03030095 (2) CITY OF CUPERTINO ��'" 'f R' -
BUILDING DlvisloN PERMIT a G01"I '6 ',01VANVO MATION , ..
.x?„'4 nn � '�, ;1 H' ;3"�«°-�7� ^'S,a.x,"$6, X3.4 L?aSs'n4 r.."�$
RUILDING ADDRESS: PERMIT NO.
EDINA 0-T
OWNER'S NAME: PERMIT L'SU
IEo - SANITARY N , OL NO.
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT - PLUMB MECH
00 z" LICENSED CONTRACTOR'S DECLARATION JobDeacri tion
pp I hereby of lrm Nn 1 am licenced under provisions of Chapter 9(Commencing p
n IP wJ
ith S.cti.n7")ofDivlelon3of Me0'sM�e and Pmfesflnns Co�edmylkenwh
p�n In full fortx'an t. v 7 6
pOZ� Licence Clsss/ _UIe.M - � REROOF
t r _'
conT/O SHAKE, INSTALL -PLYWOOD & " 50 YR. PRESIDENTIA
ARCHI7ECrS ATIO
Tun nJmyp6naMtllbeusedsspMli. COLOR SHADOW GREY. CONTRACTOR: ERNEST DAVIS ROO
tp, Licensed Professional. - - - -
5 OWNER-BUILDER DECLARATION-
1 hereby nfRrm that I em exempt from the Contractor's License Lew for the
`.0 o o following remora.(Section 70315,Business and Pmfmiom Code:MY city Of county _ -
5 S which requires a heroin to csmumeL alma Improve.demolish or repair any structure
_ZJrnpdoro its issuance,also requires the applicant for such permit to rile a signed atsmment
< that he Is licensed pursuant to the pmvisiona of the Commons License Law(Chapin 9 Sq.Ft,Floor Area Valuation
E a (commencing with Section 7000)of Division 3 of the Business and proportions Code)or '
.. that he le exempt Unarm.and the basis for Me alleged emmption.My violation of "
Section 7031,5 by a y epplkant for a permit subjects the applicant to a civil penalty or - APNNumber Ca�lor,•yp�,Type
not mon than Ow hundred delta.($500).. ass
D-V
❑L m awam or tba property.mmy employ.with vngm u deur sele eompeneadon,
wllldo de work and the swnu,i.noti.Mndedarofferedfuual,(Sce.70ae,BuMrm 342I5O5800
and Pmfeuiom Code:The Consomme.License Law does trot apply o own .
an
owner or Required Inspections
propenywho build,or improve.thereon.and who doessuM work hbmselfor Juough his MAR 18 2003
mocroployces.provided matsuch Improvements ere not Intended OF offered for sale.If. _ 305 — FRAME
however•the building or improvement Is within am:you ofcompl,tion,the owner.
builder will have the Which of pouring that he did nut bund or Improv res purpose of 307 — INSULATION
role,. BUILDING
I,m owner of thm�con
Cut property,am exclusively contracting with licensed mto 601 — ROOF TEAR OFF
connotes the pmject(Sec.70".Business and profession Cade:)Tin Conusstm's Li' 602' - ROOF PLYWOOD NAIL
come Taw does not pply man owner of property who Wilda or improws daemon,and, 6O3 — ROOF BATTENS
who convects for such pmjec%with a eontn tag0licensed pursuant o tie Contractors
Lm°nae Lew'�-'� 604 - ROOF. IN-PROGRESS .
piame.emy+t nA c ,Bk PCfar thio reason ;
Ownay Datec
d W 'RI R' OM NSATION DECLARA N
1 hereby Anne;#r pcmthy of perjury o00 of the Ing dedantiom:
have end will maintain a CenlOcam of Consent o self-Insure for Workei sCompeer-
sstion,as provided for by Section 3700 of the Labor Code,for the performance of the - - -
work for which this permll is in.& i ,
D 1 have and will maintain Workers Compensation Insurance,u required by Seedon '
3700.17 the Ta W,Codo,far the lanfmrromm of use,work for which this permit Is bound. -
MyWorkersCompensationln.m=Canler end Poll umber am:
Ca tt: Poli ..
CERTIFICATEOFE%EMPnOeWORKERS'
COMPENSATION INSURANCE
(This section need rat w completed Flux,permit H fmonchundmd d.11an(SIM)
or mss.) . . '/ -
1 many Met in Mc performance P))he yloy for whit h permh 4 issued.I Mell not _
empaynypc...in ynn fore c� othewerkewcom arvamn _
Levee of Celifomie.D -"
gaDC rat
NOTICE�TT��ll APPUCAMt Ig,alcor making Mh Genion of the
Exemption,you u must "
baomet5nml m the Worker's Compensation previsions ar the Imed Cod.,you must
,J O foMwl comply with such provisions or this permit shall ho domed revoked.
y CONSTRUCTION LENDING AGENCY -
E••t Ihereby&Mm that there is a connructlnn lending agency for the performance of _
Mo work for which this permit is Issued(Sec.3097,Civ.C.) -
';�Q Lcndcr'e Name
=x Lender's agme t
(.7 0 1 certify that I low read thlupplicNon and sum that the show information is
W coned.I agree ct comply with all city and county oefliM Or and sou tswt renting to
p aWK-mentioned
hereby euthmimreose,. ivor of this city to enter upon Mc
[27 aM1. mentioned progeny ger inspection keep br.
(We)agree o cows indemnify and kith harmless the City of Cupenit against ^
y
liabilities,Judgmenun 1.0 undrape smit. may in any wayaccuse against old City �(J1
V 7 In co of Me gra ng all s permik
A APP ANT NDE AND AND WILL COMPLY WITH L NON-POINT Issued by: Date
SO E A NS.
v~ Re-roofs
x[raturmorKpPlicy,oconabscru Data
OFHAZARDOUS MATERIALS DISCLOSURE Type of Roof ..
Will the applicant or future building occupent,tore or handle hamdous maudal -For defined by the Cupenum Municipal Code,Gbmur 9.12.and the Health and Safety
Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ;K.
Will the applicant of Ninure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hamrdaus air contaminants as definad by the Bay Area Air Quality Management all 4t—uer
terials fo Inspe tion. _Won?
oYus �o %
I havereW the MtUd smauriatsreyul menu under Chapmrfi.95 of de Glifoo
ai.Hmlth B:SsfelYCode, =25 5 end 2553 a.lundenundthetuueluilding ` s
does nm no fly hew nano t i y responsibility o nudiy de Occup.1 of thepp
m0he hi IM uumccofa CenfieU u Y- ? gpplic n to
ncranuthotimd age Dnm 'ATI 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
CUPEkTINO
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 co with� above stated polio roofing.
i
Homeowner's Name: �
Job Site Address:
Roofing Company Name: � — > R,c> %i i G
A plicant s Signature: _ Date:��6'
\it/61n1DLXi '
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper