03090004 CITY OF CUPERTINO ' - �'� ,f-"w�A` v a
BUILDING DIVISION PERMITCO,NTRA,C.TnR�INFORMATION
7 ,
BUILDING ADDRESS: - PERMIT NO.03090004 3O90004
IVR'S NAME: PERMITWUR DATE
META T.ANr,
• PHONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+00 LICENSED CONTRACTOR'S DECLARATION
taF I bereby affirm that I am littnud under mvlsions of Chapter 9(commencing Job Description
SZa� with Section 701 of Division 3 ofthe Basin and P.Raxnm Code.and my licca.is
s d in roll fart (d tt
jtA4 Lice. �,I18i '1,81—L;c. ROOF-REMOVE EXISTING WOODSHAKE
;moo Dale�v i - vx Contac INSTALL 1/2 PLY-40 YR ASPHALT Y
e p,� A�TELTS DE ATI N /
)W U
rl undcmand my plans shall M recd as public records
e G LwCa.d Pmfosi...I
OWNER-BUILDER DECLARATION
p 1 hereby alTrm that 1 am exempt fru.the Contractors License Law for the
CCC) following mason.(Section 703 1.5,Business and Professions Code:Any city or county
$ which mottoes a Permit to construct,alter,impress,demolish,or repair any s aemtc
pri.noits issuance,also requires the applicant for such permit to Glc a signed.natemcnt
EES< that he isImanxedp.rmanuo the provisiomnfthe Cmatmcm,sLimen.Law(Charter 9 Sq. Ft. Floor Area Valuat�a000
e t-a (commencing wi ob Section?(1ol Division 3of the B usincss and Professions CMc)or
$ that he Is exempt ohemfmm and the basis for the alleged exemption.Any violation of
Section)031.5 by any applicamfor a permit ubjects the applicant to a civil penalty of 3A IN. .t➢tD! 700_. _-.__ Occupancy Type
not marc than Bvc hundad della.(5500). - - -
Q 1,as owner of she property,or my employes with wages as their mile compensation,
will do the work,and the structure is notimended or oRe.d formic(Sec.7W,Busimss
and Prolamin.Col The C.rummrs Littman taw dares not apply to an owner of Required Inspections
property who builds or improves thereon,and who doesauch work himself or through his 305 - FRAME
awn employees,provided that such improverhos me not inteMed or offered for sale.If. 307 — INSULATION
however.the building or improvement is sold within ane year of completion,are owner.
builder will have the burden of proving that he did not build or improve for purpose of 601 - ROOF TEAR OFF
.1.).
Q I.as owner of the property,am exclusively contracting wit licensed contractors to 6 02 - _ROOF_ PLYWOOD NAIL
Conswct the project(Sce.7044,Business and Professions Code:)The Contractor's U. 603 — .ROOF BATTENS.
ecme law does not apply to an owner of progeny who Wilda or improves thcmon,and, 604 — ROOF IN-PROGRESS
who contracts for such projects with a cone uctor(a)lican.d punoanuo the Consnctdr's
License law.
Q Lem esempt under Sec. ,B&PC for this cocoon
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of she following declantiom:
Q l hose and will maintain a CeniOam ofCon.nuo.lf-insure for W.rkchCempcn-
sati.n,as provided far by Section 3?00 or the labor Code,for the perfmmana of than ..
work for which this porno is issued.
Q 1 have and will maintain Worker's Compensation Insurance,as rayvimd by Section ..
77M of the tabor Code,for the performance of the work for which this permit is Issued.
My Workers Cnm ensatinn Insurance Cartier and
PPy�ricy number art:
Cgno R PdycyTln.:d WORKERS'F157-
RS'
✓l/'/ CER I AT M OF PT16N FROM WORKERS'.
COMPENSATION INSURANCE
(Thissectim recd not be completed if the permit Is for one hundred dollars ISIDD
or Ica.)
1 cCnify Nut in the pe,fam mcc of the work for which this Permit is issued,I shall nal
employ any person In any maeacr so as m hecema subject to the Worker'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:LL afar making this Cenifcaa of E.mption,you should
become subject to the Worker's Compensation provisions of the labor CMC,you mot
�z forthwith comply with such provisions or this Permit mail bedamcdmvnkcd.
Z O CONSTRUCTION LENDING AGENCY
1 hemhy of lon that there is a construction lending agency for the performance of
1f > the work for which this s t is issued(Sec.YK17,Civ.C.)
QLender's Name
z Lcndcrs Addram
Q 1 anify that I have rtad Nis application end site that the about information is
y F conte,.I agree to comply with all city and county onliammes and soma laws relating to
QU building comtrucsion,and hereby authorise representatives of Nis City to cater upon the
U
above-mentioned Property,for impaction purposes.
(We)agree on save,indemnify and keep harmless the City of Cuport.against
�N
liabilities.judgments,costs and expenses which may in any way accrue against mid City
in
of the
his
J
APPLICANT eUNDERSTANDSranting of tAND WILL COMPLY WITH A L NON-POINT Issued by: Date
SOURCE L TI
U;&ear -pa"yVV Re-roofs
Stgn pphCmxsC. rector Dao
HA2 k DOGS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building ucc.paint.m..,handle ha,.d.us material
cOncd by the Cupeni no Municipal,Code,Chapter 9.12,and the Health and Safety
CIISect.25532(.)? eNu All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or comm building Occupant um equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
hasardous air contaminants as domed by the Bay Ama Air Quality Management - all new materials for inspection.
District? '
QYes
I have sad the hmurdtms maarialsmyuimmcnts under Chaparb.YS of IM Califon
eiallc.lth&SafatyCr .S.N.na2305.25533.d25574.1undcrs.dth.,ifthe Wilding 46-La
� ®��Y
does not cermmly has a teem Net itis my responsibility to notify she,ecuPant of the
mquircmcn wF un far su isauarmc ofa Cenirc=of upanc. Signet fApp is Ol Date
own u t recd ageN
All roof coverings to be Class "B" or better
Dae
Community Development Department
Building Division
SAM
City of Cupertino
• 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C U P S kT I N 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: 9-3 A--�
1) Pre-inspection and/or tear off approval.— 1l m
2) In-progress inspection approval.- ?-Ll -
3)
-y -3) Final inspection approval. 9-S- J F�
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.-
6.
equired.-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: 7�7 V� 4? /
Job Site Address: fl � Jr� GGL �iLt� /d
Roofing Company Name:
AplicanYs Signature: Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
• CITY OF CUPERTINO
tem 1 of 1 PERMIT RECEIPT OPERATOR: quem
COPY # 1
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35916006.00
DATE ISSUED. . . . . . . : 09/02/2003
RECEIPT #. . . . . . . . . : 22982
REFERENCE ID # . - . : 03090004
SITE ADDRESS . . . . . : 20651 MC CLELLAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : META LANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2956
RECEIVED FROM . . . . : TRINITY GENERAL B
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 8, 000.00 137.00 0.00 137.00 0.00
BSEISMICRE VALUATION 8,000.00 0.80 0.00 0.80 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 137.80 0.00 137.80 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 137.80 7130
TOTAL RECEIPT 137.80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
CITY OF CUPERTINO
REROOF
C OF
�•CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name: Phone#:
�I�313365'Y
C I ract r. Phone License#:
All Contact Phone#: Cupertino Busin s Licensy0#:
`108 13369x/ ` n/�m
Type of Roof Covering: jG�h � _ /����
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ®- Asphalt Shingles
Ir Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings f ❑ Provide I.C.B.O. Report# {>
0- To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: D
Job Description:
Residential Conurn6rcial ❑ ^
Fire Zone: Yes ❑ No ❑ Confirmed with Planning f
there are anrestricts
Cost of Project: Type of Cons ti Occupancy group:
Qty
Appticabk 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