03050112 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTItAGTOR INFOYtMATION -
BUILDING ADDRESS: PERMIT NO.
t ROOF GUARD ROOFING CO 03050112
AM PERMIT ISSUE DATE
740 W SAN CARLOS 05/23/2003
1 (408) 293-9519 SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIECf PLUMB MECH
0 0
300 LICENSED CONTRACTOR'S DECLARATION
i 1 hereby affirm that I em Recantedapu r under ponviumis of Ch9(CommencOg Job Description
With Section 70110)of Division 3 of the Bu%r And Professimu Code,and my license is
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,nZ LmcnseC - Lk.11 REROOF
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MAY 3 0 2003
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OWNER-BUILDER DECLARATION
Communes
_
.�<f I hereby.(firm IM'11. exempt from the Como$Co License Law for the
EDD
which
mean.(Smit t 703 1.3,Business andmpr ve.de io demolish,
Code:Any city or county BUILDING
4 o' which requires a Permit m mmsS the Allum.applicant
improve.such
h permit t care pair any uumoCnt
y primmits issuance,also
nt tot a theapplicant far Cohpanni'nitiseLaw snmmcm
< (commencing
comms licensed pSenan 70th)of Division
of the ConmcmgnLicense lsio ChapterCoca)or
Sq.Ft.Floor Area �7ValUs7t100
zC$ (haemes immin therefrom
70M)ofbasis for
oAthe
egeBusiness ndon.Any
,5j UU
�3
that he B swept Iany applicant
li and Ne aper Ire dm alleged a pliant On Any violation of T I
Section 7071.3 in my applicant for a permit subjects the Applicant n e civil penalty of �y.pj��"�wst, Occupancy •]P
not more than Bw hundred dollars(g500). 3 C 7.J lYU L�.'YefO O CCU araC C
0 Las owneroftheproperty.mmy employee with"JIMpe their solecompemMdon,
willdothework.And thesuucnm is not ntended reoffered mnele(sm.7044.Business 305 — FRAME Required Inspections
And Promuni
Professions Code:The Communities License Law dope not Apply n an mwrcer of q P
property who Wild,fr improves thereon.and whodm..h work himself.,though his 307 - INSULATION
awn employees,provided that such Impromments art not intended or offered for sale.If,
however.the Wilding or improvement is wild within ane you of completion,the owner- 601 — ROOF TEAR OFF
hurler wiS tun the burdan of proving that he did nm bund re impna for purpose of 602 — ROOF PLYWOOD NAIL
Anne.).
0 1,M owner of the pmpeny.am esclu inly canmecting with licensed Contractors in 603 - ROOF BATTENS
constmct dse pn}en(See.701d.Business and Professions Code:)The Contractor's Li. 604 — ROOF IN-PROGRESS
cense Law dope not pply n an ower of property who builds or improves thereon,And,
who contracts for such pmjecu with a contractor(s)licensed pursuant w the Conuanoes
License Low,
0 l Am Mcmp'under Sec, .B to P C for this neewin
Owner Dan
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of the following declanlior¢
1 hem and Will..Ima n•Certificate Of COARM to self-Inmm for Worker's Common-
sailor,pe pmvidcd for by Section 37011 of the Labor Code,for the performance of de
work for which this permit is issued.
❑1 ham and will maintain Worker's Compensation Insurance,As required by$action
37(10 of 0e Labor Code,for the performjrcm Oldie work for which this permit is issued.
Mykcr' Com sats p5n Ion Jnsunnce prier and Polley n he
Q�S'
Ce er�')'�`r ,r"'Lt_A Polity o
CERTIFIC M W
COMPENSATION INSURANCERKERS
(Thr section need not an Composed If'1e Permit Is forum hundred dollsrs(SIM)
or loan)
1 certify that in Ne performance of sae work for which this permit Is issued.l shall not
employ any pcnon in any mancerw pe to become subject to the Worker Compensation
Laws of Calif..!..Dow
At
NOTICE TO APPLICANT:IL afar tusking this Cct iricau,of Eecmpaon,you should
become subject in the Worker's Compensation provisions of the LAW code,you most
.J Z forthwith comply wit such provision or this permit shall be deemed necked.
'ZO - CONSmucriON LENDING AGENCY
[—i 1 hereby affiren that them is a Construction lending agency for the rcrformaoce of
Rvi7 de work for which Nr permit is issued(Sec.3091.Civ.C.)
QLandce.Name
.7 z Lender's Address
f,Q I mnify dot T haw read this application and slow Nat the slow inform W on is
correct.I agree to comply with all city and county ordinances and Arne res ranting In
O V building construction.and hereby 1Udhmme sepmsentubms of Nis city to enter upon the
Lkl shove-mentioned propcny for inspection purposes
G (We)agree to nn,indemnify and keep harmleu the City of Cupertino against
fq liabilities,judgments.costs and espenwis which may in any way scene against Mid City
U 7 In covegmnce of the gnnlmS of[his permit.
t1—
APPLICAW UNDERSTANDS AND WILL COMPLY WITH ALL NON DINT Issued by: Date
SOURC GULATI
Z3 Re-roofs
Ssrc of Applt onmcmr �— am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she Applicant of futon building meupantnme rehandle hanrdous material
a MMed by she Cupertino Municipal Code.Gaper 9.13,and the Health and Safety
Code.sentianus3a(.n �/
Yee �q^a All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building occupant use equipment Or men. which If a roof is installed without first obtaining an inspection,I agree to remove
pelt harardous air conlominanu u defined by the Bay Area Air Quality Management all new materials for inspection.
Disuict7 ',(
Dy. "K,
I haw read dse WeardoussllmanrAr requirementsumkr Chapser6.95ofshe Califon
niaHnith4Sdny Cmh.Sc6.re 505,25533u 25534.1uMermanldmifne building
dors rot c ndy Mw a enact,that is r my responsibility in ratify de oceupnt of the ,Z I
mquirt whichmOnWromPoor
niuuanCoof.CatiRMseof $' UI ofApphcant V`/ Date
ser hariM D.ow All roof coverings to be Class"B"or better
Community Development Department
Building Division
SEIM,
City of Cupertino
10300 Torre Avenue
CITY OFTelephone: (408)777-3228
UPEf�TINO Fax: (408)777-3333
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: ,T L)
Job Site Address: M1,1 ( C'
Roofing Company Name: ✓A Y _
A plicant's Signature: Date: 20 63
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name: Phone#:
Contractor: Phone# License#:
Contact: Phone#: Cupertino Business License#:
G'r9-� r yog� y •-•
Type of lZoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles JIC Asphalt Shingles
Jk Wood Shakes ❑ Wood Shakes
❑ Wood Shingles O 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:
Job Description: /
'�eK✓ ofr-P
Residential ❑ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planninf t. if
there are an restric '2 .
Costo rojec • CM Type of Const o Occupancy group
l —
Qty. if
ApplicFee 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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