03060085 CITY OF CUPERTINO '" "�° �r",�. z �. a . °` �F
BUILDING DIVISION PERMIT �CONTRACTOT2,TNFURMA'CION ;R
aulLDwc ADDRESS: LEGACY ROOFING & WATERPROO TffY*D[E3p060085
OWNER'S NAME: 860 FAULSTICH CT . ft1/2003
yNE:
(408) 467-0150 SANITARY NO. CONTROL NO.
ARCHnEC1'fENGINEER: BUILDING PERMIT INFO
BLDG EIFCr PLUMB MEC14
0 0 0 0
uoo LICENSED CONTRACTOR'S DECLARATION �p p
with
I hereby amrm That I am licensed under provisions of Chapter 9(commencing Job Description �Q N�A IL(=
ith Stttion]IXIU of Dlvuion3of Ne @a3 alkofeuinrocnae.anamyreemea
.=_ a«KIK CI 9a ®a2 Ti's cv REROOF
=p Dam Coir
JUL 1 0 2003
�7W7Wf ARshall W 1'$DEQ public mcmdst
1 undewnJ my plans shill de use
wt;k Liavctl Professional BUILDING
5 OWNER-BUILDER DECLARATION
E I Worby affirm that 1 am exempt from the Contractor's License Law for the
20 following recon.(Smuon 7031.5,Business and Professions Code:My city of county
5m which requires a permit to consumer.alter,improve,demolish,or mpoir any structure
zi prior m its isstumm.alnsrcqu;v theapplicart forsuch permit.,rile asigned statement
@moo drtWisOcensedpursuan0othepenvision.ofth,Comrsctor'sLicense Law(Chapter 9 Sq. Ft.Floor Area $1Ntgpfion
nl-$ (commencing with Section 7000)or Division 3 of the Business and Profcssiau Codc)or
that be is exempt thomfmm and 0m basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 02N Mffi er 0 0 Occupancy Type
trot mom than rive hundred donars($SM. P Y YP
❑Luh,mrof Ute themnY•re is employees (See
compewtiess
will do Um walk ma theswaurt is not intended oroRertd fanilc(Sec.]W4,Business
and Profession;Code:The Contractors Li¢tnm Law does sot apply to an owner of 3 0 7 — I NSULAT�V N d Inspections
propeny w ho Wilds or im proms themon,a nd who dos such work himsel f or through his
own employ=.provided mat such improvements me not inmuled mothered for sada B. 601 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion.the owner.
builder will have due burden of proving mat M did not Wild or improve for purpose of 602 -. ROOF PLYWOOD NAIL
sok 603 - ROOF BATTENS
0 I,as owner of the property,am exclusively contracting with licensed rontraemrs to
romwct the project(Sec.7044.Business and Proftessioua Code:)The Conuacw's W. 604 — ROOF IN-PROGRESS
terse law does not apply ue an owner of preparty who builds or improv thereon,and.
who camncs for such projees with aeomra enh)liamed pursuant m the Contractors
Lmmm Law.
❑Tun uempr under See ,B&PCM,hismMa
137W
ner Dam
WORKER'S COMPENSATION DECLARATION
1 Iereby,affirm under pointy of perjury one of me following decluatiou:
T have and will maintain a Certificate of Consent m=If-mmm for Worker's Compen-
um,u previdel for by Section 3]00 of dm labor Code,for the pro..a of me
mak for which this Permit is issued.
I have and will maintain Workers CompeasNon W uramtt,as requited by Section
of me Labor Co/d'e.for the peAormana of the nark for which this permit is issad.
Workersu tion d Palmy number arte Pali�YF7N1oD,[^1^'DS�2/�J
ERTIFICA OF EXEMPr10N MWORKERS'
COMPENSATION INSURANCE
Gbls section need not Wcomplemd ifthe Pewit is Inform hundred dollar($1001
or W a.)
1 Certify that in the performance of the work for which this Pewit is issued.I shill not
employ any person in any manner w as m become subject so the Worker:Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Exemption,you should
become subject to the Worker:Compensation previsions of de,labor Code,you muss
,Z forthwith comply with such provisions or this Permit shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby IM.theI mere is a rouwctinn lending agency Iw the Perrwmantt of
Y► dm work for which this pewit is;ssad(Sec.7(191,Civ.C.1
A lender's Name
2 Lender.Address
J O 1 ttNfy that 1 have mad Ws application and scam that the above information u
:L F rower.1 agree m comply with all city and county on in umns and soon laws relating to
O C) building conswmdon,and hereby authads mprexnutiv of this city to enter upon the
yaabill I'd I; Property for Inspections Purpura
(We) e m save,ind mfy and keep harmless the City of Cuperuna agaiut
h Iiabili' ,jug ens,coxa xpeasu which may in arty way carne agiluat said City
J z ire que ee fthe gram: (this Pewit.
A L A N RST DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
UL ON L
LVI mum of ApplicanUCon cror am Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam w forum building accupam uoo or handle haurdeu materiel
de0ncd by the CuPeNno Municipal Cade.Chapter 9.12.and the Health and We,,
ode.secunn zssl2py/ -
❑Yn All roofs shall be inspected prior to any roofing material being installed.
Nu
Will the applies.,or future building..Pa.,mean egcipm mL w devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havudnua air ronuminanu u Jeftaetl by ds Bay Area Air Quality Management all new mater: Is for inspection.
:stria? /euI(/
0 Yes
1 have mad Use bvasdous mamrialremenm under ChnPter h95of dm Califon
riaHcalthB afety Cade Savo.,25305.2553325513 and 25534.1 undersmnd thui(thc building 0
does no u ntly ha mnNL.mat Ir;a my mspoaslbllly b nfN11Y IIIc aYYPNt Of dm
reyui ten bete pnnrm;s4aananhcertifimm�rOcnp ey. i ureofApplicant D to
0
cr tar authomctl agcni m
All roof coverings to be Class "B"or better
Community Development Department
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) h1-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: -Q
�
j i
Job Site Address: /s-`�
Roofing Company Name:
A plicant'sSignature: Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
` CITY OF CUPERTINO 0 ,3 o 6d 6'_SO �
REROOF
CUPEkTINO PERMIT APPLICATION FORM
". APN# Z,p Date:
Building Address:
SD /N W
Owner's Name: Phone#:
sy/s- 7,3 -
Contra r. V 7 Phone#: License#:
S1
oz
Contact: Phone#: Cupertino Business License#:
411zY S' 7- v1s-d
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
ophalt Shingles ❑ Aslt Shingles
ElWood Shakes Cr 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 Descri n: t
Residential Commercial ❑
Fire Zone: o ❑ Confirmed ann g Dept. if
ere an restric i LJ
Cost of P oject: / ype of Constru ion: cc panty oup:
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRESeismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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