03040034 XNv
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,CITY OF CUPER9'INO
BUILDING DIVISION PERMIT „ , ,tea• ,::� 1 , t<.,� ta ''
PERMITNO.
BUILDINGAQL L 8:1 LONG DOWN RD FO
JR SEA SONS R
PERABf LSSUB DA
M
OWNERSNMMUNITY MANAGEMENT SERV CES645 HORNING
C�CJ SANITARY N0. 0.
P
(408) 278-0330
BUILDING PE rwil l INFO
ARCHITECrfENO1NEER: BLDG PLUMBO MECHO
�Zp LICENSED CONTRACTOR'S DECLARATION Job DPy��rI
th Stion
i I beraby ain,m that 1 am Imajorl under P=vlalo.of Chapter 9(commercial
wicetlon 71)(M)ofDivialon 3 oflhc0 and Profeuinru Code,and my license a
B
/icen
i s in full fon en (f c�
Lie MCI REROOF
N
Date o Ganueme —s
"A
Eiu
ARCH HcAT10N
MAY 21
2003
ndmyphslle simblierW
1
R
s BU'
?�
Licensed Professional LD'� '
OWNEon exempt
f DECLARATION Coal.ON
n O 1 maxo eBir that 11. exempt from the Contn,Co License taw for the
�7
0 o which re meas..permit
(Section 7(n L4 Business and Profetanm Code:Any city m county
$ which Its h u a perp u,csmtmcL slut improve,h permit 10
m Kash any statement
S Ft. Floor Area Valuation
Z�^ pdormits lssuams.ei$u requires the applieam f,a file a lChap rI
that he is licensed pursuant to the pmvielona^f the Comr=mie Llccnants=(Cheper9 q•
zC� (commencing with Seetloa 7(1 afob,iilan 3^flhe BuMmmsand Pfofce$lons coah)ur
a.. that he is exempt therefrom and do bus Ne far alleged exemption.Any violed.of ApN Number Occupancy Type
Section 7D31.5 by any applimat fm it Permit subjects em the ePI'lleto•civil Parity of
rot mom than An hundred dollars($5003 34240019 . 00
❑1,u owner of the Property,a my employe.with was.a rich In eompeondun, Rsquired Inspections
willdo tic wor"nd theMusum is not not intendedoffered for We(Ron.7041,Enamor 305 — FRAME
and Profession,Code:The Communes Lt.=Law does Out apply m an uwnar of
prepertywhobuild$^,improv.durems.rdwhodom$uehwmkhlmselfm Bo^ughhla
awn empuyw,provided first m
at Such improvetms tee not Intended oroReiad Imola if. 307 —
INSULATION
hmvevet the buildings,improvement 1.said within-ft Yeas of completion,At Owner. 601 — ROOF TEAR OFF
Wilder will have the burden of proving that he did Out Wild of lmproso for Purpose of 602 — ROOF PLYWOOD NAIL
sale.).
❑I.as Owner of the property,am exdriwly contracting with Insides anuadon n 603 — ROOF BATTENS
com=et the Pmjen(Sec 76d4 Business and Profslmn Code:)The Comncur's LI•
cehoc Nncu�for a,.such,I.Pajaau ;nnwith erof erwc mr(U eased pursuant praae Conon.and 604 - ROOF IN-PROGRESS
Lkense U. ,B k P C for this renin
I Mn exempt under Sec.
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury One of the following deeluatio"..
m and will maintain a Ctrtifinte of Covent u-if"mum for Woft"CamPen'
n,n provided for by Section 3700 of the tabor Cade.far the Performance of the
weak for which this permit Is issued.
❑I have and will mainWn Worker's Compensation Insurance,u acquired by Section
37M of the labor Code,for Ne pedemm=ce of she work for which this Permit Is Issued,
My Workcf$Compe nuen In urare,cardand P Ilcy oumbenac:
P No.: LU Ori
,/y CERTIFICATE OF EXEM NFROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed If the permit Is frommhundmA dollen 0100)
at Ices.)
1 mnify Our in the Performance of the work for which this permit Is issued,I shall not
employ any person In any manner=ss No become subject to Ncworkew Compensation
Laws of Califomia.Data
Applicant
NOTCETO APPLICANT.If,afar making this Cedifrcae of Exemption.you should
become subject N the Work"Compensation PMiMa$of she lahm Cout,you mat
.7. Z fonbwith cemply withsuch pmvisio.in NU Pcrmitehall a diamond mwked.
,ZZO CONSrRUCDON LENDING AGENCY
I hemhy alarm that there las,construction lending spry for Ne Performance of
W> the work fur which this permit is broad(Sec.3097,Civ,C.)
W QLender's Name
z Lender's Address .
1 amity that 1 have read this application and Marc that the show Information IN
U C correct.1 agree to comply with all city=d county ordinances and Bute laws mlating to
IL,pU building conswction,and hereby=thodze rtpresenutiw.of Niwity menterupnntha
ILI ahwe•mentioncd property for inspection purposes.
G (We)agree ro taw.indemnify and keep harmless the Cily of C-Pcnino seg C
fA IiablllRu,judgauns,costs sndexperes which may in eny way accrue against cud ltyL
0cn in consequence of tie granting of this permit. Di
ate
COMPLY WITH AL;N Issued by:
S U E CULATION
Re-roofs
Slgaatute of Applic=UCont=01 Dau Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will No apP11.^t or(alum building Occupant Manor handle hvndous material
.defined by tie Cupertino Municipal Code.Chapter 9.13.and the Health ad Safety
Gude,Icction 25532(e)7 All roofs shall be inspected prior to any roofing material being installed.
[3yca If a roof is installed without first obtaining an inspection,I agree to remove
Wi11 the e1mllcent or future building occupant use equipment df dcvfm which
70wner
hevardam Mr esnuminanu a defined by the Bay Area Air Quality M=agcrecm all new materials for inspection.
in7
❑Yr u /
I hew red ac beardmm eauriab mquimmenu under Chapter 6.95 of the Califnr v /l
om.momiilyCoda Sectio.25505.25533a2353q.lundemend Nstlftic building notcurtcntiy hawaroc=4 dotit u myrte rihlllrym.reifyWeDate
ignature of ApplicantAll roof coverings to be Class"B"or better
or authorized agent Dau
Community Development Department
Building Division
City of Cupertino
,� ,•" 10300 Torre Avenue
C
CITY OF Telephone: (408)777-3228
L U PE kT]N 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.
Homeowners Name: d� JA / -,Z,
Job Site Address: Aa 7 g l o it>4 4/0 4'_.;A-., Z/Z"Pe c``
Roofing Company Name:
A plicariYs Signature: ��� l Date: 44 -7-0 -3
r
Greg eel
Building Official
Revised 1/30/03
- _ _ Printed on Romled PaOer
CITY OF CUPERTINO o3 c
REROOF
ZIM
CUPERTINO PERMIT APPLICATION FORM
APN # lo O/ Date:
Building Address:
�,7 / Loa. • ��N iaa
Owner's Name: Phone #:
Contractor: Phone#: License#:
10C'00a .SP soti Odr ^7d' 033d `�7 O�
Contact: hone#: Cupertino Business License#:
�i. s . SS`' r' 7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 2!� Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shinglesn ❑ Wood Shingles
IF Other(Specify)_e-5-Al - �� ❑ 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 Description:
Residential 0� Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: � Type of s titin: Occupancy
� OO I � '
Qty,if
AppVc'aDlp Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Enerev BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING