03080183 CI'T'Y OF CUPERTINO .L '1� .z `
BUILDING DIVISION PERMIT ; C0NTRACT0W NFORMATION•
6R Jr".Cvi'c^ ..Py4tdS
0UI LDINGADDRESS: WILLIAMS ROOFING PERMITN%3080183
8 0 NORMANDY W34
a OWNER'S NAME: 4921 CABRILLOPOINT PEWIT ISSUE DATE
RRCKY WA (I OR /29/2001
HE (408) 252-5120 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 o
!00
LICENSED CONTRACTORS DECLARATION
of CDN
£wF I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing - Job DDSCflpIIOn
Za`j with Scorcean arx,DivisionSofthcBusinuvandPmfcssinmCode.andmyliccnuis P�IVALE®
"o ran in mu roma and arta I(-y.�rr�q
I„J License Cl �3q Llc.a
t- Date b Co.[,. �...� REROOF
ARCHITECTS DECLARATION SEP 1If, 2003
I I understand my plans shell w uuJ as p51ic rccmdz
)aU
ro� Licensed Professional
OWNER-BUILDER exempt
DECLARATION BUILDING
M 1 hereby mYrm that I em exempt from the Contractors License Lew for the
p o (allowing reason.(Section 7031.5,Business and Professions Cole:Any city or county
<m
°� which require a pennil m c rmungel,elw,improve,demolish,sir repair any structure
P prior to its issuance,alga requires the applicant for such permit to file a signed Statement
a C u
that he isliccnJpursuant uuheprovisions ofthe Conbacmr'sLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
2F (commencing with Section 70M)al Division 3 Orion Business and Professions Code)or
that he is exempt therefrom and One basis for the alleged exemption.Any violation of 36617053 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not moe Nan five hundred dollars(S500). APN Number - Occupancy Type
----
O I,As owner of the property,or my employees with wages As their sole compensation,
will do the work,and the structure is not intended or ofremd for sale(Sec.7044,Basi ness
and Professions Code:The Conlnno's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his 307 — INSULATION
own employees,provided that such improvements are not intended ororcered for sale,If. 601 — ROOF TEAR OFF
howevea Ne building or improvement is said within one year of completion,the owner-
builder will have the burden of proving that he did not wild or Improve for purpose of 6 02 — ROOF PLYWOOD NAIL
y1t' 603 — ROOF BATTENS
❑I,as owner of ct Sec.7 ,Business udus and confessions with;)TheContractors
contractors a -
conswawdoect the sojcct(5eytoanownroropenywhoInuCaorJpromthumrsLb 6O4 — ROOF IN—PROGRESS
come Law does nal apply a an owner of pmpeny who wilds or improve thereon,and,
whonse LacLL for such projects with s convanor(q licensed pursuant to Ne Comranora
License Law.
❑Iamcaemp thiciOSec. ,B&PChathismagam
Owner Data
WORKER'S COMPENSATION DECLARATION _. .
IhembyaRrm under penally of perjury aro of the following declarations:
I have and will maintain a Certificate of Conunuo self-insure for Worker'sCompen-
safion,ns provided for by Section 3700 of the Labor Code,for the Performance of the
work for which Nis permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,As required by Section
37M or the labor Code,for Ne performance of the work for which this permit is issued.
My Workers Compensation rich carrier and Policy number am:
Cartier: � I= Policy No.: 0+&—d'9317
CERTIFICATE OF EXEMPTION FROM WORK ERS'
COMPENSATION INSURANCE
(This section need not he complete if the permit is for one hundred dollars(51110)
or less.)
I cera fy Nal in the performance of Ne work for which his pemnit is issued,l shall not
employ any person in any manner u As to become subject o et Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ceniffcate of Exemption,you should
become subject to the Worker's Compcnution provisions of the labor Code,you must
Oforthwith comply with such provisions or this Permit shall he deemed rcvokcd.
Z y CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency(sir the Performance of
Y� > the work fur which this permit is issued(Su.3097,Civ.C.)
'31Q Lordcr's Namc
Z Lender's Address .
:J C) I certify that I have read this applicadon and rot that Ne above information is
.j comet.1 agree to comply with all city and county ordinances and stale laws relating to
7 V building construction,and hereby authorim representatives of this city to enter upon the
6 above-mentioned progeny for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
lA liabilities,judgments,costs and expenses which may in any way acerae egams,
said City
JZ in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Signature of APPlicaHA - Data
HAZARDOUS
A2AR0O0S MATERIALS DISCLOSURE Type of Roof
Will due e Cupertino
futurebuildingooccupantstore2.handle Health Aid
As defined by the Cupertino Municipal Coda Chapter 9.12.and the Itcalth and Safety
Code.anion 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant or future building Occupant use equipment or deatu which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air conm rmanu as defined by the Day Area Air Quality Management all new materials for inspection.
11,7z,mar
❑VcsIhamreaJtheharalloesmatrialsmyuimmcnuunJerChaptr6.95ortheCalifar-Health&SafctyCade,Scedom25505,25533and25534.1undcnwdNwiftin wilding
u not currently hate a mart.Nal it u my responsibility to notify tw occuPanl of Ne
ui oro hichMoslhemetPoorlalasore.oraCanificamofLYCYpyerSignature of Applicant Date
1/67
or authorired tical pale All roof coverings to be Class "B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U����'�O Fax: (408) 777-3333 I
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: $r,47 WAU
Job Site Address: 7&92 /W,01
Roofing Company Name: l U-(A"s
A plicanYs Signature: �—� Date: 3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
t CITY OF CUPERTINO
REROOF
CUPERTiNO PERMIT APPLICATION FORM
APN # Date:
Building Address:
-76-6-0 rfaarla9.c/ w
Owner's Name: W hv� '-'r- : 2-S- 3 -
S 3 C p!-'OW r hone#
� 2-403
Contractor: Phone #: License#:
VJit�t s �o� '
74,x- 5-1z4> 4-1 ,gof9
Contact: om Phone#: -Z 2-1 _( -1 Zd Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
X Asphalt Shingles 0—�'Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings y ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr. Installation Specs. C L te
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: :17".4 L ALU- !;73 7a Com`
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planni De t. if
there are an r Ceti
Cost of Project: q DD0 � T nstruction: Occupancy o
jZt<FM�' r
Qty. if
A lic 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