03080182 CITY OF cutaEaTtNo ;. < z= •t ek . ;q
BUILDING DIVISION PERMIT t COIVTRACTnR INFORM ATIO ;;
BUILDING ADDRESS: PERMIT NC0 3 0 8 0 182
i
OW NER'S NAME: PERMIT ISSUE DATE
SA CIARKE AND SANDRA
NE: SANITARY NO. CONTROL NO.
ARCHITE-CGENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+Ones LICENSED CONTRACTOR'S DECLARATION
� F 1 bamny affirm that 1 am licensed ander provisions of Chapter 9 commencing Job Description
Zw Of S lion7(XXfuf Divieion3of Oc Basinesj a dPmfesxiuns Code,andmylicenseia
)q Z f° �((J
Licca LielN— REROOF
D cammem CONTRACTOR: GEORGE ROOFING aa�'NALE®
Hr3ELTe RAT10t
I z'a 1 understand my plana shall M recd public¢coNs
)yU
L"`ousedPn"""°"" SEP 2,4 2003
OWNER-BUILDER DECLARATION
00 1 hcrcby affirm that 1 1. exempt from IIIc Caliona o License Law for the -
o O following rtuoa permit
t )onstr Business and improve.
d mo demolish.
Code:Any oily nr county
<m vi which requires a pctmit to cores the,alar,improve,demolish,nr erepair anygned structure
°iy prior mits issuance.also inquires the applicant for such Permit Rleasigned statement ILDING
BLU
eSC that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valu8t1,og000
21— (commencing with Section 7900)of Division 3 of the Business and Professions Code)or Y
Nn be is exempt d¢mfrom and the baso for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a pnmit subjects the applicant to a civil penally of
not more than five hundred dollars(3500). - --- - - 3 0i-$er0 0 _ . Occupancy Type
I,as owner of the property,or my employees with wages u their sole compensation,
will do the work,and the structure is not intended or ofremd for said(sec.7044,Business
and Pmfessmm Code:me Coommum's IJceme Law docs not apply to an owner of Required Inspections
propenywbo builds or improves themon,and whudoessuch work himsavor through his 305 — FRAME
Own employees,provided that such improvements are not intended or offered for late.If, 307 — INSULATION
howeveq the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that be did not Wild or improve for purpose or
care.). 6 O l — ROOF TEAR OFF
❑1,as Owner of the property,am exclusively contracting with licensed convectors to 602 — ROOF PLYWOOD NAIL
mconstruct the project See,7044,Business and Prufossiona s Code:)Tire Contractor's 603 — ROOF BATTENS.
om Law does not apply to an owner or property who Wilds or impows memon,and. 604 - ROOF IN-PROGRESS
who eomraets for such projects with a contractor(s)licensed pursuant to me Contractor's
License Law.
❑l am exempt under Sec. ,B&P C Or oris reason
Owns, Data
WOR KER'S COMPENSATION DECLARATION
1 hereby of oro under penalty of perjury Once of the following declarations:
1 have and will maintain a CcmBcma of corium to self-insum for Workers Compcn-
1307CM
on,as Provided for by Scctiun 3700 or me Lamr code.for the pemorroarie,of me
' k for which Nis permit is issued.
I have and will maintain Worker's Compensation Insurance,ax required by Section
of the labor Codc,for the performanec of the work forwhich this permit is issued.
Workgrx Cnmpussati Inunne artier and Policy numMram:
�oticJ�
' aC RTI \TEOFE3 EMPfy{$R'xROM WORKERS', ^
COMPENSATION INSURANCE
(Thismerlon need not hecompIcted if the permit is Imo m hundred dollars I31f)(1)
in,less.)
I mnify that in the perfommnc,of Or work for which this permit is homed. shall nut
employ any person in any manner sir as to become subject to the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,al ler making this Certificate of Exemption,you should
become subject to the Worker's Cam pensadon provisions of the labor Codc,you must
D z forthwith comply with such Provisions m this permit shall be decreed cooked.
OCONS RUC ION LENDING AGENCY
1 hereby affirm that Then is a construction lending agency for the Performan c of
x 7 the work for which this Permit is issued(Sec.3057,Civ,C.)
Q Under's Name
3.
3 z Lender's Address
;J Q I cenify that 1 have read this application and sure that the above information is
y comer Iagme l°comply with all city and county onto nanaes and cam laws relating to
J V building construction,and hereby authorize,representatives of Nix city to enter upon rote
W above mentioned property for inspection purposes.
p, We)agree to save,indemnify and keep harmless the City of Cupertino against
rq liabilities.judgments,costs and expenses which may in any way accrue against said City
J z in consequence of thd grand ul'bis Pocono
^ APPLICANT UNDE S 5 AND WILL COMPLIT9LL ryON-POINT Issued by: *,2--
so EGUL S. �(/".",fC/s/D3
ApplcanVCunvacmr Re-roofs
Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sm,or bandit ha esus maarial
as defined by the Cupertino Municipal Code.Chapter 9,11,and the Health and Safety
Code,rection 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑vas ova
Will mea fieanl or Ivmre Wildln If a roof is installed without first obtaining an inspection, I agree to remove
pp g occupant use cyuipmcm or devices which $
it hvardnus air conuminano as defined by the Bay Area Air Quality Management all new materials for inspection.
trio?
Fly.
I have mad the haaardmos mtocludreeded.underChapter&95ofineCalifor-
nia Heald&Safmy Cod,.Secdunc 2554.2553'anJ 25534,1 undersand Nal if and Wilding
dos td is ndyh n the Tom
P r csponsibilityc.w nosey tad oapanl of and
rc eon w I us Moa I pr r w issuance of a Cudficate of cupanc
G Signature AApplica Date
Owner ordSl6onrcJ agcnl`� Dad 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
qUPEPVTINO 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 compIX with the above stated policy on re-roofin .
Homeowner's Name:
Job Site Address:
Roofing Company Name:
A plicant's Signature: L±1:�, Date: 25/O
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERINO PERMIT APPLICATION FORM
APN # ---,Datq:
_! —, 0 03
Building Address:
10 7D /hr r V 2
Owner's Name: Phone#:
_ .2Sr) - - 2
Contractor: Phone #: License#: o? 7 q a 4/
tweor- 5 S- 8—C— _ �(, C-
Contact: Phone#: Cupertino Business License#:
i2xz,.4- .'avow 6-5-9— ago a
Type of Roof Covering:
Existing: Proposed:
NM Built-Up Roof --,El 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#
`Q To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: �1
Residential ❑ ICommercial
Fire Zone: Yes ❑ No ❑ Confirmed with PI De t. if
there are anres actions:
Cost of Project: Type of ccupancy gr p:
�`1Dmv
Qty. if
A lic 1 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