03090156 CITY OF CUPEWI'INO
BUILDING DIVISION PERMIT x CONTRACTnRlNFORM MON`*?.
BUILDING ADDRESS: EL CAMINO ROOFING CO INC PERMITNO03090156
1901
OWNER'S NAME: 1650 S 7TH ST PERMITISSUEDATE
ONE: (408) 292-7644 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT' PLUMB MECH
0 t 0 0
+oo LICENSED CONTRACTOR'S DECLARATION
1 hereby arum that I.m licensed under milia
or chapters 9(commencing Job Description
a< with S"tion 70111 ttDivisipn fNC Busi MFY f n� and mylieenx is
< thmnr.ncean r��'7- ,^cJ4t� Z, REROOF
j El i License ase Lic.11
t- Cun Tactor
e shallse
use RATION '
L�$5 1 understand my plans shall he uuJ es a tic records
>yU 000
e o Licensed Professional
3 OWNER BUILDER DECLARATION
<g 1 hereby affirm that I am exempt from the Contractor's License Law for the
000, fallowing mason.(Section 7031.5,Business and Professions Code:Any city or county
which remoter a permit m consumer.alta,,improve,demolish,or rcpalr any structure
5iy prior in its ountmm,also requires the applicant for such permit to Glc a signed statement
2Sp that he is licensed purauanuoNe pmvisiooe of the Contractor's LiecoseLaw(Chapter 9 Sq.Ft. Floor Area Valuation
`H (commencing with Section 7")or Division 3 of the Business and Professions Conk)or
�.-
that IT is exempt therefrom and the basis for the alleged exemption.Any violation of 3 5714010 00
Section 703 r.5 by any applicant for a permit subjects the applicant to a civil penalty of 'APN Number OT _
not more than five hundred dollars(9500). - - - "- -- Occupancy y YPe
----- -
I,as owner of the property,or my employe"with wages as their sole compensation,
will do Ne work,and the suucwm is not intended or offered for sale(Sec.704a,Business 305 - FRAME
and Professions Code:Tha Conlractori Liam law does not apply to an owner of Required Inspections
property who buildmr improves themad,and whoduesmehwoh himself.,through his 307 - INSULATION
ownemployccs,prmeided thn men improvements aremn intended mortared Tar selu.It. 601 - ROOF TEAR OFF
however,Ne building or improvement is sold within one year of completion,the owner- .
builder will have the burden of proving Nat hve e did not Wild or improfor purpose of 602 - ROOF PLYWOOD NAIL
sale). 603 - ROOF BATTENS
❑ L".wwr ej Ne property,.Business exclusively convening Cod :)TheeConnmoors m
consumer Lawhoes notaSec.o i Ownofproand Professionses Code:)The Connector's Li- 604 — ROOF IN-PROGRESS
ansa law dors not apply je ts owner ter property who Wilde.,improves thereon,and
whocontractsacts for wprojects projewith a contncmr(s)licensed 0 pursuanto the Contractor's
Ciccone Law
❑ lam exempt under See. ,B&PCfor Niamaann
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby oRnn under penalty or perjury one Of the following declarations:
I have and will maiouin a Certihmm of Consent m selLinsure for Workers C.mpen-
salion,m provided for by Section 37W of the labor Code,for the perfurmnnce of the -
workforwhichthispermitisissued. -
x 1 have and will maintain Wmkeri Compensation lormas ec,"required by Section
3700 arrive Libor ewe.for the performance of the wart for which this permit is issued.
My Workers�FCmmpjen^sation.[IReInn�C\carticnnd P icy numhcnrc: ,j�7
Cant r:�\AF' . VNV yNO.: S\o IJL��
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(thissection wed not W completed if the Permit is fwanc hundred dollars(SIM)
less)
I certify that in die perro ounce,time work for which this permit Is issued,I shall not
employ any person in any manner so u to become subject o the Workc a Compensation
Laws of Cahfornia.Data
Applicant
NOTICE TO APPLICANT:If.after making Nis CeniEcne of Exemption,you should
become subject to the Worker a Compensation previsions of the labor Code,you most
:iQ forthwith comply with such provisions or this perm it hall W deemed invoked.
Z H CONSTRUCTION LENDING AGENCY
1 hereby oRrm that there its construction froth no,agency far the performance of
Y. Ne work for which this permit is issued(Sec.3097.Ci,C.)
1 A Lenders Name
z Under's Address
J Q 1 certify that I have read this application and stem that the above information is -
E' correct.)agree to comply with all city and county ordinances and sin¢laws relating to
�U building coneuu0ion,and hereby authorise rcpmacramres crude City to enter upon the
0. "hove-mentioned property for inspection purposes.
(We)agree to safe,indemnify and keep Mrmless the City of Cupertino against r�
liabilities,judgments,casts and expenses which may in any way across,against said City
J Z in consequence of the granting of This permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WI H ALL NON-POINT Issued by: Date
SOURCE ' ULATIONS. a-M^J
kn ( ` Re-roofs
Sig wrcc plicaHAZA DO Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill the applicant or future building occupant Hamar handle hararduus material
Tined by the Cupertino Municipal Code,Chapter 9.R,and the Health and Safety
tide,S Ion 35533(01 KIM All roofs shall be inspected prior to any roofing material being installed.
Y"
Will the epphcamor future building occupant sex eyuipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it humdous air cormmmants"dcrined by the Bay Area Air Quality Management all new materials for inspection.
suin7
❑Yea DAYS
Thaw lea YNeharaNnus materials reyvimments under Chapmr6.95 of tie Califon.
Hie HcalNkSafct Code.Secdtw 25N15.25533 anal]553x.1 unJersmnd Nmif the building
Nes not currently haw a mount.that it u my responsibility m madly the o¢upant of Ne
otuircomms h mstbcmetpdmru)iuumcccfaCeiIamofOvapaneg Signature ofApplicant Date
G
w rmmu o wdagcnt o All roof coverings to be Class"B"or better
' Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
Fax: (408) 777-3333
4UPEkTINO
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.
1 I .
Homeowner's Name: �/ ✓l�� w 1 I
Job Site Address: Iqy 1 G
Roofing Company Name:
Applicant's
Signature: Date: - z 2�, 'U3
\�l/+61/11DLX1
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
CITY OF CUPERTINO o v 7c 410
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Gi - 14/ Date: q_,
Building Address/: L
a\ &Oea_vN
Owner's Name: Pho a#:
Contract r: (, i O P,�Ione#:1 C944 C License,#;
Contact: P #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles U�sphalt Shingles
Lr 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: ❑
Jobe riptign: (a Z Irl O �� _.t/1 t� CDX Q( Y
Residential �� Commercial ❑
Fire Zone: s ❑ Confirmed with Planning Dept. if
0 there are any restriction
Cost ofroject�o Type of onstruction: �—O cupancy�roup:
Qty. if
A li bje 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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