03080076 CITY OF CUPERTINO
ONTRACTOR INFORMATION"`
UUILDINC DIVISION PERMIT C
BUILDINOADDRESS: ZIMMERMAN CATHERINE L PERMIT N003080076
OWNER'S NAME: PERMIT ISSUE DATE
ZIMMERMAN CATHERINE L 08/lc;/2003
ONE: SANITARY NO. CONTROL NO,
ARCHITECrlENG1NEER: BUILDING PERMIT INFO
BLDG ELECT PLUME MECH
0 0 0 0
200 LICENSED CONTRACT'OR'S DECLARATION
u❑ 1 hereby affirm Thal 1 am licensed under provisions or Chapter 9(commencing Job Description
F�W with Section lOfAB of Divkkm Sarum Business and Professions Code,and my hot..is
s in full force and effect REROOF
Liccnsc Clazs Contractor FIw,�LC® _
F Dam Contractor 'tl `gg
££ ARCHITECTS DECLARATION
C a I understand my plans shall he broad as public records
s 0 y Licensed Pmfcssional
APR 1 3 2004
Oat lam exILDERempt
DECLARATION
C<f 1 hereby maso .('firm that 1 oro cxcmpl from the Comment's s Liccnsc Law Icor the .
po following mason.(Section 703 1.5,Business and ve de Professions Code:Any city or roomy BUIL
MNG
<$ which requires a permit nt construct aIle[improve,demolish,or repair any structure e`�/�1r
prion,,its issuanee,als.requires the applicant fur such permit m file a signed statement
that he is licensed pursuant o the provisions of the Contractor's License Lew(Charter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7")of Division 3 of the Busimes and Professions Code)or
That he is exempt therefrom and the basis for the alleged exemption.Any vinlauon of 36215007 . 00
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred delta. 55007. P Y YP
❑ Lmowner ,the the
struc,mmycmntendes withwagesmthel(Sec.compensation,
will do Ne work,end Ne suunurt is not intended or offered for sale(Bac.7044,Business —
sad Professions Code:The Contractor's License Law done not apply to an owner of 307 - INSULAT pAgd Inspections
property who builds or improves(hereon,and who does such work himself or Ihrougb his
Own employees.provided that such improvements are not immndud or offered for sell If. 601 — ROOF TEAR OFF
however,the building or improvement is sold within one you of completion.the owner.
but lder will have the burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
Asia')' 603 - ROOF BATTENS
El 1.as owner of the property,am exclusively contracting with licensed contractors to 604 - ROOF IN-PROGRESS
construct the project(Sec.]044,Business and Professions Cade:)The Contractor's Li
cense Law area not pply to an owner of property who builds or improves Hereon.and
who contracts for such projects with a contractor(&)licensed pursuant to lite Character's
Li`cense Law.
Ql am cmpl under Sec. B h P C for this..an
_ —Date ,
`. ORKER'S C NSATION OECLA TION
Therebyafam,under Pcnehy o(perjury one of the o lowing declarations:
1 have and will maintain a Certificate of Consent to self-imam for Workeri Compare
cation,as provided for by Section 37M of the Labor Code,for(Ile performance of the
work for which this Permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
370)mf dm Labor Cads,for the perform ince of Ne work for which this pcmtit is ismad.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need am be completed if the permit is fmanc hundred dollars($100)
or leas.)
1 certify that in the pcffonnmea of the work for which this permil is issued.l shall net
employ any person in any manner m as to become subject o the Workers''Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ccrdricam of Exemption,you should
became suhjcct to the Worker's Compensation provisions of the labor Code,you must
�O forthwith comply with such provisions or this farm it shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that%am is a construction lending agency far the Performance of
Y.> Joe work for which this pormah is issued(Sec.3097,ON.C.)
y Q Lenders Name
z Lenders Address
J Q 1 certify that I have read this application and Sam that the above information is
L H coned.l agree to comply with all city and county oblinanees and state laws relating to
'U building construction,and hereby authorise representatives of Nis city to enter upon the
Ushove-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino egaiml
Ley fin liabilities,judgments,coats and expenses which may in anyway accrue against said City
JZ in consequence of Inc granting of this Permit.
APPLICAN_j UNDERSTANDS AND WILL COMPLY WITH ALL NONPOINT Issued by: Date U
RCE ULAN
ate-roofs
a, ign o p'c mmctor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle haoardous material
as defined by the Culamno Municipal Code,Chapter 9.12,and the Health and Safety
oda.Section zss3xan __'/ All roofs shall be inspected prior to any roofing material being installed.
Yes
Will the applicant Troon building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardnus air contaminants as Ened by the Bay Area Air Quality Management all new materials for Inspection.
Istria(?
❑Yes u
1 have mad the havardous materials requiroments under Chapter6.95 of the Califor-
nia Health K Safety Code,Swoons 755115,25533 and 25534.1 endamund that four building
does not curremly have a tenger.Nal it is my responsibility In obal'y the nmmarm Of the
tai
hr et poorer issuance of a CeniOcamn cupancyw a.af Signature of 'a ••// Date
ner or brmnriu a t o a wV All roof coverings to be Class "B" or better
Community Development Department
Building Division
` 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 Addresy 625? 4(cve10ei, r- Oct /A0
Roofing Company N�qe:
Applicant's Signatu te:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
aCITY0
CUPERTINO PERMIT APPLICATION FORM
APN# l� Date:
r
Building Address:
Owner'sam�: Phone#:
kv GL 4A Z —7
Contractor: Phone #: License#:
(� (�
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ ,Built-Up roof
❑ Asphalt Shingles t 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 Description: / t,J
Residenti4VM Commercial ❑
/—
Fire Zone: Yes ❑ N11
Confirmed with Pla ing.Dpt. if
there are anre fictions: LI
Cost 0f PMPCt. -Type of Cons Occupancy gr u
Qty. if
A lic 1 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