03090010 CI'T'Y OF CUPERTINO s%,l
BUILDING DIVISION PERMIT COO NTRACTOR�INFORMATION
OWLDING ADDRESS: T D ROOFING PERMIT N003 O 90010
685 MIA:nTNA CT
tate NAME: 3540 MARGATE AVE. �2`1°'�ue DATE
NE:
(408) 892-8872 SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT' PLUMB MECH
0 0 0 0
i00 LICENSED CONTRACTOR'S DECLARATION
I hcrcby.afOrm that 1 am licensed under provisions of Chapter 9(commencing Job Description
With SeCdon79f1IH of Diviaion3of Ne Bustne. dPro(cuinm Code,and mylicense is
± „ mmna . derr , 6 6 3'L REMOVE WOOD SHAKE
y Z Liccmc q Lk,a .
G°^t d° REPLACE WITH 50 YR. COMP SHINGLE
Cs
N ARCHITEdasp ATIO PINA/..ED
z
I < 1 understand my plans shall he used u public regards
yyu
.at; Licensed Professional
OWNER-BUILDER DECLARATION [ f� (� Q 9
4 1 hereby affirm that I am exempt from the Contractor's License Law ror the SCP 2 9 2003
p O following maxim.(Section 7031.5.Business and Professions Cade:Any city or county
<m which requires a permit its construct,alter,improve,demolish,or repair any structure
YZY prim to its issuance,also requires the applicant for such Permit to Glc a signed..satement
Sp that he is licensed pursuant to the previsions of the Comracmri License Lew(Chapter 9 Sq. Ft. Floor Area �. '1 gt11000
c5I- (commencing with Section 7003)of Division 3 of the B usiness and Professions Calc)or W'LD' 4
that he is exempt therefrom and the buffs for the alleged exemption.Any violation of
Section 703 1.5 by any applicant for a Permit subjects the applicant o a civil penalty Of 3¢ Ill fg1tigr0,0 _- __ Occupancy Type
— -- not mart Nan rive hundred dollars 5!100). -- - --
O 1,u owner of the prepeny,or my employees wish wages as their sole compensation,
will do she work,and Be'wase,is not intended or offered for sale(Sec.7194,Business
and Prefeuiom Code:The Contractors License taw dose not apply on xa owner of Required Inspections
Property who build,or improve.ton,mrand who doc...h work hireselfor threugh his 305 - FRAME
Own employ.,provided that such improvements arena intended orofrered formic.If. 3O7 — INSULATION
however,she building or imprem
rcent is sold within one year of completion,she owner
builder will have the burden of paving shat he did not build or improve for purpose of 601 - ROOF TEAR OFF
sale.).
❑I,as owner of the property,am exclusively contracting wish licensed contractors to 602 - ROOF PLYWOOD NAIL
CO SLMCI the project(Sec,7044,Business and Professions Code:)The Contractor's Li- 603 — ROOF BATTENS.
cense Law does not apply to an owner of property who bud Ids or ins proves Nemon,and 604 - ROOF IN-PROGRESS
who contracts for such projects wish a contractor(&)licensed pursuant to the Contracmra
License Law. -
I am exempt under Sec. .B S,P C for this reason
r Data
WORKER'S COMPENSATION DECLARATION
I hereby of ams under penalty of perjury One of the following declarations:
1 ban and will maintain a Certificate of Commit m W INASum for WOrkersCompen-
-.,an,u provided for by Section 3700 of Ute Labor Cade,(or are Performance Of the .
ark.for which this Permit is issued.
Q 1 have and will maintain WmIgc5 Compensation Insurance,as required by Section
37IXl ofmc Labor Code,ka Ne peRarmm$�Qfar work for which Ni&permit is issued.
M��y//Workch yCompensation lnsunntt airiet god Policy numhsr ort:
CNricr: aS l Q \\ ✓Policy No.: _
VV CERTIF.. TEOFEXEMITION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed Rtie permit is for one hundred sadism(SIM)
or Ives.)
1 steady Nat in the performance of she work for which this permit is issued,l shall not
employ any person in any manner so as to become subject to the Workeri ComPcnsad^n
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ceni FICA¢of Exemption,you should
become subject to the Workers Compo notion previsions of the Lima Code,you must
7 z forthwith comply with such previsinm Or this permit shell he deemed revnk.d. -
z O CONSMUC30N LENDING AGENCY
I hereby affirm Nat there is a commandant lending agency lot the performance of
Y. > the work for which this permit is issued(sec.3W7,Civ.C.)
Qtender's Name
z Lender's Address
J 0 1 certify Nu 1 have read this application and state that the about information is '
y F+ correct.I agree to comply with all tidy and county ordinances and state laws relating to
U building convection,and hereby autharise repr.sentatircs of this city to enter upon Ne
a ahovc(We)
Wei ned agree to saw,erly(m impeeuan purposes. ^ q
(Wc)agreeto cove,indemnify endkeep hatraleas in
City of Curran against
rZ income.judgments,ofueomang expcmeeanit. may in anyway ecerec against said City
U z A consequence NDERSming of this permit.
^ APPLICANT UNDERST N SAND WILL COMPLY WWIL.IO.LL NON-POIM' Issued by: Date
S U CE REGULA ON ��
- 9 3 0 Re-roofs
SlIgmaine fAp,Iicsn C.nlacRb Date
HAZARDOUS MATERIAL D CLOSURE Type of Roof
Will she appl,cant or future building occupy t&I r�i'm handle har4rduus memriei
as defined by the Correction Munjifilral,Code.Chapter 9.11,and the Health and Safety
Section 25532(a)7
Fly. IVN. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future buildingaccupam um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.mit hezudam air conmminan cfined by she Bay Arca Air Quality Management all new materials for inspection.
District?
0Yes Nu
I have mad she Wmanus materials requirements under Chapter 6.95 ofthe Califer, 3
nice HcalN&Safcty Co ., uom25505,25533md15539.1una.wdOuifth building /I /
d.nor come sly a enanL Net it u my=Wmlhiliry notify rM occupant of she Lg_U L
requirements ubcmnprio issuanccohCcnific of er. Signature of Applicant Date
3 Oj
wnermetrthariand,gem DowAll roof cove s to be Class"B" or better
CITY OF CUPERTINO
4VREROOF
cUPERTINO PERMIT APPLICATION FORM
APN# Date:
34a `r
Building Address:
a,Z C. ,&S N19d;.,a eC
Owner's Name: / / Phone#-
-R ,4, f & Co,�,�. e C6U �. `lob B '1" 3 4 1 4 '2
Contractor: Phone#: License#:
I n Roo4og 24 c7 1042 6 I Certo 31
Contact:'n Phone#: Cupertino Business License#:
bkk" f'1iu�v �4oS ) 6t_6 S35o
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >aD Asphalt Shingles
)( Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
y
T To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
remote wood J\u,4ZQ reP,ac¢ vv', j-e... So y,r �, S�a'„��'
Residential Commercial ❑
Fire Zone: Yes ❑ No Er Confirmed with Planning-DepE>i
there are anrest 'C lip LJ
st of projeet� Type of Construcliorr—� Occupancy gr p
u Dao he - noo
Qty-
APPWcable 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
Community Development Department
Building Division
f 'W; City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
CUPEISTIN0
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: fie„Ate ei1 ,
Job Site Address: a a r�R ,1
Roofing Company Name: i D R
A plica t' Signature: Date:--L3 0 3
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper