03070075 a CITY OF CUPERTINO ''" ''% - a -
BUILDING DIVISION PERMIT CONTRACT,(JR INFORMATION
BUILDING ADDRESS: DUBOIS ENTERPRISES """"030700750
WNER'S NAME: 99 DUARTE AVE PERMIT ISSUE DATE
VTCKTP HARVEY 07 /1.0/2001
"E' (510) 793-9760 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
nse
CJ
+Op LICENSED CONTRACTOR'S DECLARATION
m❑ I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
�ito with section 7IXU)Of DWi.km3ofhc Busincssand Prufcuions Cod and myliccnse is
i'�? :ifs era dna err�k3 u, a L 23 REROOF
'�,❑ Dam s amracmr_
al
� TION
na I undersand my pins shat M usedARCHITECTS as public record JUL 2 q
2003
sod Licensed Professional
g OWNER-BUILDER DECLARATION BUILDING'ya a f I berth,./firm Nm I am exempt Gum the Couraaar's Litems taw for the .. LDIN G
10 following w n.(Section 7(H 1.5,Business and Pmfexaions Code:Any city or county
5. which requires a permit to ennslrun,alter,improve,demolish,or repair any stsuetu e
_Iy noon its issuance.also requirts the applicant for such Permit to file a signed statement
ESQ
that be is lice Toed pursuant oheprovisions Ofthe Contractors License Law(Chapmr9 Sq. Ft. Floor Area Valuation
et- (commencing with Section 7000)of Division 3 or the Business and Profeumor Code)or
i Nat he is exempt themfsum and he basis for he alleged exemption.Any violation of 3 7537061 . 00
Section 7031.3 by any applicant for A permit subjects he applicant m a civil Penalty of AIN Number Oceu ane Type
not or,hair Gv,hundmd dollars($500). P Y YP
❑1,as owner of he pmper y,or my employers with wages ss their Solt compensation.
will do dm work,and tbeswclurs is not intended or offered for sale(See.70,14,Business
and Pmfcmimu Core:The Camities Liceve dors Law donot apply to an owner of 3 0 7 - INSULAT 1VN d Inspections
property who builds or improves hereon,and who does such work himselfar through his
own employees.provided that such improvements we not intended or offered for vie.¢ 601 — ROOF TEAR OFF
however,The building or improvement is Bald within one year of completion,he owner-
builder will have he burden of proving hat he did not Wild or improve for purpose of 6 02 - ROOF PLYWOOD NAIL
saw.). 603 - ROOF BATTENS
❑1,asowner ofproperty am Business
contracting with Tic Contractor's
to
constructeLaw
pplyt an Basin essandrywhi bus Code:)am Con vector's and 6O4 - ROOF IN-PROGRESS
cense Law docs not apply a an with
of property who sed p or improves hemon,antl
whLatta for pmjcca wih a conmxmrts)licensed pursuant to he ConvanOla
0
License wo Law.
❑Ism exempt under See. ,B&PC for this r,azon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I hale and will maintain a Certificate of Consent m setr-hrum for Worker's Compere
cation,as provided for by Section 37M of the Labor Code,for he performance of he
is for which this p,miit is issued.
have and will maintain Worker's Compensation Insurance,as required by Section
37W or he Labor Code,ror the performance of the work for which this ponsil is issued.
My Wm1wo,S n scion lnsunn micr and Policy numry am:
cvrirn_ f-- Pob, Na. 67-0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TTh acerin Med not bemmpleted Blue permit is forone hundmd dollars(SIM)
or leas)
I certify that in he perfmmarce of he work for which his permit is issued.I shall of
employ any person in any manner an u vi kCOme subject TO he Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,at making this CCi11EQle of Exemption,you should
become s bjen m the Worker's Compensation provisions of he Labor Cook,you must
.JO fothwih comply with such provisions or his perm i t shall he deemed revoked,
Z CONSfRUCIION LENDING AGENCY
(-+ Ihereby affirm that hose is a construction lending agency for h,Performance of
1' the work for which this permit is issued(Sce.3097.Civ.C.)
Q Lender's Name
Lender's Address
V Q 1 cenify That 1 have read his application and sets that he shove information 0
(g F correct.1 ague m comply with all city and county ordinances and Sam laws¢lacing to
Q U building consvunion,and hereby authorize representatives of his city to enter upon the
[31 abovom.judg tlPropcny for inspection purpowhich may
'(We)Agree to arc,indemnify and keep harmless the City of Cupertino against
Hy
in dbi
or the goad and which may in any way seems against said City
CJz in cprsequenee of he graining of this Permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. /I fs
�y
Signature of ApplicanVmn
Corsor �JIe-fi't� [�D Re-rooIs
HAZARDOUS MAtERIALS DISCLOSURE Type of Roof
Will the,applicant Of future building Occupant store or InrNle harardous manorial
u defined by the Colton.Municipal Code.Chapter 9.13,and the Health and Safety
Cole.Section 35532(a)?
❑Yes ggr_ All roofs shall be inspected prior to any roofing material being installed.
Will he applicant or future building oteta ant axe equipment If a roof is installed without first obtaining an inspection,I agree to remove
pp g p qui t or devices which g p
icr, nus air contaminants az JcfincJ by The Bay Arca Air Quality Managcmcnc
isvieic0 all new materials for inspection.
❑Yes d+
I have read he haraNrms materials¢quircmcns under Chapter 6.95 of the Califnr-
Tia,noh6rently Cow,fereanasawitI5.a5513anda3334.1 understandodons
occupant
Ofim
oras Toth A,Seel hero. eWant 25 0 h 5 3 wil25i 34.1ility m notifymixon tb,ref dim holding of Ih,
require mcnu whit met pniunn suancc of a Ccoulaam ofccy.
�'p�� � Signature ofApplic Date
Owner Of aaharimd ocou D,te All roof coverings to be Class "B"or better
Community Development Department
s Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
U P E Q I N O
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: y p
Job Site Address: !D ( S / �//0-�fi�warov� /Z CL
Roofing Company Name:
A plicanYs Signature: `--r� Date:2 /D 0
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO7.�
REROOF D
OF
CUPERTINO PERMIT APPLICATION FORM
Date: O O
Building Address:
Owner's Nam . c+ Phone#:
25 Z-6 3 7 `j
ContractCEWPone LL License#:
� J793-976 0 8'l2 304�
Contact: y� Phone#: S Cupertino Business License#:
Type of Roof Covering:
Exis mg: Proppsed:
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 g2_mply With Cu ertino's Tear Off Policy:
Job escr' tion:
. 1zW 3 %UwLt
Residential 'K Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De I. if
there are an restrictions: u
Cost 4P�qject: Type of Construction: Occupancy group:
Qty. if
ti able Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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