03070005 ( CITY OF CUPERTINO -
BUILDING DIVISION PERMIT .CONTRACTOR INFORMATION
BU ILDING ADDRESS: R E ROOFING & CONSTRUCTION PT1�ND03070005
OWNER'S NAME: 15230 CLYDELLE AVENUE PERMITISSUEDATE
lw% i�'
NE' (408) 925-9995 SANITARY NO. CONTROL NO.
HITECT'/ENGINEER: BUILDING PERMIT INFO
BO ELEC PLO MOo LICENSED CONTRACTOR'S DECLARATIONI hereby affirm Nat I am licensed under provisions of Chapter 9(commencing Job Description
Scni 7(Ngnf o3o Pr ssinns Cndc. dmyliccnscisurnrcgp <rkt� V REROOF
j Z License C�fs �i I� p g�B�t�
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ppry AR HDECTS DE
k U I understa y plans all w used as xcodx
=o„ 1-wenxdPmfmsional JUL 1 7 2003
$ 3 Oat I am BUILDER DECLARATION Contra
A a P 1 hereby.(Sere that 11. exempt from the Cssions o License Law for the
HO following Inaxn.(Scctiun IIID L3.Business and Pm(casinm Code:Any city or county ��'�®���
e m which Inquires a permit m ennslmeL,Oil,improve,demolim.or repair any structure
prior to its issuance.also nations the applicaut for such permit to file a signed statement
EiC that he is licensed pursuant to the provisions of the Contractor's Lil Law(Chapter 9 Sq. Ft. Floor-Area Valuation
ct- (commencing with Section 70l of Division 3 of the B usinem and Profcssimrs Cost)or
i
that he is exempt therefrom and the bazis for the alleged exemption.Any violation of 3 5922018 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ppN Number Occupancy Type
not marc than five hundred dollars($500).
❑T,m owner of the property,Or my employees win wages u their sole compensation,
will do the work.and the structure is not intended or offered for sale(Sec.701 Bulinus — yp��gq�(Q
and Podeuions Coal The Contractor's License law does not apply to sen owner of 3 O 7 - INSULA 11'VPJ d Inspections
propcny who builds or improaes thereon,and who does such work himself or through his
bon employees.provided that such improvements are not ntended or offered for aide.If. 6O1 - ROOF TEAR OFF
however,the building or improvement is Mid within one year Of completion,the owuer-
builder will ban be burden of proving that he did not wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
szk.). 603 - ROOF BATTENS
❑1.as owner of the pfopeny,am Carl convening win licensed erntnpors to
eoonmct the pmject(sec.7tN4.Business and Profmsions COde:)The Cultural Li. 604 - ROOF IN-PROGRESS
coax law does not apply to an owner of property who wi Ids or improves thencon.and
who contracts for uch projects with o eontrxtor(s)licensed purwant m be Contraaots
Liccnx law.
❑I am exempt under See. ,B&PC for this moon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affimt under onsaby,of perjury one of(be following declarations:
I have and will maintain a Certificate of Cnnsenl to self-insure for WOrkefs Compere
lotion,m provided far by Section 3700 of the labor Code,for the pesfomr m.of she
wmk for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Imt m,az Inquired by section
3700 of the labor Code,for the pesfarmanec of the work for which this permit is issued. ,
My Worker's Cnmpperstabonnlnsuence�ca/rtlier and Policy number ase:
Cam 1 fl I t, Nr/ polity No: V
CERTIFIC ON KERS'
COMPENSATION INSURANCE
(Thancbe
is ction hd not completed if the permit is for Monhundred dollars(S 100)
nr less.)
T cenify but in the performance of the work for which this permit is isswd.I shall not
employ any person in any manner an as to become subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If after making this Corti Ecoc of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Cndc,you must
.J vz forthwith comply with such proviair s or this permit shall be deemed Invoked.
'LO CONSTRUCTION LENDING AGENCY
'e+ l beal aRrm that then is a constoul lending agency for the perfurmanee of
Ci the work for which this pesmil is issued(Sec.3M7,Co,.C.)
QLender's Name
] z Lender's Address
U 0 1 cenify not I have read Nis application and sate that the all Womruiun a
D. f-' correct.1 agree to comply with all city and county Ordinances and late laws selecting to
0 building consmerion,and hereby iuthodae repmxnlatiws of this city to enter upon the
awvcmemiil m property fon Inspection expenses
plopowhich ms.
H 1 (We)agree to saw.indemnify and keep harmless the City of Cupertino against
N liabilities. n mem se granting eapensesmit. may in anyway accrue against said City jh U yenec he griming of this Permit.LI N STA ILL COMPLY WITH ALL N POINT Issued by: Dat
I N
arAppuanuco tar na Re-roofs
kMZARDOUS MATERIALS DISCLOSURE Type of Roof
c applicant or future building uccupanl once or handle hvardaus malarial
fined by the Cupertino Municip C.Chapter 9.12,and the Health and Safety
I.Section 25532(.)7
❑Yoe NO All roofs shall be inspected prior to any roofing material being installed.
/Will the applicant or future wilding Occupant use equipment or device -If a roof is installed without first obtaining an inspection,I agree to remove
m hazardous air mmaminanR az do y the Bay Arca Air Quality nagcmcnt eW ills for inspection.
istrict?
❑Yes Nn
Iban mad tbede,SEC msm terials 5505,25533 requirements 95ofthe Califno-
.is &Safety GoM.Scfti 5505,25513 and 25514.1undcrswn iftbe wilding --A
more
I ,\
I and the y to feasibility to notify the cupam n the \ l_I
imme ra et riont i an or,cgmfigamOra I IureofApplicaut Dale
Owner or..the Date V All roof coverings to be Class rB"or better
Community Development Department
@1 � ' Building Division
U City of Cupertino
10300 Torre Avenue
4 1 I
CITY OF A Telephone: (408)777-3228
V P C k'I v 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: 1 l� ,k 1 c L
Job Site Address: 14 ��-uw 1 o Lf ,,l L
Roofing Company Name: 0 16( 3 CJ`oi ST R UvC l I b rJ l N�
Applicant's Si ature: Date: '1 aL
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
i
CITY OF CUPERTINO0 _
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # � , 0 Date:
Building Address: 1
14 K�r� w N L ANL
Owner's Name: I Phone#:
Contr ,ctoc , (l � Phone#: License#:
�; IN s lAlJS . t�o�� Q2s-°I�q
Contact: Phone#: Cupertino Business License#:
Z.ob
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) �I 11AR9 1Gt
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ Tobe Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will CompiWith Cu ertino's Tear Off Policy: 0�
Job Description: JeMoW (,%-(t�rflnit( I Lx`1& OY-' wvudy 3U A-,-TK
I, T t t,
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an trictio fi
Cost of Projecl"S t[ +Ut t Type of Construe tio Occupancy r
j5 ,�0,
Qty. if
A lic 1 Fee ID Fee Description Fee Gro
BPERMFEE BldgPermit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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