03070017 I CITY OF CUPERTINO '" *" ��' +� '`° = .�`
n BUILDING DIVISION PERMIT ;CONTR:AGTOR INFORMATION
WILDING ADDRESS: PERMITN003O70017
OWNER'S NAME: PERMUISSUEDATE
NE: SANITARY NO. CONTROL NO.
ARCHITECDERGI NEER: BUILDING PERMITINFO
BLDG ELECT PLUMBMECH
30z LICENSED CONTRACTOR'S DECLARATION
W 1 hereby affirm That 1 am licenxd un er oviaimu of Chapter 9(commencing Job Description
�Z with Section lOR)of Division 3 of I Businee nl Professions Code,andmylicense t.
<< in full fo ea effect. FINAL
®®
;req: Lame 9 Lie.« v6ov9a REROOF Iy LC
;- Dale Cemtaaa CONTRACTOR: EAGLE ROOFING
ARCHITECTS D ARAT ON DECt 1 2003 r�
O Iunderstandmyplansshallheusedaspublicrecords g3 5
e Licensed Professional
OW NEm BUILDER DECLARATION
COO hereby Maso affirm on 1 em exempt from leamractofs :License Law for SUR ^ING
COO following wires a Permit
t 11131.5.Business and Professions cote:A air an S county i •• ■M�
5$� which requires a permit m construct,alter,improve,demolish,or repair any Stmcturt
-ai
prior o its ismanca.also requires the applicant for such permit to G to a signed statement
££xx< that be is licensed pursuant to the provisions of the Contractor's License Law(Charter9 Sq. Ft. Floor Area Value[ 843
yl—D (commencing with Section 7")of Division J of the Business and Professions Code)or
y $
that he is exempt therefrom and the basis far Ne alleged exemption.Any violation of
Section 1031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3.9LPI94s1b0* r00 Occupancy Type
not more than five hundred dollen
❑1,m owner of the property,or my employees with wages As;their sole compensation•
will do the work,and the slmdure is not intended oraffemd restate(Sec.1014,Business
and Professions coda:The Contractor's License Law dors not apply to an owner of 305 - FRAME Required Inspections
prow
peny who builds or imprea themon.and who dace Such work himself or Nmagh his
own employees.provided that such improvements are not rounded or offered for Asia.If, 307 — INSULATION
however•the building or improvement is cold within ane Sear of completion,Ne w.r.
builder will have the burden of proving that he did not Wild or improve for purpose of 601 - ROOF TEAR OFF
C:)1, 602 - ROOF PLYWOOD NAIL
❑1,asowner of ctproperty,emsinesi and contacting with licensed conB6lors to 603 - ROOF BATTENS
comeva the project(Sec.o an Business and Professions Cede:)The Contractor's and
aenseLaw does
ornot
such ply man own ararprapeny who
sedprrimpto du thereon.,rad. 604 - ROOF IN-PROGRESS
who contracts for projects with a convacmr(s)licensed pursuant m the COnuaetaM1
C3 m.I.12W.
❑Tem eacmpt under See. ,BAPCfar Nis rcmon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby Orime under penally of perjury one of the following declarations,
1 hew d
and will mntsm aCenifcau dConsery to selginsure far Worker'sCompen-
eW nn,as provided for by Section 3101 of the Labor Code.for the pesformanee of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,ss required by Section
7100 of the Labor Code,for the performance of the work for which Nis permit is issued
My Worker's Compensation Insurance carrier and Pro numWis.
C 'er: P "y o.: LTHD A4AS'-02
CF.RTIFICATE Op EJ(EMPnON FROM WORKERS'
COMPENSATION INSURANCE
(This seainn need net he completed If IbC Permit is intone hundred dollars($10))
M leu.)
1 Ocniry that in the perrom arse or the work for which this permit is issued,I shall not
employ any person in any manner a as to become subject to the Workers'Compcnsafirm
Law.of California.Dmc „
Applicant
NOTICE TO APPLICANT:IL after making this CCBlneale of Exemption.you should
become subject to the Worker's ComPematian previsions of the Ledur Code,you must
.JO raMwith comply with such Provisions or this parmit shut to Beamed revoked.
zCONSTRUCTION LENDING AGENCY
[—r V) I hereby Orion that there is a comtactinn lending agency for Performance of
C'> the work for which this permil is issued(Sec.3W7.Civ.C.)
I:) Q lender's Name
C Lender's Address
V C 1 certify Nat 1 have rod this application was sum that the show information is
4. Pcorrect.I ague to comply with all city and county ordinances and scale laws relating to
C V building construction,and hereby authorise representatives of this city to enter upon the
G ahom-mentioned rusticity for inspection purposes.
(we)agree to saw,indemai fy and keep harmless the City of Cupertino against
,F.t Iq liabilities,judgments.costs and expenses which may in any way accrue against said City
U in consequence or Out granting of this permit.
t--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL ON-POINT Issued by: Date
RCE REGULATIONS.
Re-roofs
It Signaarcaf pliconVComanor Data .
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle havallous material
As defined by the Cupertino Municipal Code.Chalur 9.12.and the Health and Safety .
Cattle.Section zss3z(.)1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes �No
Will the applicant or future building Occupant use equipmmB or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
It hmardous air contaminants u dcfned by the Bay Area Air Quality Management all new materials for inspection.
isuat
❑Yes ®Nu
1 have mad the Imummus materials requirements under Chapter 6.95 million Califor.
.in Health b':Safety Cole,Sceamm 25915.25533 mul 25534.1 understand Net if the Wilding
J not currently haw a unam that it is my respom of ity to madly the Occupant of the
icy menu which must be met prior In issuance or a Cemneale of Occupancy.
Signature of pplicant Da e
Owner ersat nzedasent Data All roof coverings to be Class"B"or better
r
Community Development Department
Building Division
1 �r City of Cupertino
10300.Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
UPEI�TINO
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: SONAI GARCIA
Job Site Address: 21915 M c C DELL A N ROAD
Roofing Company Name: EAAI F ROOFING COMPANY
A plicant's Signature: Date: L�Z0o3
Greg teel
Building Official
Revised 1/30/03
Y .
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF /
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
571919021
7/i/2oo3
Building Address:
21815 MCCLELLAN ROAD
Owner's Name: Phone#:
TOHN GARCIA LY08 252-3588
Contractor: Phone#: License#:
EAGLE ROOFfNG COMPANY L-/08 119Z-9656 C-39 `160790
Contact: Phone#: Cupertino Business License#:
PHILLtP SANCHEZ LIog 926-ToLtZ
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ® Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
® Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) -
Number of existing coverings Cl 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:
EXISTINGm o R. ELK
Residential ® Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed wi lanning a I. if
there are an restrictions:
Cost of Project: Type of Constructio r Occupanc gro
6,8 Ya.'O %� r
Qtric�bl
A 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
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