03100048OP CUPERPINO
"'; 4�'BUILDING
DIVISION PERMIT
*nCON.TRACTOR INFQRMAT10DING
iITY
ADDRESS:
JIM KRAUSE ROOFING
PERMITNO.03100048
ER•s WMe:
2310 DIANA AVE
PERMITLSSUEDATE
NE:
(408)779-0704
SANITARY NO. CONTROL NO.
ARCHITEC-IENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hcrchy effum that 1 em licensed under provisions of Chapter Y (commencing
p
with Section DivisianJo(oc Business an fcsionsC c licensei,
ndeffif
in full form and err u 3 `%
ROOF
License Cl s Lic.
DateCunlr lar
ARCHITECTS DECLARATION
1 understand my plans shall he used as public records
!
j
P
Licensed Pmfe,aioaal
OWNER -BUILDER DECLARATION
\�
I hereby d(Bfm that 1 am1. exempt from the Contractors License Law for the
mass a. (Section 7031.5, Business and Tessio
demob Code: Any city orcounty
which re improve, x or repair any nmnam
which requires a permit pe comms, ahcc impmw,
h mort
prior m its i also the applicant far tach permit m Elm a signed Chapter l
its
Sq. FL Floor Area
Valua[lon
toires
eased pursuant provisionsofthe CooeBuiness LimnselaonsCasmr9
(commencing with Section 71100) the Basin. and Professions Cale) or
(cot me cingWitSectio7") Division J
Nat he is exempt therefrom and the buts for the tllcgcd exemption. Any violation of
the the
APN Number
Occupancy Type
P Y.
Section 7031.5 by any applicant for a permit subjects the artificial no e civil penalty of
not mom Nan five hundred dollars ($500).
❑ 1.Mman. of the pottery, or my employ. with wage, u their sole minimization.
305 — FRAME Required Inspections
will do the work, and the structure is not intended or offered for sale(Sec. 7044, Business
and Professions Cod. The Contactors Liceme Law d. not apply to an owner of
property who builds or improves Norton, and who doeasuch work himselfor through his
307 - INSULATION
own employees, provided that uch improvemcno are not intended proffered formic. If.
601 — ROOF TEAR OFF
however. the building or Improvement is said within one year of completion, the owner
builder will have the burden of proving that he did not build or on prow for purpose or
602 - ROOF PLYWOOD NAIL
sal`)
603 - ROOF BATTENS
❑ 1. as owner of the property, em .fines; and propulsions wim licensed onnu ton's to
thoespartpplytotInOwnein.andPotwssionadsorhThowstheran,
come
- 604 — ROOF IN -PROGRESS
act
rad
emote Law tits nm apply to an owner of proper( who or improvee memos, end
sed p
who contracts for such projects with a canuacmr(q licensed pvrauem m me ContnnOM1
Law.
License Lew.
❑ I em exempt under Sec. , B & P C for this .otos
r Data
-
WORKER'S COMPENSATION DECLARATION
I homey affirm under Penalty of perjury ane of me fallowing d.l.ntions:
I ban and will maintain. Cerdficete of COmem to selbinsum for Worker'. Camper
ion, n provided for by Section 3700 of the Labor Code, for fie performance of the
rk for which this permit is issued.
1 ban and will maintain Worker's Compensation Insurance, es rcyuired by Section
j
00 of the Tabor Code,fordm performance of the work for which this permit is issued.
y Workers Com nasion Imunnce camicr and Polity number art:
Cartier: 5 ate,(_ PolicyNO.: ifrS-e2'!
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This ¢dins need not be completed lithe Permit Is for one hundred dollars (Slily
or leas.)
I ccnify that In the performance of the work for which this permit is issued, I shall not
employ any Person In any manner nn as to become subject to the Work.,'Compensation
Law, of California. Dem
Applicant
NOTICE TO APPLICANT: If. after making this Ceni Beate of Exemption, you should
become subject to the Worker's Compensation previsions of the Labor Code, you most
forthwith comply with such provision, or this Permit shall he dttmed Revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm met short isa Construction lending agency for Be, performance or
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
- -
Landers Addmas
Icertify dust 1 ban read this application end ..in thaz the aeon information is
comm. I a{me to comply with of city and county ordinances and swe laws to
�- a
building construction, and hereby authon r upon{
rePreunutiw,,(this city m enter upon the
above for INP.tian pafpaml
p
')
(We)a re to Curly
(We) agree to otos indcmnily and keep humless the City of Cupcnino against
liebilitieajudgmenrsl costs enJ apenxs which may in any way mems against said Cily
/
in canugwncc o(t gmming of this it
APPLICANT RSJ'AN ILL CO LY WIRH ALLPOINT
"
(/
Issued by: Date
SOURC E
Re -roofs -
Type of Roof
/D
Signature of AppliermaCumncmr 0 te
HAZARDOUSMATERIALSDISCLOSURE
Will the applicant or future building occupant spare or handle haurdous material
ss defined by the CupenlMunicipal Code. Chapter 9.13, and [be Health and Safely
m
.gecnzssJz(an -
All roofs shall be inspected to any roofing material being installed.
❑Yes No
prior
If a roof is installed without first obtaining an inspection, I agree to remove,
Will the applicant or future building Occupant use Nuipmem Or devices which
h ha'rardaus air cont ors u defined by the Bay Area Air Quality Management
all new materials for inspection.
auict?
❑Yes NO
I have mad the hazardous materials requimmcnts under Chapmr6.95 Of the Califon
ria Hcallh&Sa(cryCode, Somme; 35505.25537 and 25534.1 understand oofrom building
/ U/7
docs not cummily new a tenml. at it is my mspomihility to notify We occupant of
��/"'�•///
requircmcnts which bemat I. emote Cc r1caueO(0=.uy.
Signature of Applic t Date
•
)0 %
All roof coverings to be Class "B" or better
Owner ser out miacdagcnt Dam
CITY OF
UPE(,TINO
2 el-7—
Printed
7 -
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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 abovestatedpolicy on re -roofing.
Homeowner's Name: ///CZ_g L, /�
Job Site Address: 7,5 6 Z / L� a )C,2 e, , I! A t��
14
Roofing Company Name: �f"�S .
Applicant' s Signature:
t 'A
Greg teal
Building Official
Revised 1/30/03
Printed an Recycled Paper
Date: �v�7
10/07/2003 00:25
�CUPEkTINO
5105383202 LEGALITIES INK �Q
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
PAGE 03
/d v
APN #
I BPERMFEE
Date:
l�^
Building Address: _25 Z / ll } C_--t-P,,
Owner's N
BENERGY
Phone #.
Contract,/
K�1duo iz
Phone #:
-2
License #:
License 3S
Contact:
Phone #:
Cupertino Business License #:
BSEISMICOM
Type of Roof Covering:
Existing:
Proposed:
U Built -Up Roof
0 Built -Up roof
0 Asphalt Shingles
�K Asphalt Shingles
Wood Shakes
❑ Wood Shakes
0 Wood Shingles
0 Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
0 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: //7 - Q y
e
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
42 000 . W
Qty. if
Aoolicable
Fee ID
Fee Descrintion
Fee Groun
I BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
1 BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING