03110078C ITY OF CUPERTINO
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BUILDING DIVISION PIJRMIT
CONTRAC 0R, INFORMATION `%
zl
-ROOFING
BUILDING ADDRESS:
WESTSHORE CO
PERMIT N003110078
10303 MINER P
OWNER'S NAME:
5,869 WINFIELD BLV
PERMIT ISSUE DATE
ABRAMOVITZ NORMAN AND RACHEL
S
11/14/2003
NE:
(408) 629-2100
SANITARY NO. CONTROL NO.
ARCHITECIPENGINEER:
BUILDING PERMIT INFO
RLDG ELECT PLUMB MF.CII
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby I am licensed under provisions of Chapter 9 (commencing
thatrchar
thatI
p
with Scarce 7") of Division J of me Business and Professions Code, and my license is
) or
m fun force and crcen.
License Close
REROOF �'� ��®
A
Dale Contractor
Con
DECLARATION
As
I untlersmnJ my plans shell W used a public records
shall
DEC Z003
Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm the, I am exempt from the Comranor's License Law for the
follnwing mason. (Section 7031.5, Business and Prom fordoCode: Any city or county
BUILDING
which mQUIMS a petted to COASLMCI, alter, Improw, demolish. Or repair any structure
$14500
Sq. Ft. Floor Area
Valuation
Prior m its issuance, also mquircs the applicant fur such permiuo Me a signed statement
that he is licensed pursuenl m the PMVI91Da of the Contractor's Licenu Law (Chapter 9
(com mencing with Section Mm) of Division 3 of the Business and Professions Code) or
31646031.00
Nat he Is exempt themfrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
P y YP
Section 7031.5 by Any applicant for a permit subjects me applicant 10 a civil penalty of
...more man five hundred dollen
I, as owner of the property, or my employees with wages As their sole compensation,
"
will do the work, and to structure is not intended or offered for ale (Sec. 7044, Business
Required Inspections
and Prmfamions Code: The Conlracmri Llano law Aces not apply to an owner of
progeny who builds or improves mereon,and who does suchwork himselfor through his
Own employees, provided that uch improxemenu are not intended oroffered for sale. IL
however. the building or improvement is sold within one year of completion, the owner-
builder will ban the burden of proving that he did not Wild or improve for purpau of
sale.).
C:) 1, as owner of the properly, am exclusively contracting with licenud contractors to
coawct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
ccae law does not apply to an owner of progeny who Wilds or improve themon. and .
who contracts for such projects with a eontracmr(s) licensed pursuant w the Contractors
License Law.
❑ I am excmpt under See. . B & P C forms comm
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Am following declarations:
1 have and will maintain a Cco ificam of Consent to AAK-insure for Worker's Cmmpen-
"aton, u provided for by Section 3700 of the labor Cade, fm the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code. for me performance of the work for which this permit is issued.
My WorkcrQ{ Coommpe1paamid sonnet 1p rticrand Polmyn klm/:y_7
I 0
Cartier. Jl A 1 Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
,
(This section need not beCOMPlmed Kind Permit is Orman hundred dollars (SIm)
nr Ices.)
1 certify that in the performance of the work for which this Permit is issued. I shall not
employ any person in any manner sat As in become subject o the Workers Compensation
Laws of CalifOmiA Date
Applicant
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions Of the labor Code, you must
foMwim Comply with such provl]IOAS a this Permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency I'or the Performance of
me work for which this person Is issued (Sec. 3W7, Civ. C.)
Lender's Name
lender's Address
I certify mat I have read this application and sine that the abut oinformation is
corlCcl. 1 agree m Comply with all city and county ordinances 'u tine ser¢ laws relating is
building conswcti0n, and hereby authorbe represenmdws of this city to enter upon the
abow-mentioned properly, for laNction purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabiliva,judgments.eosts and expenses which may in any way arnc against mid City
in conmquenec of the granting of this Permit,
APPLICANT UNDER;TAhRLOD WILL COMPLY WITH ALL NON-POINT
Issued by: Date
SOURCE REGULAT NS.
Re-roofs
"
Type of Roof
i I I l I -�3I0S
Signature ofAantyContranor Data
HAZARDOUS MATERIALS DISCLOSURE
will the applicant or future building uccupam store or handle havardaos material
m defined by the Cupenino Municipal Code. Chapter 9.12, and the Health and Safety
Cndc, Section 25532(a)?
All roofs shall be inspected to any roofing material being installed.
❑ Ycs
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
it hamrdnm air contaminants As dcfned by the Bay Area Air Quality Management
all new materials for inspection.
❑ Ycs
.have mad the herald ous materials mquitemens under Chapter 6,95 of We Califor.
of Health&SafelyC ,Secuoa 25505,25533 and 25534.1 umlcmand that if tW Wilding
does not currently M! Cn tat it Is my ma�alhlllly m Amity the 4eupant Of mC
E%
rcyuircmc W ' most At pdncCOf8CC19BG q� rr�
'
p
S- ata e A licant Date
g PP
i L IV�•
All roof coverings to be Class "B" or better
Owner
orouthminu agent Date
Nov 13 03 12:37p
CITY OF
CUPEkTINO
Paul Fowler 14081 629-2100 p.2
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408) 7773333
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
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: A 1)(-A1AAQt1 il'Z
Job Site Address: _10305 7 t-o'c e.
Roofing Company Name:
A plicanll Signature: Date: t i 0
Greg 1
Building Official
Revised 1/30/03
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 reroofing
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 inspectiom
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: A 1)(-A1AAQt1 il'Z
Job Site Address: _10305 7 t-o'c e.
Roofing Company Name:
A plicanll Signature: Date: t i 0
Greg 1
Building Official
Revised 1/30/03
Nov 13 03 12:37p
• Coc
UPERTINO
•
Paul Fowler (408) 629-2100 p.l
CITY OF CUPERTINO
REROOF 0 3 i < " 0
PERMIT APPLICATION FORM
APN / �
r/ (�
, �
Date:
iif lLi
Building Address:
1()3(-%)
[A, I.+ER PLACE.
Owner's Name:
�bvu.�.vvtt2•
one #:
yc>'s' 2SS-YYC-'
Contractor:
1 Jz
Phone #:
12.ortn�iy ir.t.. ��{C�J(2? Z1C0
License #:
79-7ZZI
st.l�o>i
BUILDING
BPLANCHK
Contact:
Phone #:
Cupertino Business License #:
Business License
BUILDING
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
Cl Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
Id Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Other
❑ Wood Shingles
Other(Speeify)(-n%�-) 'S'�Ce«ti.riS*�e17.
(Specify)
Number of existing coverings
,dn
❑ Provide I.C.B.O. Report # ; F je N 2 T .
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com 1 With Cu rtino's Tear Off Policy:
Job Description: bit--la7
frr-Y�� Sre:.a C�r,r<<i
Residential
Commercial ❑
Fire Zone: Yes ,No -0
Confirmed with Planning IZeut. if
there are an restrictions: Q
Cost of P Ject,
/vsvo.—
Type of Cons ti Occupancy grou :
/ 71,)1'e
Qty, if//
Annlio� it' , Fee M
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
t'