03090117 CITY OF CUPERTINO s 3e
BUILDING DIVISION PERMIT - CONTRACTORtINFORMATION
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BUILDING ADDRESS: MAXIMUM ROOF CARE CORP PERMITNt�3O90117
)A KIM qT
OWNER'S NAME. 423 QUEENS IN PERMITLSSUEDATE
KP,VTN ROWETT TRUST 09/16/2003
NE' (408) 441-0933 SANITARY NO, CONTROL NO.
ARCHITEC ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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Fi o o Lm that IO CONTRACT'OR'S DECLARATION
OU 1 nctcbyPff rm Nei 1 am licensed r pm.iann,of Chapter 9(eemmcncing Job Description Lam'w y ®p ��®
i�i with sectio ))of Division 3 ofth and Prufcasions Code.and my license is r 1Yi"'1A
-t2„ tmm�mceaode k TEAR OFF EXISTING SHAKE
a et. Liceme slip
t W °"= 2REPLACE W/ 50YR. ELK SHINGLES SEP 3 'tf 2003
ARCHITECTS LARATION
1 U raylp ,Yplana�r' c a Olic]L�nrdx /\
o Licensed Professional �� BUILDING
g OW NE.exempt
DECLARATION
COO heresy affirm 1 em exempt from h Contractors,Any,c Law for the
O O (allowwhich ung team..perm,(Section co3 1 nt, t.alter.and improve.
demolish,
Calc:Any,city or county
5m which myurm estoae.also re cnnswdalcor,nt for suh pirmish,orc.sig anyamcmm
-iy pdonnits
censed c,amantto(he the
ovisiosOf far Contrator'sLicense ow(Chislmcm
:Z< twthcisliecnxJpursoannoNepmvisinnsnfthe CommcmriLicenulaw(Chap¢r9 Sq. Ft. Floor Area Vah$ti(@560
rt$ (commencing with Section 7")Of Division 3 of the Business and Professions Cale)or
3—
that he is exempt therefrom and the hssis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of3 51�PN3'71d$113et0 0
not more than five hundred dollars(s50B). - - - - - Occupancy Type
❑ 1,as owner or the import.or my employees with wages as their vote compenaadon,
will do the work and Ne shunure is not intended or offered forma.(Sec.]814,Business
and Professions Code:The Conmctnrs License Law does not apply to an owner of Required Inspections
property who builds or improves themon,and who does such work himselfor through his 305 - FRAME
own employecs,providedthat such improvements are not intended moRemd forsale.If. 307 — INSULATION .
however,the building or improvement is sold within one year of completion,Ne owner.
builder will have Ne burden of proving that he did not wild or improve for purpose of 601 — ROOF TEAR OFF
sale.). 602 - ROOF PLYWOOD NAIL
❑s v owner of the property.,Business nd doffusi ng with licensed conbaelors to _
comtrva doesnoct(Sec.]OteywneoandrtywhoibuidsoriproConvector'sLi- 603 — ROOF BATTENS
«nxLaw dtfrsuchapply manownarofpropertywhobudprrimptothethemracand 604 - ROOF IN-PROGRESS
whocontractsLasts for such projects with a conuxmr(s)licensed pursuant m the Contractor's
License Law.
❑ 1 un exempt under Sec. ,B&P C for his reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one Of the following declarations: j
1 have and will maintain a Cenifco¢of Chromium self-insure for Worker'a Compere
IF31]00
urn,as provided for by Section 37 0)of the labor Code.for the peromtance of the
rk for which Nis permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
of the labor Code,for the Kdamnanee of the work for which Nis permit is issued,
Workers nmpettsationlnsumntt artier and Policy number are:rtier: f - Policy N .: ^2 Il] �-✓
CERTIEI ATEOFEXEMPITON WORKERS'
COMPENSATION INS ANCE
(This section need not be completed if he permit is for one hundred dollars is l00)
or Icss.)
I eerily Nat in the perfomoom of the work for which this permit is issued.l shall not
employ any person in any manner so as m become subject to the Woftni Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenifcate of Exemption,you should
become subject to the Worker'S Compersallon provisions of the labor Code,you must
z forthwith comply With such provisions or this permit shall be deemed mvokcd.
z O CONSrRUC`DON LENDING AGENCY
I hereby allure Nat there isamtutruainn lendingagency rortit petitions.of
1' the work in,which this permit is issued(Site3097.Civ.C.)
7.1 0 Lender's Name
3. Landers Address
D
J O I certify Nat 1 have read this application and state that the above information is
yF correct.I agree to complY with all city and county ordinances and sate laws relating to
0 Uwading cortswction.and hereby aumorire representatives of this city to color upon the
W above mind uned property for iexpenses
pe uses purposes.
y (We)igrm to Ove.indemnify and keep harmless the City of Cupertino against
i,iZ tobilmaquudgmcn",costs andhegmino,of dus cswhich may in any way accsuc againstmid Ciry
.�z A consequence of DERS AN of Nis permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUL9TIONS.
P't'y �'4 Re-roofs
stntature.rnppbeawconlr t
J(/ HAZARDOUS MATERIALS DISCLOSURE ' Type of Roof
Will the applicant or future building Occupant store or handle haa4rduus..Wool
as defined by tw Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.gonion M532 a)7
a�a
❑Yea ra4.Nn All roofs shall be inspected prior to any roofing material being installed.
Wdl thea liana or fuwmm buildin oeer and use equipment If a roof is installed without first obtaining an inspection, I agree to remove
nn s p qui a lit device:a men g p
It navardnus air conwminants az defined by tw Bay Area Air Quality Management all new materials for inspection.
iatrin?
IYes I' jVo
I have mad the h satdousmamriols requirements under Chapter695 of rhe Califon
rias noNXSal,have.motomhatitI1in 255il understands cup wilding
Joc1 rot currently have a tenant,that it ism res mihilil a oral' d¢cecu ant of ins `\/`////
regri cnywhit:n a.ana aceninca or apane. I a[Ore ofApphcan� �- e— Date
40
aion."'o.ay Dae All roof coverings to be Class "B" or better
r Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U����I�O 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 comply with the above stated policy on re-roofing.
Homeowner's Name: �V j Ro
Job Site Address: 8 26 k I nn, st e�
Roofing Company Name: r.Aax rn (Y)
A p'cant s Signature: " . Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
O �QOICITY OF CUPERTINO
I�
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Se m bei- 15 2WO3
Building Address:
k lrn
Owner's Name: Phone#:
Contractor: Pho e#: icense#:
►�c��crmuml� '4I 3 9�vsq�l
Contact: Phone#: Cupertino Business License#:
Stew, N irn/ C 4o 5HO-- 22
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Q Asphalt Shingles
MEL Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report# Sq IN
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: 19
Job Description: Off Of eS<tS-hn ShrA,ke. CDO-5_. icti.6rne-rt pi- 112,1J OSB aryl
31b -Fel+. 1 nsta.A\a e3E 5v C-CIL ska
Residential Z1 Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions-
Cost of Project: Type of Cons do Occupancy group:
IC4-
Qty. if
aib Fee ID Fee Description Fee Group
BPERMFEE PEner
rmit Fees BUILDING
BENERGY BSEISMICRE Fee Res BUILDING
BSEISMICOM Commercial BUILDING
BPLANCHK eck Fee BUILDING
BUSLIC s License BUILDING
2,31 6S�
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