03060170CITY OF CUPERTINO'"
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BUILDING DIVISION PERMIT
,CONTRACTOR INFORMATI,0N
BUILDING ADDRESS:
PERMIT NO03060170 30601%0
1-1
W NER'SNAME:
PERMIT ISSUE DATE
ONE:
SANITARY NO. CONTROL NO,
ARCHITECT'/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
I hereby that 1 of Chapter 9 (commencing
Job Description �''�^
p
affirm am fth. r under provisions
w with Section )IXXq of Division NC Busincxs and P fcssionxCMc. and mylicense i
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License Clash' ST Lie N
REROOF JUL O ZOOS
p Dare canDECL
CONTRACTOR: GUANANTEED ROOFING
ARCHITECTS DECLARATION /' U Aa
6 andcrundmyplanaMalllxa,cd.,paM1hcrecnrda V nST
BUILDING
a
u Lmanmd Pmfcssinnal
117,
3 OWNER -BUILDER DECLARATION
Y 1 hereby affirm Nal 1 am exempt from the Contractors License Law for the
O following ninon. (Section 7031.5, Business and Pmfeasions Code: Any city or county
'
which minutes a report at construct, alcor. improve, demolish, or repair any suu[mm
i prior its issuance. also requires the applicant forsuch Permit to file a signcdsummenl
cmatbeislicensed pursuant tothe prevtamnsoftheContractors License law(Chapter 9
Sq. Ft. Floor Area Valuat"000
$ (commencing with Section 700o) of Division 3 of the Business and Professions Code)or
— Nat he is a.cmpt thcmfmm and the basis for me alleged cremnin m. Any vitiation of
Section 7031.5 by any applicant for a permit subjects the appl¢anuo a civil penalty of
3B�BI3xD39i1leS00
Occupancy Type
not ream than five hundred dollars ($500).
I, ot owner of the ny, ar employees with verges Heir Solt
due a is r
044, Business will d" the work and the swcmm is not. Livens Lir offered Tonle (Sea. 7Dd4, Business
and Professions Code: The Contractor; License Law docs not apply to an owner
Required Inspections
and who dos Such work his
is
who builds or ed
305 - FRAME
that suThereon,
... any
awnedthough
M1imprmemenuartnet intendedearolfcmoRercd for safe.Ir.
.,offered
307 — INSULATION
ver. doces,ping or i prove
however, Nc building or improvement is sold within one year of eompleuon. the owneo-
wilder will have the bares. of proving that he did not wild or improve far purpose of
601 — ROOF TEAR OFF
sale.).
602 - ROOF PLYWOOD NAIL
❑I, as owner of the property, am exclusively contracting with licensed contractors to
comtma the pmjem(Sea.704d, Business and Professions Code:) The Conuamer's Li.
603 — ROOF BATTENS
[arae Law dares not apply to an owner of property who wilds or improves thereon. and,
who contracts for such projects with a cone acmr(a) licensed pursuant the Contractor
604 - ROOF IN -PROGRESS
Li ss taw.
1 ar/lyxcmpt under Sec. a h P C far this lassoo
r
WORKER'S COMPENSATION DECL�gbo`ION
1 hereby Nine under Penally of pc jury one of the following declarations:
I have and will maintain a CeniBcam of Concert m salt -insure for Worker'sCumpem-
soup, ss provided far by Section 3700 of the lawn Code, far the Performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, u required by Section
3)00 of the labor Code, for d¢ Pefformvtce of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cam p
CERTIFIC FROM WORKERS'
OMPE S
COMPENSATION INSURANCE
(Phis seadontread not w completed iftbe permit is for one hundred dollars (SIM)
Or less)
1 certify than in die pelforroame of the work for which this permit is issued. I shall not
n
employ any perae i manner m u or become subject the Wmlmrr,Compensation
Laws of California.
A Pica"
N ETD APPLICANT:If,afmr making this Ccnif[eteof Encroquomyn shnul
e subject to the Worker's Compensation provisions of tbe labor CsWc, you must
with such povisiner or this Pcrmit shall be claimed mvnked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency for the Performance of
the work for which this permit is issued (Sec. 3097, Co. C.)
Lender's Name
buildings Address
/v _
I certify that I haw read this application and sum that Nc .hove information is
correct. l agree to comply with all city and county ardinarees and stare laws relating to
construction.andhereby of this city to enter upon Nc
Chow-mandarnalding
forimpctiorimrposescmatives
for i purwhich
(We) agree to save, indemnify and keep harmless the City of Cupertino against
Nadlitmcnuunedpmpcnt
expenses may
men0. costs and expcmu which may in any way accrue against said City
in consequent of the Prolong Sthis Permit,
A APPLICANT
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N POI
SOW{CEREGU_I�t IOIN /)In-',.
Issued by: Date �C
� /
let
Re -roofs
cofofAppluaint/CcouurricaurAw^,(a
I Data
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Willthcapplicanturfuturewildingn upantstoreorhandle ha
i
u defined by the Cupertino Munn�al Coda, Chapter 9.12, and the Hcalth and Safety
Cade. Section 25532(a)?
❑Yea [UN.
Will the applicant of future building acceptor use equipment or devices which
it hmardnus air contaminancfncU by the Bay Area Air Quality Management
nrin7
C] Yes N
1 have read the hmarNms materials requirement, under Chapter 6.95 of the Califon
nice Hculth k Safety Coda, Sectimt, 25515,25533 and 25534.1 understand that if tM building
does nal currently have a ¢.ant that it is my mspmuihiliry m notify the ogcupanoi of Utc
requy.Tanti which musl 4pgcMmlof or issuance of a ocioreate of Gear, nnev.
AH roofs snail be Inspected prior to any rooting material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
n_!� A
Signature of Applliiean Date
All roof coverings to be Class "B" or better
�CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408)777-3333
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:
Job Site Address:
Roofing Company Name:
A phcant'rs Sig^nature: .
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
—,27
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CIT 0O
CUPEkTINO
s
CITY OF CUPERTINO
REROOF o3 0 l 7 0
PERMIT APPLICATION FORM
APN # -> 2
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BUILDING
Date:
Ener
BUILDING
BSEISMICRE
Seismic Fee Res
Building Address: 0
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Seismic Commercial
BUILDING
BPLANCHK
ner's Name-
BUILDING
Phone #:
7 ,/
ontrac
h #:�-63
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License #o? Lj-3 4z
Contact: �n
#: on
CupertinoBusiness License #:
Type of Roof Covering:
Existing:
Proposed:
p Built -Up Roof❑
uilt-Up roof
❑ sphalt Shingles
B Asphalt Shingles
Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings
❑ Other (Specify)
❑ Provide I.C.B.O. Report #
AY'_ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply
With Cu
ertino's Tear Off Policy:
Job Description: P"p m 0 1,- 46
Residential P,1� Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with P ning gpt. if
there are an re fictions: W
Cost of P sect: T e of Con c
n: Occupancy gro p-
0
Qty. if
ApplirabI
Fee m
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T _ I
BPERMFEE
Bld Permit Fees
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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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