03120040 CITY OF CUPERTINO 'n
BUILDING DIVISION PERMIT CON'P�iC,�UR INVO'IiIVIA"CIE?Na °
A F
BUILDINGADOREES: PERMIT NO.
CROWN ROOFING INC 03120040
OW NEWS NAME: PERMrr ISUEDATE
E B SANITARYoL NO.
(4QA) R74-07A4
ARCHITECAEI4GINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p 0 0 0 0
aIOC LICENSED CONTRACTOR'S DECLARATION - Job Description
'M 1 hemby affirm that 1 am liecnsed under provisions or Chapter 9(commencing P
IN Section 7")of Division 3 of the Busineas (ural...Cme.mdmylemiscis a w� ,q
�n pppq�z �uenaa�l and yra_a. Lk.»' Pra 2� REROOF FIYYie�'LE0
�F Dam]_CIOS DEC
QQ ARG"ITECI'BDEC TI DEC 1 0 2003
n.ra and my plans shall he used as pido ds
pon
3 C Licensed Professional
OWNER-BUILDER DECLARATION BUILDING
I herchy alarm on 1a.1. exempt from dke Convactoh e:Any
Lew for the
pD following moss.Pectis FDL;Business and Profession Cade:Any city m roomy
K$ which mqulma a permit to cores the altar,improve,demolish,,fie a sig any structustatement
Fly
prior to issuance,also requires the applicant for such permit mfileasignOd sutemem
EE < that he ts licensed pursuant to the prmision..f the Contractors License Law(Chapter9 Sq.Ft.Floor Area Valua On
C�g (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he di eumpt therefrom and the basis for the alleged eaemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of 3 Occupancy Type
nut owe than five hundred dollars($500).
❑I,an owner of the prepeny,or my employees with wages as theh vele compensation,
will do the work...it th mritwo a isnot intended mitffered for We(Sec,7044.Busiws
and Professions Code:The Contracors License Law does not apply to an owner of Required Inspections
property,who builds or improves Nemon,and who does such work himself or through his
ownemployces.provided that such improvements are not intended Or offered for sale,If,
however.the building or improvement Is sold within one year of completion,Ne owner.
builder will have the burden of proving ton be did nor Wild or improve fm puryom of -
ask.).
❑1.as Owner of the property,am exclusively contracting with licensed contractors to
construct One Project(Sec.7044,Business and Professions Cade:)The Convector's Lb
more Law does not apply to an ownu of property who builds or impoom therdon,and
who cantncts for such projects with a conVanwr(s)licensed pumsnt totim Contnuor's
License law. _
❑lamuemptunder See. ,B&PCforthisnnsmn
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penally of perjury one of the following declarations:
I have and will maintain aCenlOcete of Consent m self insure far WorkeesCompum-
7C337."00
lon,as provided for by Section 3700 of the Ichor Cade,for the paid.....f the
rk for which this permit is issued.
1 have and will maintain Workers Compensation Imurance.as required by Section
of Ne Labor Code,for the performance of the work for which this permit Is issued.
y WorkerTs.Cmm�pensedan Insurance cartiryw�anl Polity number Ore/ .7 T/'17H ✓asiYPOIIG,)'lamed/
✓ CERTIFICATE OF EXEMPnONFROM ORKERS'
COMPENSATION INSURANCE
(This sectlan need nut he completed if the moull is force hundred dolma DIM)
or less.)
1 certify that In the performance of the work for which this Permit is bond,l shall not
employ any pecan in any manner an as o become subjmt to the Workers'Conarnmallan
Laws of California.Dem
Applicant
NOTICE TO APPLICANT:IL after making this Cenificete of Esemplies,you should
become subject or the Worker's Compensation provisions of the labor Code,you must
0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z h CONSTRUCTION LENDING AGENCY
[—i Ihereby M.Out then is a mommetinn kndingegenry far the perfurmonco of
lY> dm..,it for which this permit is issued(Sec.3097,Clv.C.)
WQ Lenders Name
0.
0 Z Lenders Address
U 0 1 car ify that 1 have read Nis application and stake too the shove information is
(L F Correct.I agree to comply with all city and county ordinances and state laws relating m
0 O
Wilding construction,and hereby authorise ru maenutives of this city to enter upon the
Lit ahov-mentionad property for inspection purposes.
(We)agree to an.indemnify and keep harmless the City of Cupertino against
liabilities,Judgments,costs and expenses which may In any way accrue against said City
V rZin. APPLICAeNT UNDEor the guTANDSOf Ihis AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
/We/ Z'
SOURCER UL NS. (2_k,
03 Re-roofs
Si s e of PPIhu1h,1CMvmx1mr Dao
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hovardous material
as defined by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Code,Section 25532(a)?Dy. ANO All roofs shall be inspected prior to any roofing material being installed.
Will the applies(orfolwre building scupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haaardous air contaminants in defined by dte Bay Area Air Quality Management all new materials for inspection.
District? `
❑Yes @No
I have mad the Wardens materials requirements under Chapter 6.95 of the Califor. I— k ____ '�
nisi Health&SafctyCodc,Sec6ms35M5,]5533 am175534.1 umlcrsund dutif d¢building
it.not currc I It a tenant,that it is my mepomiNlity m nadfy titc acupant of the
kancrocnu hichm tbemetprionuinuanccofaCCNftcekeafOce`pan Sig of pplicant Date
owns rant zeaasent Dau- All roof coverings to be Class"13 or better
Community Development Department
f MW
Building Division
1 ,Mad
City of Cupertino
10300 Torre Avenue
' CITY OF Telephone: (408)777-3228
U P E IST I I A I�l 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 th above stated policy on re-roofing.
Homeowner's Name: ��ti
Job Site Address:
Roofing Company Name: ✓��
APP
licanYs Signature: —� Date: /� /
w /�
• ll/451�.�0 Greg teel
Building Official
Revised 1/30/03 '
Printed on Recycled Paper
CITY OF CUPERTINO
RERCOOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
cldl 00 Lct n-P,
wnes me: (,J Phone#:
�'..
Contractor Phone#: q� License#.6
Co tact: Uone #:, X Cupertino B siness License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
;K Asphalt Shingles ;d Asphalt Shingles
❑ Wood Shakes ' ❑ Wood Shakes
❑ Wood Specs es j� ❑ . Wood Shingles / WDec;
�n❑ Other(Specify) U — ❑ Other(Specify) 1 t9 Number of existing coverings ❑ Provide I.C.B.O.Repor❑ To be Removed ❑ Provide Mfgr. Installatis.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
job Description: -
' I ✓1� VA PcJI �f
Residential Jam, Comm rcial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Pl ning Det. if
't are are anre rictions: LJ
Cost of Project: Type of Co ruc n: O cupancy g up: .
Qty. if
A Lica e Fee ID Fee Description Fee Grou
BPERMFEE Bld Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
1 2� 7. 7