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03050081
CITY OF CUPERTINO ffi� BUILDING DIVISION PERMIT C.CONTRACTOR INFORMATION - BUILDING ADDRESS: PERMIT NO. 03050081 1 OWNER'S NAME: PERMIT LSUE DATA 05/ 19/2003 RTHY GARD E: SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH CJ uoo LICENSED CONTRACTOR'S DECLARATION Job Des u 1 hereby affirm that 1 am licensed under provisions of chapter 9(commencing fL�I]qy with Section]O]0)Of Di'don3 By vend Profs ' rax Code.and mylieense is mrmunme rR REROOF = Licence �� JUN 0 5 2003 Dae — con ARCHITECT-S LA ATION '� my plana shall be use as public records it 5 BU'L®In! 0 7 Lice easionai - Ga OWNER-BUILDER DECLARATION af I hereby affirm that I em exemq from the Contractors License Lew for the i oo O fallowing reason.(Section VD 1.5,BmWas and professions Code:Any city or county m which mquira a Permit to contract.alter,improve,demolish.or repair any structure „ prim to its issuance.atsono doe;the applicant forsoch permit to Glees signed sutemenl 6 that W is liccnxd pursuant to the provision of Ne Comm�or'Warsc law(Chapkr9 Sq.Ft. Floor Area �{-arf�IOn $ (commencing with Section 7W)M Division 3 of the Businms and Profeasinns Code)or $ vv that he is exempt thuefrom and the basis for the alleged exomption.Any violation of Semon 7031.5 by any applicant for s permit subjects the applicant m a civil penalty of 38igrgbpe 0 0 Occupancy"Type not mote than five hundred dollars(1500). I,uawrer of me property,ear mY cmployw with wegeauthelr sole compensation, willdo thework,and thestrumute isnot intended oroffeted forsale(Sec.7W.Business 305 - FRAME and Professions Code:The Contractors License law does not apply W an owner of Required Inspections property who Wildsorimpmvesthemer,andwho doca.ch work himself.then lihts 307 - INSULATION own employ=,provided that such improvements are not intended croffened brute.If. 601 — ROOF TEAR OFF however.the building or improvement is sold within one ti yeof completion,me owner- builder .will have the burden of proving that he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL sale.). ❑1.as owner of du property.am exclusively contracting with licensed contractors to 603 - ROOF BATTENS construct the project(Sec.]oa4,Business and Professions Cade:)Tise Contractor's LL 604 — ROOF IN-PROGRESS ecnm law does not apply to an owner of progeny who Wilds or improves thereon.and who contracts for such projects with a contractor(s)licensed puncher to the Contractors as law. lama�er�o under Sec .B&PCrorthismavon DNS!/ � RKERF COMPENSATIONDECLA T N 1herebyaffirmunder pcnityof perjury one or the fo gdeclaradonc - ,�1 have and will reelnuin a Certificate of Consent m self-intim for WmkeOCompen- adon,as provided for by Section 3700 of me labor Code,for the performance of the work for which this permit u issued. (]1 have end will maimein Worker;Compensation Imuran¢,u required by Section 3]00 of the labor Code,for me performance of the work for which this permit is issued. My Workers Compensation Insurance grim end Policy number ere: Comer: Policy No.: CERTIFICATE OF FXFMP ION FROM WORKERS' COMPENSATION INSURANCE (Ildssection sed nm beeompleted lime permit It(anon.hundred dollars($100) or leas.) 1 unify that in the a,Aformers55ggttrf�the�work for which osis permit b issced,I dull not employ any petso''h i,((Arrny.ma7¢eStdiy�r�ybjecl to rhe Workni Compcnsatian Laws idironryryayA A NOT TO APPCCANT.IL after making this Ccnificato of Exemption,you sbould barn object to the Worker's Compensation provisions of the talo,CoIc.you most .,0 forthwith comply with such provisions or this permit shall W deemed mvrkcd. z.~N. CONSTRUCTION wood(See 3( C.)CV [-r I hereby affmm cost then tea corutroction lending geney for me perfonom[e of C the work for which This permit is issued(Sec.309],Co.Civ.C.) U]Q lenders Name M fenders Address U C) 1 unify that 1 have rad this application and sure rho the eWvc inrmmadun u U4 correct.l agree to comply with ell city and county ordinances and sure laws relating to O V Wilding concoction.and hereby authodm repreaenutim of this city 10 enter upon the W above-mentioned progeny for inspection Purposes. Lk, (We)sera save.indemnify and keep harmle¢the City of Cupertino against ("1 rn Iiabili,aaJ ,cossandexpeosa which may In any way aecrueagainsl said City ? tO into the Bunting of this permit. •^• APPLI DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU LATIONS / D r� S i ure of ApRe-roofs plicanifCormoscor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant of forme Wilding occupant nom or handle haallous material u d"=by me Cupertino Municipal Code.Chapter 9.11,and the Health and Safety otic.Section 15531(a)T All roofs shall be inspected prior to any roofing material being installed. ❑Vu was tha a liCent or forum Wilding=u ant me If a roof is.i lled without first obtainingan inspection,I agree to remove pp g e cyvipr Qu or devices which / P g Tl'District? s air conuminans u deRncd by the Bay Ara Air Quality Managcmem all new'tnate ' for inspection. Diurin[ P ❑Yea No Ihars a ¢materials re33wsd 5534.1es under Chapter6.95Ofthe Cellh., nieFkelthASar y tioru 155u5.2553J wW 15534.1 wdcrsund Nott(the Wilding 5 /S doss mol circ a tenant,that it u my respo idbiiity to notify the oecupanqt or the myulrtmcn mmpri.rmiatrumcnr.certirms orae �GO IgnatureofApplicant Date Ow, . noon .a.genl Date All roof coverings to be Class"B" or better Community Development Department cg Building Division I' City of Cupertino 10300 Torre Avenue CITY OF' Telephone: (408)777-3228 Fax: (408)777-3333 U P E IST 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: ^/ 11)n e 4 k To 94v i 1�, 4-1— Job Site Address: U L) Roofing Company Name: d/ / A plicant's Signature: Date: • Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF •� CUPERTINO PERMIT APPLICATION FORM APN# — O aPD 0 � L Buildin A/ sdres � ' 5 O ame: Phone onC ,Kac or: P�#•?�� ?YZ / License#• Conta,r.lp v Phone # Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof -0"' Asphalt Shingles /M 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 Daspription: YAt. © CdGu t I c Residential XD Commercial rl Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are anrestrictions: Lf Co of O'er Type of Cons con Occupancy 06 Qty. if A le Fee ID Fee Description Fee Group MBSEISMICOM ERMFEE BldgPermit Fees BUILDING NERGY Ener BUILDING EISMICRE Seismic Fee Res BUILDING Seismic Commercial BUILDING LANCHK Plan Check Fee BUILDING SLIC Business License BUILDING z27. 7Z)