03070139 CITY OF CUPERTINO w * ''m a rK"
BUILDING DIVISION AC TRACTOR�IN ,r.R�MIATI-
BUILDING ADDRESS: ASH ROOFING INC 11R11"03070139
• OWNER'S NAME: 620 ORVIS AVE PERMIT LSBUE DATE
ONE: SANITARY NO. CONTROL NO.
(408) 295-7681
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 t 0 0
y00 LICENSED CONTRACTOR'S DECLARATION JOb Descriptionup 1 herehy affrmt that 1 me licensed under provisions of Chapter 9(cm
omencing
ZW with Secan ))nfpivisionJ of NC Bui and Pmfeuinns Codc,andmylicenm is
_ vnmmnrne e �2 TEAR OFF 2 EXISTING ROOFS .
S�z Liccnm c.X
Z, Date + ] Conir rAPPLY ELK 30 YR 2/ 30 #;`ASTM FELT UNDERLAY
RrInTE LARM114
zto 'Vfder.i.bdmypinaidallku publicecnrds ADD EYEBROW VENTS/ NEW METAL FLASHINGS
to
t
30� Licensed Professional
3 OWNER-BUILDER DECLARATION
Ay 1 hereby affirm that l am exempt from the Contractor'&License Law for the
_p0 following reason,section 7031.5.Business and Professions Code:Any city or county
K m� which requires a permit to construct.al¢n impmve,demolish,lir repair any structure
Fal prior est its issuance,also requires the applicant for such permit to file a signed stammcni
££YY< that he is limned pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
KFO (commencing with Section 71oxiof Division 3 of the Business and Profusions Code)or
$ that he Is exempt therefrom and the buts for the alleged exemption.Any violation of $4900
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nen Eve hundred dollars(S500).
1,u owner of the property,or my employees with wages as thelnole compenu0om 32602 O14 . OO
will do the work,and thestmctue is not intended or offered for wlc(Sec.7614,Business
and Prodoxi on Cndc:The Ctmearcmr's Lice.law clow nor apply loan owner of Required IOspeCUO �^n��0�
pmpeny who build&ormse
imprnse•thereon,and who does such work hilf orthmugh his 11�t
own employees,provided Nat such improwmenu are not intended or offered total,.If. 305 — FRAME
zeraill
however,the building or impmwment 1s sold within one year of completion,the owner-
builder will have Ne burden of proving that he did not Wild or impmw for purpose of 307 - INSULATION JUL 2 5 200
❑e1,as owner of the property,am exclusively contracting with licensed contractors;to 601 — ROOF TEAR OFF 3
consumer the project(Sac.7(kd4,Business and Profusions Code:)The Conwctori Li 602 — ROOF PLYWOOD. NAIL BUILDING
law don not appy ve
to an owner of property who Wilds or impros Wemon,and, 603 — ROOF BATTENS
who contracts for such projects with a contractor(•)licensed pursuant m the Conuactor'a
License law. 604 - ROOF IN-PROGRESS
❑I am exempt under See ,B A P C for this mason
Own" Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Ne following declarations: -
I have and will maintain a Certifieato of Consent to self-insum for Worker's Compere
1031E
on,u provided for by Section 37IX)of the labor Code,for the performance of the -
for which this permit is iuucd.
71 have and will maintain Worker's Compensation Insurance,u required by Section
of the labor Cade,for Ne performance of the work for which this permit is Issued.
Worker' Cnmpeuation Imunntt nrtien r Policy numkr•m:rtier Poliq N _
CE I e FFXEMPITON OM WORKERS'
COMPENSATION INSURANCE
(Thisscedom need nottecompletedIfeek permiti&forone bummeddollarsnif )
lir Its,.)
I cenify that in the performance of the work for which this permit is Tamed,l shall not
employ any person in any manner m as In become subject to the Workers Compensation
Laws of California.Dam
Affluent
NOTICE TO APPLICANT:IL after making this Cenifcate of Exemption,you shnuld
become subject to the Worker's Compensation provisions of the labor Code.you must
.,z forthwith comply with suchpnvisiou lir this permit shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hcmhy arprmNat he"I,.conuuctimn lending agency for the performance of
fk the work or which this permit Is issued(Sec.3097,Civ,C.)
W 0 Lender's Name
z Undere Addran -
tJ 0 I cenify that I haw read this application and stare that the shove information is
Fcooed 1 agree to comply with all city and county ordinances and State laws relating to
C)V building construction,and hereby authorie mpesebut of this city to enter upon the
0. .hove-menlioned property for inspection purposes.
F (We)agree to saw,indemni ry tied keep harmless the City of Cupertino against
In Iia fides,judgmenu.costs and expertses which may in any way seem,against said City
C.)z consequcn of thcEnming of this il.
^ APPLIC UNDERSTANDS A WIL COMPLY WITH ALL NON-POINT Issued by: Date
OU ULATIONS.
7-17'0'>) Re-roofs
ser of App bend rancor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the applicant or forum Wilding occupant store or handle hatemmus material
m nem by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safely
e,Seetfon 25532(a)7
❑Yon �N c All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant no equipment ofthvircs which If a roof is installed without firs[obtaining an inspection,I agree to remove
It havardma air contaminants u defined by the Bay Area Air Quality Management altrew,matrials for inspection.
istrin7 1i,'� r
❑Yes I�Qvo
I hove real the huraNnly materials rcyuircments under Chapter of he Califoo- , �� tj ,5,�
nialieelth afctyCMc,Sccdon25515.x5533andx5534.1undcrsWMthmifthc building / / U
res nor cmly haw a tenon at It is my re.ponihility m nnily never,
rot of the
r c whichm tk c riot rismanceor. crdfcamorOccupancy. Slg rC0 Applicant Date
All roof coverings to be Class "B"or better
er un thoriwd&gem Dam
I.
Building Division '
10300 Torre Avenue
. Cupertino,CA 95014-3255
Telephone: (408)777-3228
CIO CUPEPTINO F= (408)777-3333
Building Depai ent
Subject: Reroofing policy for the City of Cupertino.
I. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. New roof coverings shall not be applied without first obtaining all inspection
Wand written approval from the building inspector.A final inspection and
approval shall be obtained from the building inspector when the reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V'per foot slope and demonstratethat
there is no ponding.
2. An I.C.B.O.report is required to be on the job site at the time of inspection
We understand the above policy
on rre—roofing and will comply with this policy.
Homeowners Name: P`f I Id(/i Ohl l I
Address: ^,
reroofing Company ame: 90O�j AJ G nJL
Applicants Signature: / Date:
Joe Antonucci
(Chief Building Official)
6/25/01
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 3z(o — 02 — 0 14 Date: T
V
Building Address:
10881 AA4 y, In e, DrivL
Owner's Name: Phone#:
Al Imo,4- bi 1 ) i 408 24S 2493
Contractor: Phone#: License#:
900C-I46 IN(. 406 201S-7661 w21 z-7
Contact: Phone#: Cupertino Business License#:
S�iZ-'7 3
Type of Roof Covering:
Existing: Proposed-
❑ Built-Up Roof ❑ Built-Up roof 7 r
Asphalt Shingles `if Asphalt Shingles GLK PII 30 YR WEN WAT
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 2 ❑ Provide I.C.B.O. Report
XTo be Removed ❑ Provide Mfgr. Installation Specs.
. I Have Read, Understand and Will ComplX With Cu ertino's Tear Off Policy:
Job Description: 7TV_ 04—p- 2 8XAST/ FCDX. iv L Q.y_ Bio 4 3D_Vr ASTM Y
Residential 9Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plan ' epL if
there are an restr' tons: LJ
Cost of Projec 0� /Type of Construed: : y Occupancy gro
Qty. if
A ca 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
Z'2 '