03090098 CITY OF CUPERTINO d'^ ""
BUILDING DIVISION PERMIT CONTRACTORtINFORMATIO,N
BUILDING ADDRESS: R E ROOFING & CONSTRUCTION PMFcb3090098
630 KIRWIN IN
IOWNER'S NAME: 15230 CLYDELLE AVENUE, PERMIT ISSUE DATE
3
NE: (408) 925-9995 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
_ BLDG ELECT PLUMB MECH
l00 LICENSED CONTRACTOR'S DECLARATION
FC 1 hereby af¢rm Nmixi1 am licensed under provisions of Chapter 9(Commencing lob Description
,Xai with Section]IMNp of that
Jof the¢uessineand Profession.,CnJc, amylianm is is
1�= in full foam and crfec , q REROOF Y'
Liccnm lass 1 LiCYt
�Fp DaLL' CC f r.�
I u ARCHLCTSOF
cCi ndly pro.full beumJas Phods /r-s
Illaaa V` ?
eOv, License...... anal v
cv, OWNER-BUILDER DECLARATION
j<E 1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p 0 following mason.(Secdun 9831.5,Business and Professions Codc:Any city or county
w which requires a permit In construct,alter,improve,demob.h,Car repair any strvcwre
iy poor to its issuance,also mo,tims the applicant for such permit to SIC a signed statement
:z< that he is licensed pursuant m the previsions of the Contractors Licenim Law 5 Ft. Floor Area
c q Valuation
u I-$ Bar he is exemng pt therefrom
T0n0)of the Division r of al a ed exe and Professions Code)laund or
mat he is exempt therefrom and Inc brevia mf the waged exemption.Any violation or . 35922019 . 00
Section 7031.5 by any applicant for a Permit sum the applicant s0 a civil Penalty of APN Number. '
not mare man rive hundred dollars fs500). - - ' - .. Occupancy Type
❑I,as owner of the prepcny,in my employees with wages for their sole compensation,
will do Ne work,and the suuaure is not intended or offered for age(Sec.JOaa,Business R y�r�
and Professions Cade:TheContractorsLicense law dont not apply to in Owner or 307 - INSULAT VN d Inspections
progeny who builds or im ves thereon.and whudoes such walk himself.,throw hhis
Own employ=,provided that such improvements are not intended o,offered for sale.If, 6O1 — ROOF TEAR OFF
however.on building or improvement is sold within one year of completion,heOwner-Wilder will move,he burden of proving that he did not wad or improve for purpose of 602 - ROOF PLYWOOD NAIL
cal..).
O 1,as owner of the progeny,am"elusively contracting with licensed contractors m 603 - ROOF BATTENS
constructure project(Sec.]Oaa,Busineu and Professions Code:)The Conuacwri Li. 604 — ROOF IN-PROGRESS
corse law dors not apply to an owner of property who builds or improves he¢on.and
who contracts for such pmjcm with a c.monm(s)licensed pursuant o the Contractor's
License Law.
1 em exempt under Sec. ,B h P C fanhis reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
.......
hereby a1 mo under penalty of perjury om of he following dmlwatiom:
I M1avc and will maintain a Ccnificaof Consent m self-insure for Workers Compen-
sation,L provided far by See ion 39te00 of the labor Code,for the performance of the
for which this permit is issued. '
I have and will maintain Workers Compensation Insurance,u required by Suction,
from labor Code,for IM performance of On work for which his Permit ix issued.
My Worker' ompmnsation Ins reme Carrier and Policy number art:
Carrier: , Polity N..:�j 1
CER IFICATE OF EX P PON FROM WORKERS'
COMPENS ION INSURANCE
(This section need net k complcmd if me Permit is(Of on hundred dollars(SIM)
If,less.)
I certify hal in the performance of the work for which this Permit is issued,I shall at
employ any person in any manner so as to necrotic Subject o the Warkerc'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Coffins,of Exemption.you should
become subject 10 the Worker's Compensation provisions of he Labor Code,you must
�z f.nhwithcomplywithsuchprovisionsofthisPermitshalltodeemedconked.
70
CONSTRUCTION LENDING AGENCY
1 hereby mRrm mar then is a cnnslruction lending agency for the performance of
la he work for which this permit is issued(Sec.3099.Civ.C.)
1 Lender's Name
Z) z Under's Address
J Q 1 certify Bial l have reed this application and sus that me above information is
y F conml.1 agree to comply with all city and county ordinances and state laws slating so
U building Construction.and hereby euthorim representatives of this city to enter upon the
ah.vcmemiuFem Properlyfor ld.I.fiturpi'pe Purp.sax
G (We)agree to save,indemnify and keep harmless the City of Cupertino against
h li "'s,judgmcnu.cosu and csPcnus which may in any way accfm againn said City
J meonseq C of the granting of his Permit.
APPLICA RSTANDS AND WILL COMPLY WITH NOEwn.l
Issued by: Date
SOU S.
of APphcmtlC.!. �ZRe-roofs
ZARDOUS MATERIALS DISCLOSUREType of Roof
Will he applicant or future building Occupant store or handle haraNu
u defined by the Cupertino Municipal Code.Chapter 9.12.and Bic Health and Safety
'Cade.Section 255J3(a)? All roofs shall be inspected prior to any roofing material being installed.
�Ycs Nu
Will the applicant 0rfutuin building.ttupantuse equipmentordevices which- If a roof is installed without first obtaining an inspection,I agree to remove
it hvardnus air c.numinanu u JcfincJ by Bic Bay Arca Air Quality enagcmenl a ew materials for inspection.
it
❑Yes ,
I have sad the nvaN.uxmaterials rcyuimmcnu unJer Chap ,695 of the Calif.ry / _ I /`
IhASalcty Codc,Sccduu 25N)5.255ll anJ 85Jq.l unwrsWd huifd,c wilding (/ \� (.`, l I U
dues no urtcn am,hTll.r
' ' inility 1.nndly Cabe wauPant Car di '
rcqu� w test" anee C reate of Oce cy.
Z_._—Sign urcofApplicant� Date
Uwnr{ .h.nr<dagent Da1C ��All roof coverings to be Class "B" or better
y Community Development Department
' Building Division
f`��1Y J; City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I 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.
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: , I D R/k'D/k�U lj1 VCTj kLr
Job Site Address:
Roofing Co y Na
A plican 's Signature+ L--Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t CITY OF CUPERTIN0
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name: ` i D N u 1 Phone#:
J EryKfkf -7�7� -1n 1
Contractor l Ulf Phone#: j License#: Z- y 9
l
Contact: 1� mR�1ul -l- U(Phone#: �21 I j Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) . Other(Specify) KIC�11
Number of existing coverings / ❑ �rovide LC.B.O.Report# SwfL
�To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply"-omply With Cu ertino's Tear Off Policy:
Job Description:"�&µN�--' 1 L-A-tot,_ ori-- Skk t
ST Ll.. N CW Z_J't�' A51 Pk *1 th.
Residential Commercial
Fire Zone: N Confirmed with Pi ng D,e,Pt. t
there are an rests tions: e5
Cost of rojec�l Ivo Type of Const c n: Occupancy group
t i
Qty. i
A Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Enervv BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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