03060065 z CITY OF CUPERTINO - "' '"+"� . '•�
BUILDING DIVISION PERMIT CONTRACTOR INFORMA'CIQ V ".
Oaf; r'-wY,S. Dry" »&.lfi •Irdn. w
Bu1LDINC ADDRESS: JIM KRAUSE ROOFING PERMIT lvo.03060065
OWNER'S NAME: 2310 DIANA AVEPERMR LSUa�A'j$v 9/2003
NE: (408) 779-0704 SANITARY NO. CONTROL NO.
ARCHITECr7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONIRACIDR'S DECLARATION Job Descri [i n
rd 1 thereby alfim Nil 1 am licensed i underprovisions of Chapter. 9(commaneln{ p y
with SW tion]IXq)o(Division Jof Ne Hudneaand Profvaalav Code,and myli, is I�
I.full force end e
�g4 License Class 9 Lic.fr REROOF ZOOS
Data Convenor I'f,'N, 'f
1
' ARCHfIFf.TS DECLA jU
I undnlanJ my plain Nall M used u puhllc rtco
ALL Licensed Professional
yg0 OWNER-BUILDER DECLARATION BUILDING
i i I I hereby affirm that 1 am exempt from No Conuactu's License Law for IM
O O following Mason.(Section 1171.5,Business and Profcsiuu Code:Any city or county
5$ which rcq.1.•permit w eouwc4 Alae Improve.dmolksh,M repair any swnure
Yys prior u its issuance,Alan mquirca the applicant forwch Permit to rile a signed summers
gggg�F<
that he is licensed pursuers N the prevision.of the Contractors License Law(Chapter 9 Sq. Ft. Floor Area $1(y9l"ion
q $ (commencing with Secdon7001hof DivfllonJafdm Busineuaod Pmfauamde)
Cour
(,s dose he is exempt therefrom and the basis for the alleged exemption.My violation of
Section 70713 by Any applicant for a permit subjects the applicant to a civil penally of 3 ADN PltlnbWr 0 0 Occupancy e
not mare than fico hundred dollar(S500). P y Typ
❑L As owner of tiro property,or my employee with wages as their sole compensation,
will do the work,and Nestsucture floor Intended moffered forsem(Sec.]044,Business — Regy�C�
and Profesdou Cine:The Canmclofs I.Iceve law area nor apply m m owner of 3 0 7 - I NSULAT 2 VNd Inspections
property who bullas orimpmws cum on.and whodmuuch work himselferr Nmu{h his n
awn employee,provided that such lmmoveme s,art not Intended Mattered(orale.If. 601 — ROOF TEAR OFF
hawser,Ne building or improvement is cold within am year ofcompledon.Ne owner- „
Wilder will Nva the burden of proving that he did not build or improve for purpose of 602 ROOF PLYWOOD NAIL
ale')' 603 - ROOF BATTENS
1,As owner of Ne property,am exclusively contracting with licensed mnmnora in
construct Ne pmject(Sec.]OAA,Business and professions Code:)The Coomnprs Ll. 604 - ROOF IN-PROGRESS
cove taw does nes apply in An owner of property he Wads or improvca thereon.and,
who contracts for such projects with a<pntranoKs)licensed pun rant or ger Conmctu/s
License Law.
❑,I ion ucmpt under Ser. .B h P C far thfl Avon
Owner Data
WORKERS COMPENSATION DECURATION
I hereby tlRnn under penally of perjury am of the following declarations: -
I have and will main W n•CeNRate of Co..,to xlfdume for WarMfa Camper.
7E3i7r00
on,u provided for by Section 7700 of the labor Code,for the performance of Ne
k for which Nu permit is issued.
Mw end will maintain Wohe/a Compensation Iuurance,u required by Section
of the labor Cud,for he performance of the work forwhich this Permit is issued.
Worker's ComrtenaIII les rice rimer and Poliry number Am:
ier. ��4Yn�u46C PoIIryNa.:a$ssfl.3
CERTIFICATE OF MEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not Mcanpleted If1M Permit is formic hundred dollen(SIM)
or lea)
1 unify that in the performance or the work for which this Permit fl issued,1 Nall not
employ any person In my manner an As In become sub*l to Ne Wmrkars Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.After making this Cedicam of Exemption,you should
become subject An Ne Worlee i Compcmanion provisions of da labor Cod,ym i mum
,O Forthwith comply with such prevons ar NW m
is Permit shall counted revoked.
Z CONSTRUCTION LENDING AGENCY -
I hereby 4MM NV Vert is A construction lending agency for the Perrumance of
Y' the.,it fur which this permit is ivmd(Sec.3097.Civ.C.)
Q Le"Ames Name
= z Lender'.Address
J Q I certify that I haw read this Application and sum Nn Ne above infuriation is
W ^, coma I agnea to comply with all city and county on inance,and sue laws totaling to
building mrmuation,and hereby corium empmsenuliws of this city to enter upon the
Na Above-menliored Property for inspection purpaes
(We)agree to saw,indemnify and keep harmless the City of Cupertino against
r gn liabilities.judgments,cam an xpeue which may in any way acerae against aid City
J z incen�AIWUNC
thesnit.
APPLWILL COMPLY WITH ALL NONPOINT Issued by: Dat
Re-roofs
Sig un of 6nilcantiConturactor f Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII Ne applicant or future building Weimar,store or handle hanrdous material
as defined by the Cupertino Municipal Cad.Chapter 9.12.and the Health and Safety
Ina
ds.Section
25572(a)? All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding=.Pont use equipment or dvices which If a roof is installed without first obtaining an inspection,I agree to remove
It hvsrdu air contaminants u dMed by the Bay Area Air Quality Management all new materials for insp�ecti n.
mict?
❑Yes u
I have read the haudnu riilA menu send,Chapter 6,95 of the Califon
HexlNhsafmy Code, 25 JarW 23571.1 undermad Nazi(Ne Wilding A
anal currend y n'eapmulhility m notify Ne Wxup.,of the L�uircm orwissuana on crnincam of Occupancy. ignaur Of Applicant Date
Owncroram dagent Dam All roof coverings to be Class "B" or better
Community Development Department
Ce Building Division
- City of Cupertino
�a 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C U PE kT 1 N O 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 comply with Ithe above stated
policy on re-roofing.
Homeowner's Name:-D--A021
�, l- 1 �J�IyLpJiS
Job Site Address: 2gn� 1- 4I(JPeAra( f
Roofing Company Name: 1�L2-V 7U
A plicant's Signature: _- — Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
r
CITY OF CUPERTINO o3
REROOF
cl
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
r
Owner's Name: cPhone#:
o tractor:. Phone cense#:
Ylt. l� d� b'
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof wilt-Up roof
❑ 4sphalt Shingles Asphalt Shingles
p�Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings X31-- El Provide I.C.B.O.Report#
p To be Removed ❑ Provide Mfgr. Installation Specs. `
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: j,O . S eS 13�n5Lo % o:),B t "36) 10 mu-i eV
U
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed withY4aRning Dept. if
there are an estrict ns: LI
Costc6 Type of Co do Occupan up:
Qty. if
A -able 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