03090082 t CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORINFORMATION: '
A ,
BU ILDING ADDRESS: T D ROOFING PERMIT"°03090082
a OWNER'S NAME: 3540 MARGATE AVE, PERMITIESUEDATE
)NE: (408) 892-8872 SANITARY NO, CONTROL NO.
ARCHITEC11INGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMO MECH
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+O00 LICENSED CONTRACTOR'S DECLARATION
UM C I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
w with Scaion]0f10)nf Division3of Ne Busine,,.ad P ors otos Codc.and mylicensers
s in full force and off
z-
in beoc 301 see.» G G6, a°LREROOF
Dmc 1 Cumranor
.7W ARCHITECTS DECLARATI
f u I understand my plans shall
be ARCHITECTS
D public recordsATIbN / ) �
eon Licensed Pridoxx nnal
I OWNER-BUILDER DECLARATION
a f 1 hereby affirm that 1 am exempt from the Contractor's License Law lot the _ 3
OO following tomo.(Section 7031.5,Business and Pmfc.cions Code:Any city ar county
<$� which requires a permit to construct,alter,improve.demolish,or repair any structure
'iy Prior as its issuance.also bottoms theapplicant forsuch permit to File a signed statement
cSp that he is licensed pursuant to the provisions of the Cotnmcmr'sLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
et- (commencing with Section 7000)a]Division 3 of the B ushers and Professions Code)or
ONE
that he is exempt therefrom and the basis for the alleged exemption.Any violation of 34215040 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
nos more than five hundred dollar.($500). '- -" " "' "- -"'- P Y yP ----
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended oroRered for sale(Sec.7W,Business
and Profusions Code:The Conuactoh License law docs nos apply m an owner of Re wired Inspections
IRME
property who builds or improves thereon,and who does such work himselfor through his 307 - INSULATION
own employees,provided that such improvements are not intended oro@red for sale. L 601 - ROOF TEAR OFF
however,lie building or improvement is sold within one year of completion.Ne mi neo-
Wilde,will have the burden of proving that he did nut build or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.). 603. - ROOF BATTENS
I,as owner of the property,em exclusively contracting with licensed contractors m -
consttact the
oesbutsp,l,a.HawseRavine., and Prof he Wi Co deUThe Contracmr'a Li- 604 - ROOF IN-PROGRESS
otos Law contracts
f not apply m an owner of property who sed p or s improves thereon,and
whoonse Lacts for such projeck with a contnctor(i)licensed pursuant to Nc Contractor's
License Law.
❑.l am exempt under See. ,B&PCfor this meson
Owner Date
IC311 ^- WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: .
I have and will maintain a Casificme of Consent toself-insure for Worker'sComPcn-
1'r,
on,u provided for by Section 37W of the labor Code.for the perli m mane of the -„
k for which Nis Permit is issued.
1 have and will maintain Worker's Compensation Insurance,ac required by Section
0 of the labor Code,for the performance of the work for which this Penn it is issued,
Workcr's Coompennssationln�nce carrier and Policy number art _ nier. �l q is l�f� Policy No.: 14 11 t J C,
CERTIFICA OTE FEAPr10N FROM WORKERS'
COMPENSATION INSURANCE -
(This section need not M completed tribe probit is formte hundred dollars(3100)
Ir leas.)
1 certify Not in the perfommncc of Ne work for which this Permit is issued,I shall nm -
employ any person in any manner so a to become subject to the Workeri Com,notation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cenifcate of Exemption,you should
become subject to the Worker',Compensstimi provisions of the Labor Cndc,you must -
=O forthwi th comply with such provisions or this permit hallbe deemed revoked.
7' CONSTRUCTION LENDING AGENCY
I hereby offrm that there is a construction lending agency for she Performance of
54 > the work for which this permit is issued(Sec.3(N7,Civ.C.)
mIJQ Lenders Name
z z Lender's Address
Q I tinily Nat I ban read this application and state that the above information is
y(~ correct,I agree to comply with all city and county on inam'as and state laws relating to
7(J building cmnstruction,and hereby authorim representatives of this city to enter upon lie
NU ahovc-mcmioned Pmporty for insicctiot purposes.
ti (We)agree to save,indcmni fy and keep harmless the City of Cupertino agaiml
N liabilities,judgment,costs and canteens which may in any way accme against said City �/
.J,Z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
Signature of ApplicaDam
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Will the a Cupertino
or(secure building e,Chapter
rstore9.1 or handle Health
mammal
as dcfinc0 by the Cupertino Municipal,Cotle Chapter 9.12,and the Hcahh and Sa(dy
ode.Seaton 23532(1)? All roofs shall be inspected prior to an roofing material beim
❑resNn P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it huvardeas oI,contaminants u defined by the Bay Area Air Quality Management all new aterials for inspection.
°Inc. No -
I have read the he-olocamamrials nequachromuunder Chapmr6.95ofthe Cabin. V
rias ca,NAeniel Cndc, tio425505,25573 and255J4Junderstood Nwifthe building (y� Q�(/ / O3
docs not curtcn11 ha mnan Nat it is my rcaponsibility to badly tbe -cupont of Nc I/�/ V lY� /
myuiremcntsw ch a bemet pnoru' arae ofa Comficam of Occu try. Signature of Applicant Dale
i � 1fo3
Owner or authorized agem D,m All roof coverings to be Class "B" or better
Community Development Department
I { , Building Division
�g{ City of Cupertino
('t 10300 Torre Avenue
CITY OF' Telephone: (408)777-3228
I N O .Fax: (408)777-3333
UPEkT
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: Ar; S+i o k e»
Job Site Address: I g`1 M c k1 .t A o c1pa n
Roofing Company Name: D V,o o f;v�
A plicant's Signature: V Date: q b 3
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 3
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
3.lali UcIJ glglo3
Building Address:
IBJ-�°I NIcI641_� c,caL v. Cmc e�rk�no
Owner's Name: nn np Phone#:
C�, y�ccw� -w&
Contractor: Phone#: License#:
T D 200 „ c clog ) a yq lo4a GTroG a-�
Contact: 'n Phone#: Cupertino Business License#:
tyc.v i c1 clog G4-fo g3S0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
)Q Wood Shakes ❑ Wood Shakes
O Wood Shingles ❑ Wood Shingles \ r
❑ 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:
Job Description: II pp
rtrnove Woocl Sllal!.r�, trQ �cace W i'c� ��t u"ULc�` ��• ( C� TCPCO # X65
ResidentiT—EF Commercial ❑ J-7
Fire Zone: .Yes ❑ No Co fi med with Plartni g De I. if
there are any restric
Cost of Project: Type of Construction: C Occupancy grou
Qtyif
A li b e 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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