03100001 CITY OF CUPERTINo s"'-'*,
BUILDING DIVISION PERMIT $ CONTRACT®R INFORMATION
B ILDINGADDRESS: MONKS ROOFING PERMITNo.03100001
OWNER'S NAME: 794 BERRYESSA ST PERMrr LssueonTE
ONE: (408) 262-4797 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
too I LICENSED CONTRACTOR'S DECLARATION '
nF I hereby affirm that lam Boomed�t�$r provisions of Chapter 9(commencing Job Description
:ZITI with Section] )of Division]oI NC B-)- gr QF'rufcssiuna Co de.utdmy liccvc is
?LlN in full fo a elEct—.'1!' ✓✓✓••vl/�J1 C/1 J/(y /
lq? Licenac ( 7 �'/ REROOF
Com r
ARCHITECT CLARA ION
i U I undemand my plans shall be used As public...ad,
.aG Licensed Prnfcninnal
3 OWNER-BUILDER DECLARATION V�
j i 2 1 hereby affirm,ha,I am exempt from the Contractor's License Law for the
:00 following mown.(section 703 1.5,Business end Profession Colo:Any city a,,...ty
5$0� which requires a permit to construct,alter,Improve,demolish,m repair any structure lizinn
,i
Her to its issuance,als.rapores the applicant forsuch permiuo file a signed statement
ce
< that he is licensed pursuanun the provisions(if the Contractor's cense Law(Chapter 9 Sq. Ft. Floor Area Val uatlon -
j S (commencing with Section 7000)at Division 3 of the Business and Professions Cak)or
that he is exempt therefrom end the basis for the alleged exemption.Any violation of 3 6617013 . 00
Section 7031.5 by any applicant for a penult subjects to applicant o a civil penalty of APN Number Occupancy Type
no,more Nan five hundred della,,($500).
❑1,an owner or the pmpeny,or my employees with wages As their sole compensation,
will do the work,and the almnture is not intended or offered for sale(Sec.7044,Busions — RCgg Ulred Ins eCtIODS
and Padfessions Code:The COntmcmr'A License Law docs not Apply m en owner of 3 0 7 - INSULATI ON p
propend who builds or improves thereon,and who does such work himself or through his
own employees,provided that such irclamemenu arc not intended or offered for sale.If. 601 — ROOF TEAR OFF
however,Ne building or improvement is sold within one year of completion,Ne Owner.
builder will have the burden of proving that he did not build or improve for purpose Or 602 r ROOF PLYWOOD NAIL
.603 - ROOF BATTENS
I,a owner of the propend,am exclusively contracting with:i The
contraaort to
ecose La theprojectnotlpplyto da,Business an
ProfessionsCod,:)or i Tk Conhecur'.anLt.d, 604 — ROOF IN-PROGRESS
cense Law doe not applytots owner of property who sed p m improves thcrcon,and,
who coalman for each projects with a,nnmcmrp)licensed pursuant to the Contractor's
License law.
1 am exempt under Sec. ,B&P C for this msson
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby from under,penalty of perjury one of the following declaration:
1 have and will radial n A CAMUlicme of Consent o self-imum for Worker'sCompen-
ration,As provided for by Section 37W of the labor Codc,for Ne perfmcco nm of the
work for which this Permit is issued.
1 have and will maintain Wei Compensation Insurance,as required by section
37W of Ne Labor Code,for Ne perform,np of Ne work for which this pmmit is issued.
My Workel¢Comhensati nsunrrce,./a//rust dPalicy numherrt/:_
Ce r. !/ liry FROM
/ 1�Dvs
CE IFICATEOFEK•k I NFR'ANCE KERS'
COMPENSA NINSURANCE
(Thusection need not becomplcted if the permit is for one hundred dollars($101)
or In'.)
1 certify tha,in,he performance of the work ror which this Permit is issued,I shall not _
employ any pereen in any manner so As to become subjcm to the Worlics Compensation
Laws of Celifomia.Date
Applicant,
NOTICE TO APPLICANT:If,after making,his CedifLate of Exemption.you Mould
become mhjcn to,he Worker's Compensation previsions Of IM labor Code,you mon .
:iO forthwith comply with such provisions or this North shall k deemed artificial.
z� CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a conawninn lending agency tar the Performance of
X to work for which this Permit is issued(Sec.3W7.Co,C.)
S]A Iandcr'a Namc
z lender's Address
1 certify Nat 1 have read this application end sate that the above information is
F, concc,.1 agree to comply with all city and county Ordinances and Stam laws relating to
DU building construction,and hereby authorim mpresenutimil Or Oils city to carer upon the J
»a above (We) nedagree
PropertyTor inspection an keep ha /
(We)agree In Save,indemnify and kith hay in a,w City or aud...Wino id City /
JN finc.itique ctIs-hecesuand g of thisCarkman
remit,hmay in ony way eccmc egeinnvoid City
J z APPILI A a NDER TA of this Permit.
ti APPLICA NDERSTA SAND WILL COMPLY WITH ALL NO -POINT Issued by: D le
sfLD$C ULATIONS.
` Re-roofs
SigrilLireo ApPliceData
HAZARDOUS
US MATE RIALS DISCLOSURE Type of Roof
WIII the applicant Of future building c.Chapter
store or handle bar Health
an materiel
As defined by the Cupertino Municipal Code.Chapter 9.12,and the Health end safety
Cod.,Section z5532(e)a //��-- All roofs shall be inspected prior to any roofing material being installed.
❑Yes IQWo
Will Ne applicant o,future building Occupant use equipment Or deviw which -If a roof is installed without first obtaining an inspection,I agree to remove
it hanrdrai air contaminants u defined by Ne Bay Area Air Quality Management all new aterials for inspection.
alricl?
p Yes - �'
x/03
I aJ Men.rtjnus materials aquiremmu under Chapter&95oftheCAlifor-
raw He & My Code,Section 25505.25533 end 25534.1 undemand Onto if the Wilding
Jars m c n,ly how a renmk that itis my rcspomihility u notify lk occupmt of the
req m is which he ri minuancnr.ccourcmemoc ,y ignalureofApplicant Date
0 Orau,hoiiredagc /� ate All roof coverings to be s "B"or better
s
H,. Community Development Department
6 Building Division
' � City of Cupertino
FFF„lii 10300 Torre Avenue
4 CITY OF Telephone: (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 comp/ly�\with the above stated
,policy on re-roofing.
Homeowner's Name:
�/
J�Il�'
Job Site Address: / 5t/b 0A
Roofing Company Name:
A plicant's
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEtt°TiNO PERMIT APPLICATION FO
Date:
n 3
Building Address-
1151,762 -
Owners�am�ll
Contractor, Phone#: License#:
MolJ KS 12OOEW q0 6 —419'7 (D
tact: • Phone#: Cupertino Business License#:
U 2u D,-4-1 17
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles C>. Asphalt Shingles
Gl� Wood Shakes ❑ Wood Shakes
c& Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings I — ❑ Provide I.C.B.O.Report#
CW To be Removed ❑ Provide Mfgr.Installation Specs.
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
J Job Description:
're a rtO S 1 t1. g )gA y S'r,sTo 11 cp.X, _:�: iC,I 1 CA r•i
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed wit -Plann ft::I? pt. if
there are restri dons: L
Cost t: Type of C n: Occup y grow?.
Qty.
A ca 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
� 2333 `f
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