License#:
2 U�/d
Type of Roof Covering:
Existing: Proposed:
O Built-Up Roof ❑ Built-Up roof
C Asphalt Shingles ''E Asphalt Shingles
Wood Shakes ❑ Wood Shakes
)Q Wood Shingles ❑ Wood Shingles
❑ Other(Specify) _� ❑ Other(Specify)
Nutntier of existing coverings_ ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
Have Read, Unders and and Miff Comply With C ertin ' Te. Off Polic :
ob Description: TO Z �c'- — 7 /6' d v
Residential Commercial ❑
J .
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project:. Type of Construction: Occupancy group:
Qty. if
Applicable FeCfED _ Fee Description Fee Group
/ BPERMFEE i ___ BldgPermit Fees BUJLDING
BENERGY.' Enerav BUILDING
BSEISMICR-8 Seismic Fee Res BUIL DING
BSEISMICOMI, Seismic Commercial BUILDING.
BPLANCHK Plan Check Fee BUILDING
BUSLIC g. _ Business License BUILDING
2 _Z4 7
/ �� q `D