03060033 :- CITY OF CUPERTINO
BUILDING DIVISION PERMIT �,CO,IVTRACTORT�N.E'OATIo �
BUILDING ADDRESS: PERMITNOO 3060033
10541 MADERA DR A�
WNER'S NAME: FERAffT y v4 2003
ACK CHU
NE: SANITARY NO. CONTROL NO.
ARCHREC rENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby mfl m Nal 1 am licensed under provision,of Chapter 9(commencing �p
�j with Section 7")ofDivlrce alo,3ofthe Business and Fmic.lotnCMo,and myllcenseREROOF is �BI�A��
in full foand effect. E
�5g Dsu: cl"I inner CONTRACTOR: J & J ROOFING
Ire- ARCHITECTS DECLARATION 't
I undcmand my plans stall 6e need as public record, JUN 1 9 2003
2Iymu
30 Licensed Profc.ional
ve OWNER-BUILDER DECLARATION BUILDING
I I hereby anirm that I em exempt from the Conlrector's License Law for IM
>.O o following mason.(Section 7031.5,Business and Professions Code:Any city or County
u�$ which tor,A.s Noun m conslmol,ellen improves,demolish,or repair any Ineclum
4„^ prior to its Wounce,also require;the applicant for such pemtil to rile asigned summent
that he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
Is (commcncing with Section 7000)ofDivision SoftheBusousumdproposal..Code)or $8000
$ Nu he is exempt therefrom and the bull for the alleged exemption,Any violadon of
SecOon 7031.5 by any applicant for a permit objects the applicant to a Civil penalty ofOccupancy Type
not mom timn five hundred dollars(5500). 3 RM".
0 0
❑1,u owner of Ila,property.or my employes with wage u their min compensation, `
will dothework,and immirocmmirmtintended WoE,md mrum(Sec.71k4,Business Required Inspections
and Profession,Code:The Comracmra U.Law does nal apply in an Owner of 305 — FRAMEe q p
property who Wildsor tmpraesthereon,and whodoessuchwork hinnuforthrough his 307 — INSULATION
Own employes.provided that much improvemart act anot Intended oroRerad foraaln If.
however.the building or improvement is mid within aro you ofcompletim.the owner- 601 — ROOF TEAR OFF
uildrwill have N,wderofproving that hedid act Wild orimprove for purpsmot 602 - ROOF PLYWOOD NAIL
❑1,u owner of the property,am exclual.ly comsaning with licensed contractm,to 603 - ROOF BATTENS
Construct the Project(Sec.70N,Business and Pmfe.ians Cade:)The Conlrmtm'a U- 6O4 — ROOF IN-PROGRESS
Anse law does oat apply In an owner of property who build,or Improv Comma.and
who contracts far such project,with acontrumr(s)licensed pursuant he the,Conamm's
License Law. '
❑Tarnmomplundm Sec ,B&PCforthhmmon
canerDam
WORKER'S COMPENSATION DECLARATION
�.� I hereby afnrm under penalty of perjury arc of the following declarations:
❑Ihaveand will malnWn a Canpomeofcomentmsel6lmumfor WorlursCompcn-
ulion,u provided for by Section 3700 of Ne labor Code,for the performance of Ibe
work for which this permit is issued.
1 have and will nuiewn Workers Compensation Insurance.u m)vin l by Section
3700 of the later Code,for the performance of the,work for which this;Ferrol is issued. '
My Workers Compensation Insurance artier and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Misseclim need notheeompleled If the permit Is for one hundred dollsn(5101)
or less.)
1 ify that In the performance of the work for which this permit Is issued.I Nell not
Crop ny Mosoninanymanner a m become subject to the Worker'ComIxemadon
e f Cali r a.Dam
pppl M
0'n APPLICANT.wool IL after making Ni,Genion of of Exemption,you Mould
Deco jmp y h Wmheh Compensation previsions ionl of Isc labor Code,you Cour
.J 0�'rMwith comply with such provitlav or this pencil NJI be scorned revoked.
z y CONSTRUCTION LENDING AGENCY
F+ 1 hereby MT,.that Vert is a Coramood nlending agency for the perfurmarl<c of
a Nuc work for which Nu Permit is issued(Sec.309T,Civ.C.)
fy Q Undoes Name
.0.7 z Lcndces Address
U 0 L ttmfy that I have read this application and mute Net Ne above Information is
IL(~ correct.I S.0 m comply withall city and county oNinancea and slate laws reining m
0 V building construction.and hereby aulbodm mpresenmivu of this city to corer upon Ne
❑7 ahove-mentioned properly for inspection purposes.
d (We)agree m save,indemnify and keop heretic.the City of Cupertino against
f/) liabilities,)uigmcus,costs and expcoms;which may In any way accrue against mid CRY
U4 In consequence of Ne granting of this permit. Aq
((J ISS
a APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: ate
C EGULATIO
Re-roofs
ig not Appliem ontracter Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
I/Will the applicant or future building occupant more or handle h.ardons material
u dcrilmd by the Cupertino Municipal Code,Chapter 9.13.and the Health and Safety
ode,Section sss3z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑y.
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
emit heurdnu air comemi u�mp u defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes
I have mud the bxvardous materials mquiremcn.under Chapter 6.95 of the Callim.
m Ho. &SNcty Cmlc,SCNons255115,25s33md25534.1undc mndthazifthebuildimg 3
not umen0y here a tenant Nat it is my responsibility to notify the occupml of the (O 7
regaire'c whichmusl poor Int.numt.r.cmncamafOccupag.. Ig ureofApplicant Date
onuNamad agent Dam All roof coverings to be Class"B"or better
L�
Community Development Department
Building Division
City of Cupertino
f 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
IUPEkTINO
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: J ACK C6//
Job Site Address: /OSS//tt rrly 0A i4 4e/LM.vd
Roofing Company Name: Co
A plicant's Signature: Date:*1
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
i
CITY OF CUPERTINO 03
REROOF
� PEIo FERMI R LICATION FORM
APN Date:
u
`- oeoelf a i,
Ow er's Name: Phone#:
ACIc C L)_.
Contractor: Phone#: License#:
Jr- J y08-73'S-331y 71a�9
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ ,Built-Up roof
❑ Asphalt Shingles 21' Asphalt Shingles('y0 Ye)
M" Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O.Report#
V'�To be Removed ❑ Provide Mfgr.Installation Specs.
`�• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy.
Job Description:
r'mot 64 UU001> K bH fx N 05e 0/6. 0- no eysp tr1l"'gles
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: Lf
Cost of o'�Ctt: oa Type of Construction: 1f2e12o /- Occupancy group:
Qty. if
A li le Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
/ BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
z37.9