03070238 CI'T'Y OF CUPERTINO !'
BUR DING DIVISION PERMIT CONTRAC Ct�R INFORMATION
Tsps: , xa - z w. s°�
BUILDING ADDRESS: SIGNATURE ROOFING INC
PERMITNG03070238
OWNERS NAME: 555 OINEILL AVE, #16 , PERMITLSUEDATB
WAN 07/11 /2003
NE: (800) 644-7410 SANITARY NO, CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
nfit .=
l00 LICENSED CONTRACTOR'S DECLARATION B.zs
£ 1 bemby affirm Nal 1 am limnsed under provisions or chapter 9(commencing lob Deseriphon
xx with Scnion 71KX1),f Division Ser Nc nuainu,.na Prufcasiom Code.ma myliccnse is
'=n in lull force and off 1 Z6 6 6 REROOF AUG 11 2003
License s J Lk.N
6 b, Dale Cum aror
e¢¢ ARCHITECTS DECLAR TION
taU l understand my plain shall lc used As public recur, BU'L®1Y
epi Licensed Prufesxwnal
OWNER-BUILDER DECLARATION
I 1 hereby affirm that I am exempt room the Contractor's License Law for the
COO following mason.(Section 7031.5,Business and professions Code:Any city or county
m which requires a Permit to construct,after,improve,dcmnlixh,nr,epalr any stroeture87749
-z�^ prior In its issuance,also requires the applicant for such Permit o file a signed statement
p < that he is licensed pursuant to the pmvisimmofthe Contractors License Law(Chapter 9 Sq. Ft. Floor Area Valuation
c+ 0 (commencing with Section 7030)of Division 3 of the 0 asirms and Professions Codc)or
that he Is exempt therefrom and the basis for the alleged exemption.Any violation of 36213029 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to A civil penalty of anC APN Number Occupancy Type
nmm.m than five hundred dollars($500),
- P Y YP
El 1,u owner of the property,or my employees with wages As their sole confirmation,
will do to work.and the structure is not Intended or offered for sale 7044,Business j U b - d Inspections
and Prof
asxiors Code:The Contracmri License Law dots not apply to an owner of 3 07 - I NSULAT MY P
pro,eny who builds or improves thereon,and who does such work himself or through his
own empmyees,provided thin such lmpmvamenu Are not intended M.ffered insole.It. 601 — ROOF TEAR OFF
however.the building or improvement is sold within am year of completion,the owner
builder will have the burden of proving that he did net build o,improve for purpose of 602 - ROOF PLYWOOD NAIL
"le')' 603 - ROOF BATTENS
❑I.as owner of the property,am exclusively contracting with licensed conuaclorsec10 604 - ROOF IN-PROGRESS
construct the proper(S .7lkas d,Busineand Professions Cade:)The Conuanods Li
cense law docs not Apply to an owner of property who builds or improves thereon,and
who contracts for such projects with o ennlraro(s)licensed pursuant to the Contractor's
License Law.
El f am exempt under Sec. ,B&PC for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby am.under penalty of perjury one of the following declarations:
I
haw and will maintain A CeniOeau of Consent p self-iasum far WorkeM1 Compere
A
as provided for by Section 37M of the labor Code,for the performance of the
rk for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as inquired by Section 0 of lie labor Cmle,for the performance of the work for which Nis remh is issued.
Worker's Compensation Insurance carrier and Policy number art:
rier, Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mhiH actin.need not becompleud ifthe Pa t is fork.hundred dollars($100)
in less]
1 cent ry that in the performanm of the work for which Nis permit is issued.I shell nut
employ any person in any manner An As to become subjecuo the Workers'Compensation
Laws of California.Date
_ Applicant
NOTICE TO APPLICANT:If,after making this CeniOcme of Exemption,you should
become subject to the Worker's Compensation provisions of the Lahnr Code,you must
70 forthwi@ comply with such provisions or this Permit shall deemed revoked.
z Vy CONSTRUCTION LENDING AGENCY
I hereby affirm Nal there is convection lending agency for the performance of
yv the work for which this permit is Wood(Sce.5097,Civ.C.)
31 Q condo's theme
z Lenders Address -
;)0 1 comfy that 1 have read this application and suu that the about Information is
LI, F-r collect 1 agree to comply with y city and county ordinances and sole laws relating to
�U ahmengconsted pro rtyhereby emhonprpoesenutiwa of this city menterupon the
Na ahovc mentioned property for inspection purposes.
(We)agree to a ve,indcmni(y end it ep harmleu the Cily of Cuperlino against
�y liabilitiu,Judgmen sea and cx ns Amey in way acme againsuaid
City
o z in conseq cc c gran
,^ APPLICA A L NggQNNN POINT Issued by: Date
SOURCER ULATIONS. „' /� �
O Re-roofs
Signature of ApPlinHAZARDOUS MATERIALS DISCLOSURE m Type of Roof
Will the applicant or future building occupant store or handle haosmous material
As defined by the Cupenino Municipal Code,Chapter 9.12.and be Health and Safety
case.seetinn as3na7 All roofs shall be inspected prior to an roof. material bei. Installed.
❑Yes No P P Y g g
Will the applicant or future building occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
It hwmdovs air cents inane as defined by the Bay Arca Air Quality Management all new materials for inspection.
Wrier?
❑Yes No
I have read the havandous mauriala req.menwos under Chapter 6.9S.f the Califoo- �J
ria Health&Safety Sections 25NI5 77 and255 a.l understood into ifthe building N/'S' , , 2 t O/1
Jou nm ermcml a�pnsn y teaporu' ray b rytil'y the o upant of l -7
myintent Ip r ^' /'1 Signature Of App)cant Date
Io l� All roof coverings to be Class "B"or better
Owner nut awhorizcd aFcm Dam
Community Development Department
Building Division
d { City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
UPEI�TINO
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 Address: 49z-" b
Roofing Company Name:
A plicanYs Signature: Date:_2Y 3//0 3
Greg teel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTIN0 0 3 7 a 2�
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# !�, Z _ L D21 Date: 2L�c3
Building Addres
Owner's Name: r Phone#: L4 y b — S )7 Si7
W lit--vv
Contra r: ' Phone#: License#:
Contact: Phone#: Cupertino Business License#:
cSoy�ut_
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles P, Asphalt Shingles
1 L 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 Descriptio}} ��,, // //
T!O J��n— �i6 •0 B 2A�G�
Residential 7PP Commercial ❑
Fire Zone: Yes ❑ No ❑ . Confirmed with Planning Det. if
there are an restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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