03100214 CITY OF CUPERI'INO
BUILDING DIVISION PERMIT CONTRACT",OR INFORMATION: -
e-
. BUILDINGADDRESS: E AND D ROOFING PERMITNO0310021
10311 MANN DR
OWNER'S NAME: 1419 LUNING DR PERMIT ISSUE DATE
ROCKY LOWELL 10/30/2003
NE: — SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 L 0 0
+o o LICENSED CONTRACTOR'S DECLARATION
YC I hereby affirm Ill.,l am licensed under provisions of Chapter 9(commencing lob Description
<G with Section?1XXl)af Divi1km Sof NC Busirmselmd Professions Code,and my license is
n inmBOarteandaffect, REROOF _ INALED
jE2? License Class Lit.#
Dam Cuntrclor
qQ dsusDECLARATION JAN ( j
ZOO
understand he d aspcecor
eyV
1
0y Licensed Prnfessiunal
3 OWNER-BUILDER DECLARATION BUILDING
<f 1 hereby at7rm that 1 am exempt from the Contractor's License Law for the
O O following reason.(Section 7(131.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure $10000
prior to its issuance,also requires the applicant fur such permit to rile a signed statement
that he is licensed pursuant to the provisions of the Commatur's License Law(Charter 9 Sq.Ft. Floor Area Valuation
`rcF$ (commeneingWith Section 7")of Division 3ofthe Businessand ProfessinnsGMICJII! 32645043 . 00
..
that he is exempt thcmm froand the baso far the alleged exemption.Any=of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of APN Number Occu ane 'fy e
not mom than Eve hundred dollars($50% P Y TYP
0 1,as owner or the property,or my employees with wages as their.mic compensation,
will do the work,and the station,is not intended or offered for sae(Sec.7W,Business
and Professions Code:The Connectors Licenu Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however.the building or improvement is sold within one year of completion,the owner-
builder will have be burden of proving Nal he did not build or improve for purpose of
sal ).
I,as owner of the property,am exclusively contracting with licensed contractors to
met the project(Sec.?044,Business and Prolessions Cade:)The Con(ranor's Li- `
cense Law does not apply to an owner or proper who builds or improves thereon,and
who comracts for such projects with a emmomom s)licensed pursuant to the Contractoi s
Licenu Law.
❑1 rept and Tee. rr�a�I .B k P C for this reason
Owder DDate 1 3 g"
WORD. 'S PENSATION DECLARATION
v(1RATION
I hereby affirm unde penalty of perjury one of the following declarations:
1 have and will maintain a Cur irate of Consent m self-Insure fur Wmker'sCampen-
salion,u provided(or by Section 37W of the Labor Code,for the performance of the
We
for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insaance,as sequined by Section
37W of the Labor Core,for the performance of the work for which this pmmil is issued.
My Worker's Compensation Inmanee carrier and Policy number art:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed tribe permit is Toss,hundred dollars(giW)
or less.)
1 certify that in the performance of the work for which this permit is imbed.l shall nut
employ any person in any mannerso as to become subject o the Workers Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Ccnifscate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Cantle,you must
D forthwith comply with such provisions or this pereait shall he deemed revoked.
4 O CONSTRUCTION LENDING AGENCY
1 hereby a1Esm that there is a contraction lending agency for the performance of
3y 7 the work for which this permit is Latina(Sec.3007.ON.C.)
QLendcr's Name
5 Z Lender's Address
�) Q 1 certify that I have read this application and slaw that the above information is
f~- cored.l agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
ti (We)agree to save,indemnify and keep harmless the City of Cupertino against
y
Liabilities,Judgments,costs and expenses which may in any way accrue against said City
J 7 inconsequence of the granting of this permit.
t� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of ApplicaHAC Ractor Data
Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or Tulare building e.Chapter
store or handle Health
and
as defined by the Cupertino Muni' ode.Chapter 9.12,and the Health enJ Safety
ode.Section 23532([)? All roofs shall be inspected prior to any roofing material being installed.
�Ycs Na
wits the appbeam or mwre Handing oaaapanl an,ewmment nr deviaa which If a roof is installed without first obtaining an inspection,I agree to remove
Iq ii hazardous air comaminanu as defsncd by the Bay Area Air Quality ManagementZ4tfoan
materials r inspection.
District?
El Yet,
I have read the h moJous materiels requirements under Chapter 6.95 of the Cali fa{
an NSSafety Code,Sccuons25505,25533and25534.1undcrsmndthatifthc buildippg
s tcarton ha Iemenl.Out it is myresponsibility la rndly IM oneupanlof the // �7
mmcnks ¢t,7hcmelpnarlr,iaa cecfaCcniGcatsofO `qmy. Date
�OAll roof coverings to be Class "B"or better
0 er ser awh d gem Dan,
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
UPEkTINO
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) hl-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 Nam@n
Job Site Address: GL
Roofing Company Name: 0 0 tVcq
A plfcant's S�ig�natu�re. ate:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO .3 /
REROOF
II' , CUPERTINO PERMIT APPLICATION FORM
APN# 3 -2Z ,/� - o Date:
Building Address:
O er's Name:. Phone#s
/l
Co ractor: Phone#: Licen
e4_ D u o��v: 5
Co tact: Phone#: Cupertino Business License#:
ID yn L Q L4 G B- . .- G 6
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt ShinglesAsphalt Shingles
1 Wood Shakes 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:
lob De ription:
P
esi ential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Pling D�pt. if
f _\� there are any r ricdons. LJ
Cost of Project: Type of Const con: Occupancy roe.
Qty. i
A li a 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