03050028 CITY OF CUPERTINO
BUILDING DIVISION PERMITONTRAC�`TO°It INkO^ RMATION ,
"'ILDINGADDRESS: RESPONSIBLE ROOFING INC """03050028
0192 /94 PARK rTR
OWNER'S NAME: 2882 SPRING ST r �pS°%78/2003
WALTER K AND GLORIA C ONE: (650) 969-6151 SANITARY N0. CONTROL N0.
ARCHITECTIENGINEER: BUILDING PERMITINFO
6LDGO ELECT O PLUMB MECH
O O
Loo LICENSED CONTRACTOR'S DECLARATION
I beRby anion that 1 am licensed under provisions of Chapter 9(commencing lob Description
ni with Section 70M)of Division Sof the Business and Nofeenons Code.and my license is
. O in full force and 5sptfeek v REROOF FI NALED
n g Z License Iva `—'3 oy Lte.0
zDames '� Contemns
111 edaA, IR f MAY 2 7 2003
1 understand my platy shall ARCHITECTS used u Public I M
30 Licensed Professional
OWNER-BUILDER DECLARATION BUILDING
F I haseanion
hy a
Nat I an cmpt from the COMMIM's Liecnm Law for the
y a O following (Sectionaa.(SeL7031.5,Business and Pnfe seas Code:Any City or County
j @� which redout a permit to construek alar,improve,demoluh.or repair my structure
prior an its issuance,also requires the applicant for inch Permit o Ne a signed statement
HZFi
that he is licensed pursuant o Ne provisions of the Communes Lima,Law(Chapter 9 Sq.Ft. Floor Area C5,� tion
S$ (commencing with Section 7(100)of Division 3 of the Business and Professions Called or
Y
that he is Ascents therefrom and the beau for the alleged exemption.Any vlolWon of
Section 7031.5 by any applicmt for a permit subjects the applicant to a civil penalty of 3 2UIbUQhirter0 0 Occupancy Type
am more thin five hundred dollen(g500).
❑I,vOwner^f the property,or my employ=with wages u their mlc compensation,
will do the work and the.neure is not intended or offend rot Asia(Sm.7044,Busircss Jub — RAME
I
hereRequired Inspections
And Profession Cine: o The Ccomminter's Liceve Law denot apply m an owner of 307 — I NSULAT IUN p
property who builds or impraws ton,and who dope such walk himself or through his
am employes.provided that arch improwmanu are not intended mortered(waste.If. 601 — ROOF TEAR OFF
hawevsr,Ne building or improvement u said within one year of completion,Ne owner-
builder will have the burden of proving that he did not build or impmw for purpose of 602 - ROOF PLYWOOD NAIL
alt.). 603 ROOF BATTENS
❑1,as Owner of the property,am"elusively contracting with licensed conwcnrs to
construct the project(See.7oaa.Ruslness and Profnssiona Cara:)The Conlzactor's U. 604 ROOF IN—PROGRESS
came law dors not apply to an owner of property who builds,or improves Ihemon,and,
who conuacu for such projeeu with acontsacmKU licerued punwnt to the Contnctae.
License Law.
❑lamaemptundet See .BkPCfmthi...
1037,'00
wner Dire
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following wclamtio s:
1 have and will maintain a Certificate of Consent to Ulf-Inseam for WmUn1 Compere
.a.ea provided for by Senlon 3700 of the labor Code,for de performance of the
rk for which this permit is issued.
I haw and will maintain Worker's Compensation Ivunna,u aquimd by Section
of the Labor Code.for the performance a!the work lm which this permitis issued.
y Worker's Compensation Wholunce artier and Policy number are: ryrrier. StGa�"it � ...� Policy No.:��� 716n0Z
CA a O'E�PTION FROM WORKERS'
COMPENSATION INSURANCE
('Thu section need not becompleted If tie permit is far one hmdred dollars($101)
or less)
1 cenify Nat in Ne performance of Ne work rot which this permit Is Lnucd.l shall not
employ any roman In my manner an As to wcome subject to Ne Workeri Compcnsalon
Laws of Caifomia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenificate of Exemption,you should
become abject or the Worker's Co epcaation provisions of the tabor Code,you mus,
,Z forthwith comply with such provisions or Nis perank mail w damW nmoed.
z O CONSTRUCTION LENDING AGENCY
F. 1 hemhy anion that Nom is a eovtmcdnn knding agency for the Infurm nee of
FL> the wink for whim this permit At issued(Sec.3097,Civ.C.)
aLender's Name
7 z Landed A&Met
O Q I cenify that t haw mad this application and state that the above infotmadun is
bunking 1 gree to comply withal city and county madws Of and sera laws l opting e
Q aww-mentioned
and rot impecharisnrposes. iws of Nis city manor upon Nc
slaw (We)A W property ret Indemnify
an keep ha
(We)agmtemsaw,indemnifyandkeep hay in msec City ofe &Cnl^add City
pZ in
judgmo Meeosuand of this cwhich may in anywyamue genu said City
U z A APPLICANT
of UNDERSTANDS
of this D WIL
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE GULATIONS.
Re-roofs
Signemrc Of Applican anwcn ate of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupntstom At handle hazardous material
IAdles,
deWed by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
ode.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
El Yes OAK Will the applicant or future Wilding occupant use es equipment or devicwhichIf a roof is installed without first obtaining an inspection,I agree to remove
mit barardous oil conuminmts u&fired by Ne Bay Area Air Quality Mmagcment all new materials for inspection.
istrict?
Yes
l have mad Ne hazardous materials Rquimmems underChoper&95 olthe CalifonNis Hcalth rdr SafetyCock,Soctiov 25505,35533 and 25534.I understand Not lfths building L--mnot cuneady haw a aokNet It u my responsihilily n wh y the occupies of theduimmenu which must be met prior m issuance or a Ccdricam of occupancy. Signature of Applicant Date
All roof coverings to be Class "B"or better
wner or authomcd agent Date
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI OF Fax: (408)777-3333
CUPEI�TINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of Y"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: tN a� Le 4c)
Address: —��q� •PCAV IL CIYC_J-e Wes-I-
Reroofing Company Name: 9eS GnYISI b�2 'R cmLn1 -rn C -
Applicants Signature: C Date: U
Joe Antonucci
(Chief Building Official)
6/25/01
G CITY OF CUPERTINO v3 o S-a
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# 32to -UZO IS
Date:
r ' 1 �S
Building Address: 2
101
Owner's Name: Phone#:
�� co o -I-eK 4o � (O-59.
Contractor: Phone#: License#:
(Z �i c • CIoS� v-S`l 2 �9�i0
Contact: _ Phone#: Cupertino Business License#:
((0SCG S(0?)-Sg50 I IOS
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof 9�-Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) .
Number of existing coverings I ❑ Provide I.C.B.O.Report#
e"To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 2GIr O d iSpos C' o -' e,-4 1 S}i ric) C U A PP kl Y�,tw
oo-F.
Residential 10 1Commercial ❑
Fire Zone:-- Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of ConstrucVwn: Occupancy roup:
°e-YaQ+ �amI� FPS alt
Qty. if
Applioke 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
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