03100186 CITY OF CUPEWHNO 4y N '•
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIQN .:.
T^ isse'vx s :,_nwA,,u us ^s_•s
ouILDING ADDRESS: ANTHONY ROOF SERVICE PERMIT ND 03100186
10441 MILLER AVE
OWNER'S NAME: 910 S MCGLINCEY LN PERMIT ISSUE DATE
BARBARA SABDBERG 10/27/2003
NE: (408) 265-5147 SANITARY NO, CONTROL NO.
ARCHITEC IENGINCER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
!00 LICENSED CONfRACrOR'S DECLARATION
10� I hereby affirm that I am littrtxd under provisions of Chapter 9(commencing Job Description
with Section 701x)).(Division 3of NC Businessand Pruffsisinne C� rad my lice..is
�la� License
nd.v 7�(IJ c5 ,� REROOF
erg? Date a L't'c��./dII
i F p Date Lbfbaelf, l
ARCIfITECI'S DELL ATIO 1
f undcrntand my pinna shall he usctly rcahiic records
>du .J �f
e u.G Licensed Professional V
�03 OWNER-BUILDER DECLARATION
I I hereby affirm that I am exempt from the Contractors License Law for the
o O following mason.(Section 7171.5,Business and Professions Code:Any city or county
53 which requires a permit m construct,eller,improve,demnlixh,lir repair any structure $5200
-Zy prior to its issuanre.alm requites theapplicanl foramen permit to fileasigaJ statement
FF< that he is licensed punuan to the pmvtsionsofthe Contractor's LicenxLaw{Chapter 9 Sq.Ft. Floor Area Valuation
�5$ (commencing wi th Section 7000)of Division 3 of the Business and Professions Code)or 36915005 . 00
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to s civil penalty of APN Number Occupancy Type
not more than five hundred della.(SSW).
❑I,a owner of the property,m my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for ale(See.7614,Business
and Professions Cud.:The Contractor's License law docs am apply m m owner or Required Inspections
pmpeny who builds or improves theme..and who does such work himself or through his
own employees,provided that such tmprowmenu ase not intended orofferad for uta If.
however,the building or improvement is mid within one year of completion,the owner
builder will have the human of proving Nu he did not build ler improve for purpose of
role.).
❑1,as owner of the propcirl am exclusively contracting with liaised eon"Cie.m
convect the project(Sec.7644,Business and Profession Code)The Contracfrh U.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a conmetorod licensed pursuant in the Contractor's
License Law.
I am exempt under See. .B At P C(or this mason
1307CM
ner Data
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penalty of perjury oro of IAC following declsntions:
1 have and will maintain a Cenifteam of Consent m self-iwum fur Workeri Comp.m
on,a provided for by Section 3700 of the labor Code,for the performmm of the -
k for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,a required by Section
of the Labor Code,for the performance of the work for which this permit is issued.
worer's " permit �au.ncc rent Pali'n��pr`yy s of No.: r �- W_
CERTIFICATE O (EMP( OM WORKERS'
COMPENSATi INSURANCE
(This section need not W completed fine rcrmh la(mane hundred dollars(SIRD
lir Ies.)
1 ecrdfy 0.11.the performance of the work for which this permit is issued.I Mell net
employ any permm in any former so an us become subject to the Workeri Compenmllon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CeniRcak of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
� O fonhwi th comply with such provisions or this permit shall he deemed haunted
Z` CONSTRUCTION LENDING AGENCY
I berchy affirm that them is a construction lending agency Ior the perfurmence of
.L' > the work for which this permit is issued(Sec.3097,Civ,C.)
YQ Lender's Name
0 Z lender's Addram
0 I anify that I have road this application and sure that the above information is
y f coast.I agree in comply with all city and county ordinances and sate laws relating to
V building construction,and hereby amhmtw raprese unim of dila city to enter upon the
W 'hove-mentioned property for inspection purposes.
(We)agree to saw,indemnify and keep harrelea the City of Copcnino against
r N ))abilities.judgments,cost and expenses which may to any way name against mid City
;J7 in consequence of the granting of this permit. u 1/f
tt-�� APPLICANT UNDER AND WILL COMPLY WITH ALL NON�POIN/y Issued by: Date
.tpyRCEREGU � y�/n
V Re-roofs
Si ave pplicanVComnctor De
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will y t e Ctiont tar(Muni building e.Chapter,
atom 9.1ler handle hvutom.Safety
u OCOncd by Ore Cupenina Municipal Code.Chapter 9.12.and the Health anJ Salary
e sguou 25572(ep AN. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant lir future building Occupant use equipment lir devices which If a roof is installed without first obtaining an inspection,I agree to remove rare
it hasa ous air contanants a IkEned by tub Bay Area Air Quality Management all new materials for inspecti
islritl7 mi /t� /
❑Yes
1 have read the Iuvallous mvcrials royuirements under Chap¢r6.95 of the Wilding `
ria Halthh SafctyCodc,Sado'hatiti MYrand25534.1 Wmmil teextM Wilding
ofthe
dna not curren0 ave tenant.Iver itis my responsibility m nnulj the arupanl of the
oouoc`c, r• met prior of issuance of a Ccnifo:au of Occupancy ig❑ r pplicant Date
eent Dane All roof coverings to be Class"B" or better
Community Development Department
u Building Division
aname,
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
UPEkTINO
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:
Job Site Address: 0 yZll lei
Ale
Roofing Company Name:
A plicanYs Signature: Date: �3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
• CUPEI �TINO PERMIT APPLICATION FORM
APN# 36e? �_ .- Date: 2 /0 3
Building Address:
Owner's Name: Phone#:
611 ,sn 7V-e r' - !//in/
Contr cortPhone#: License#•
7 /� �S3
11c h V49P-.264—t5l
Contac Phone#: ✓ Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
-& Built-Up Roof P!� Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ 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:
Job Pf scri tion: p
p �e W
Residential gf Commercial ❑
Fire Zone: Yes,❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Projsct: 00 Typef C st ction: Occupancy group:
Qty. if
Applicable 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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