03070012 CITY OP CUPERTINp -
BUILDING DIVISION PERMITX,CONTRACTOR INFORMATION :
BUILDINGADDRESS: SIGNATURE ROOFING INC PERMIT"03070012
OWNER'S NAME: SSS O'NEILL AVE, #16 PERMIT ISSUE DATE
AI I-ITIN
ONE: (800) 644-7410 SANITARY NO. '19CONTROL NO.
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X 0 0
LICENSEDMet I am CONTRACTOR pmvioLARATION
�iWw❑ I ionhereby70 affirm shat 1 am,the Bu under provisions of Chaps,9(commencing Job Description
wish Sceron 70iN))nfDivisi 3afthc Business any ProfessionsCodc,anymyliccnx is
±�N in full force and d 6 Op/ REROOF
al
1,f' ARC t10
flu Iundcfsond my plans rebel wused e Public recur
o y ucenxI hereby air,
OWNER-BUILDER DECLARATION V
00 I naso affirm on 1 a.1. exempt from Ne Comractoo License law for tw
0 o which requires g maenn.Permit
vn1.5,Business and Pro&csmns clove:Any my m eeunre
Sm which tsssunce.arit requires te6alcor,improve,demolish,fire a sig any structure
pnmmitsissusncc.alsusyo the shprovisions
visio sO fors ch ontrat Permitto
Law(ned Chapter
££ oI bot(commeshcenxapursuantwtheofDivisio„lone eBusinm'aLowsLaonsCodrer9 Sq. Ft. Floor Area Valuation
! teat he is xempwith t erefro and the
broxisuf r the
the Business prion.Annd y vi Code)or
i R$ that he u exempt therefrom and the bees for the alleged exemption.Any violation of 36229022 . 00
Section 7031.5 by any applicant for a permit subjects Me applicant o a civil penalty of APN Number Occupancy Type
not mutt Nan five hundred della,,($500).
El 1,as owner of Ne property,or my employees with wages as their sole compensation,
will do Ne work,and the swctum is not intended ser offered for sale(Sec.7044,Business 3 05
and Professions Code.The Connector's License Law does not apply to an owner of Required Inspections
propertyww builds or improve Roman,and who does such work himselfor through his 307 - INSULATION
own employees,provided that such impmvementa are not intended or offered for sale.If. 6O1 — ROOF TEAR OFF
however.Ne building or improvement is mid within one year of completion.Ne owner-
buildef will have the Women of proving that he did not wild or improve for purpose of 602 — ROOF PLYWOOD NAIL
sale.).
❑1.e owns,of the progeny,and exclusively convecting with licensed combat.to 603 - ROOF BATTENS
construct me project(See.7044,Business and Profession&codec The Contractor's Li 604 - ROOF IN-PROGRESS
rue law docs not apply to an owner of propcny who wilds or improves themmn,and
who contracts for such projects with amount tor(s)licensed um a mt 1.the Contractor's
License law.
❑I am exempt under Sec. B&P C for this anon
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of me following emlaratiom:
1 hale and will maintain a Cemileare of Consent to sel f-insum for Worker's Compcn-
xtion,u Provided for by Section 3700 of the Labor Code,for the performance of the
w rk for which this permit is issued.
hose and will maintain Worker's Compeeation Insurance,as required by Section
700 of me Ulm,Codd.for the perfitromm.of me work for which this permit is issued.
My Workei/sys�Cn/fie tin Insunneee[artier and Policy,,umbo,art:
Cartier. ]fn �� Policy N.511—O 2'N 7 D
CERTIFICATE OF EX EM(TION FROM WORKERS'
COMPENSATION INSU RANCE
(Thu section need not ho Completed if the permit is for one hundred dollars(Stoo)
fir leas.)
1 comfy that in the perfmsnanee of the work for which this permit is issued.I shall not
employ any person in any manner so as to wcomc Subject o the Worker'Compensation
Uwa of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Ceni fn¢of Exeml lmu,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
.J 0 forthwith comply wish such provisiom or this permit be deemed Evoked.
'�fjy CONSTRUCTION LENDING AGENCY
f—' I homey affirm that Marc or a comemounn lending agency for the perrufmanm of
fX me work for which this permit is issued(Sec.3097.Co,C.)
W
0 Lender's Name
= lender's nder's Address
O Q I certify that 1 have feed this application and amid(het the above information is
CL P correct.I agree to comply wit all city and county ordinances and sone laws slating to
0U wilding consuuctim.and hereby aushone,represenotives of this city to enter upon the
ahovcin,judgro property forinspersion which may
H y (We)agree to sass,indemnify and keep harmless the City of Cupertino against
N liabilide,judgments.cosm and expenses which may in any way accmc vgainxt said City
U2 in mnseyuenccof she ting of this per '
APPLICANT UN TAjgDS t COMP WITHALL NON-POINT Issued by: V-
U
SOURCER n �7/f A
Sgnalure of ApplsaMConuacmr road Re-roofs
a
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant or future building occupant amrc or handle hazardous material
u defined by tM Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code,Scnion 255RIa)7
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it W Uod ins air coniaminams as defined by the Bay Arta Air Quality Management all new materials for inspection.
strict?
❑Yes aTq.—
I have sail the hanmtwsmalerials mquircmenu under Chapter 6.95 of the Califor
7d-.0
Heanh&SafdlyCodc.Sccdma25505.25533.d25534.1.M&rswdmuifOe wiling g
not curtedha a lm hi loathat it respoosiy to nodly the Occupant ofMcuimmcnts wet i ssbF me o ,stirs Lance ora ifsasOf Occupancy
� Signature of Applicant Dale
y
Owner ser authorized agent bate' All roof coverings to be Class "B”or better
~ Community Development Department
Building Division
.a City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E kT 1 N 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.
S. 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: Kct�cJ
Job Site Address:
Roofing Company Name: giy� �„
A plicant'sSignature: _1LJ. �� '_ Date: ? i 03
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Z j Date:
i p3
Building Address:
75��s
Owner's Name: r Phone#:
K V'yG - z 2-7
Contra r: ne#: License#:
n0 q1:1-41 6 �G66 8
Contact: /� Phone : Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles *V—' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 'L ❑ 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: ^ p
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are anrestrictions: 15
Costo Project: Type of Construction: Occupancy group:
349- oa
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE BIPermit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
It Z -Z,