04040017 CITY OF CUPERTINOs�.n
BUILDING DIVISIONPERMIT CON,T,Rk1CTUR�}INFORMr1.TION
i BUILDING AODRE35: PERMIT NO.
STATEWIDE ROOFING INC 04040017 '
OWNER'S NAME: PERMIT ISSUE DATE
ONE: 9942 MONTERBY RB SANITARY OL NO.
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o o LICENSED COm ACTOR'S DECLARATION Job Description
��
1 hereby afBnm Net 1 am licmued under provisions of Chapter 9(commencing p
Ith Sw ] )afDidaim 3ofmWB and Rofuduw Code,andmy license is
R63 /�z(o REROOF
E D Con
,eARCHITECTS D ATION
y I unMw
rnd mY Plans shall tic used as Public rtcards
U
c Licensed Professional
OWNER-BUILDER eco pER OEthe ConTION
coo Weaso .(Sec Net 11. ucmpl from the Coramamars License law for tW t
coo following moon.permit
t ]1015,n,Business and Preme,dcumR hale:Any oily on carry ,I i(—
$ which mqulru a permit n Common,alter improve,demolish,or repair any smmure
!• tprior hat W its issuance,pursuant
re to the the sPPliunt for such permit m wase L as....—
that
e 9 \ ( 1 l_-f "'r
< thommencttued pScWnl to the of Division
thehe Business
and Proessionsuptw9 Sq.Ft. FIoo�AYa Valua[o
(eat he Is seem iNSerefromon 7")ofbasis for
oftWeged exempt Professions Code)or
tionof
$ that he is exempt therefrom and the bola far tiro alleged exemption.Any violation of m
SeeB031ba� forawitwbjeenthe.Mlicantmacivil penalty ser
LL
ma . applicant meU J3 U LLr� I Occupancy Type
❑I,uowmrofthepmpeny,wmycmployceswlthwageauftkwlecompemsion, —'
willdo Newarkand NeswctumisnotinmadedmoRcsed fonucf3ec.7 H,Bumneu
and professNns Code:The Cmtrscmn License law mar not apply In an owner or Required Inspections
property who WIINarimprovea thereon.and who doessuchwork MmWfwOuough hu
own employees.pmNded that such Improvemants am notimmnded mortared Imams,if,
hmnown,the building or Improvement Is sold within ave year of completion,the omer-
bullden will Tuve the burden of proving thu W did not Wild or Improve fine purpose of
ole.).
❑1.as owner of the property,em exclusively contracting with licensed conoacm s in
construct the project(Sec.7044,Business and Profusions Code:)The Contnaemrs U-
cense law doe at apply man owner of pmpar y wW Wires or improves mown.and,
who contracts for much projects wide a canmsnot(a)licensed pursuant to the Contractor's
License Law.
❑1 am exempt undm Sw. .B 8 P C for this mason
Owner Due
WORKER'S COMPENSATION DECLARATION
1 hereby effuse under penalty of perjury ow of the,following dwlarmfo u:
1 have and will maintain a Certificate of Covent to self-ho u e for Workers Coupon.
sation,as provided fm by Section 37M of tW Labor Code,for the Performance of the
work for which Its permit is issued.
❑1 have and will maintain Workers Compensation Ivtutnce,u required by Section
3700 of the L%Wr Code.for the performance of the work for which this pewit is blued.
My Worker pat ala on sunnce ee� d Policy nummber, coo al7i
Cartier. /// No.:
CERTIFlCA750P PJ(EMFROM WORKERS
COMPENSATION INSURANCE !�D)�
(This section need notbeeemplemd ifthe Permit is for hundred dolma(SKID)
or mu)
1 certify Nat in the performance of the work for which this permh is issued,I shell not
employ any person in my manner an as to become subject to the Workers'Compensation
laws of Coifomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making Ws Certificate of Exemption,you should
become subject an the Worker's Compensation Provisions of the Labor Cade.you mum
.,O forthwith wmply with such provisions Or this Permit Nail he doomed revotrd.
Z rNi CONSTRUCTION LENDING AGENCY
[—i I Wmby atlitm that there lar eovwninn larom.,egenry far the performance or
CY.> the work for which this permit is iuucd(Sec.309],Civ.C.)
W�Q lenders Name
.1. zLendcrn
'a Addre
U0 I centfy that I Mm mad this pplication and sum that the above Information is
U. f" coma I agree to comply with all city and comply ordinances and state lawn relating m
OU Wilding comumnton,and hereby authaire mpmmenmives of this city to ender upon the
W above-mentioned property for inspection purposes.
(We)agree m save.indemnify and keep harmless the City of Cupeniw against
y Ilabilitiu,judgmentsm
.cuts and expenses which may in my wayaue almost said City
V7 in co race of l5 gaming o(dis pewi
G7 APPLI Nf ER ANDS A O WITH ALL NON-POINT Issued by: Date
30 TONS.
Re-roofs
St fApplicanuCon for
HAi.f.O S ildi.g ALS DISC SURE Type of Roof
WIIby a CupertnoNose ipalCg acupmttm nehandlchuaAoumaterial
u defined by Ie Cupertino Munleipal Cade.Chapter .12.rad Ne NuII and Safety
C
an.,Section 25532(.? All roofs shall be inspected prior to any roofing material being installed.
❑Y. a
Will the applicant or future Wilding occupam use equtptrcnl or devices which Jf a roof is installed without first obtaining an inspection,I agree to remove
t h./!Masa air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
trict?
❑Yes 1_rnu
I have read the huardws materials requirements anderChanw6.95ofthe Califon-
33 534.1uademmnd latifthe Nilgimr o not curmml va a lora Iypnmhilllymunify dee ocupanLdff Ie
idem ts .e am nCenineam of anry. Ignature of Applicant Date
era suthorivodagcm Date All roof coverings to be Class "B" or better
Community Development
aClOF
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
IUPEkTINO
Building Department
B ADDRESS: PIT ' O D
1628/ /f-fP4541f/ C—
WNEWS NAME: AY,--� YP S PHONEN t7 S
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
U Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing dqtsof/ f_
Septic Tank
Sheet Metal
Sheet Rock
Tile
/Contractor Signa Date
i Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
4UPEkTINO
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 comply with the above stated policy on re-roofing.
Homeowner's Name:> HGI /9 L Al G .
Job Site Addre' .y /0 Z y / l -7 P f;uC r f7 C-
Roofing Company Name. 5_7 Z) T ZE yl/ 0 -a °O r /A/ C-
A plicant'sSignature Date:
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
aI's CITY OF CUPERTINO o
, REROOF
CUP.QINO PERMIT APPLICATION FORM
APN# �s7 /to C9C74 2— Date: D 2
Building Address/
Owner's Name: Phone#:
Conte License #:
Contact: Cupertino Business License #:
�] ;23 -O �
Type of Roof Covering:
Existing: PrQpo�sed:
X Built-Up Roof �(�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#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential ❑ Commercial
Fire Zone: Yes-r=] No ❑ Confirmed with Planning Djot. if
there are any restrictions: U
Co of Project: \ T e of Construct Occupancy group:
el le-11-0�7c' y- ;
Qty, if
Ax(plipable 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
4 ,2