03080136CITY OF CUPERI'INO_��
' `-
BUILDING DIVISION PERMIT
CONTRACTQRsINFORMATION 9'"
R ":f , ri. • ifs h `tl i . (.�Si. °
BUILDIrvcnooness:
602 N PQRTAL AV
WESTERN ROOFINGSYSTEMS
PERMIT No 03080136
OWNER'S NAME:
y4y�
2487 AMARAL CT }IC
PERMIT ISSUE DATE
NE:
(562)426-7147
SANITARY HO. CONTROL NO.
ARCHITECI'IENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Description
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
p
iccnu is
with sectinn 76raBof Divi.irn Sof Nc Qgsy)Ical Profcssinna Cole, en mylicense-
in fol rare nJe ❑. IJ
® �e
FINA�ie®
Liccn u Lic.x
OF
Date Cu QWL
AR HITECT ATION
1 W
SEP 22003
un my plans shall used m Puhlic records
nJ
Licensed Proletariat
RATI
DECLARATION
ON
Oat
Contractors
I am exempt from wrl License Law for the
1 hereby affirm that I ore excmpl from the
BUILDING
following reason. (Section 703 IS, Business and Profeasinm Cook: Any city or county
Which requires a Pormit to cmmOMcl, niter. improve, demolish, or repair any structure
e -CA 00
prior to its issuance, also mquims the applicant for such Permit o file a signed statement
Nat he is licensed pursuant to be previsions of the Connectors License Law (Chapter 9
Sq. FL Floor Area
Valuation
(commencing with Section 7000) of Division 3 of the Business and Profmsions Coda) or
that he Is exempt therefrom and the basis for the alleged exemption. Any violation of
3 1632053,01)
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subject, the applicant to a civil penalty of
art mom than five hundred dollen (S500).
❑ I, as owner of the pr,cn,t, or my employees with wages a their tale commutation,
305 - FRAME Required Inspections
will do the work, and OC wcture is not intended or offend for.,]a(Sec.7W. Business
and Professions Code: The Crmrutort Licerso Law does not apply to an owner of
property who builds or harrows thereon. and who does such work himselfor through his
307 - INSULATION
wncmployeas, provided that such improvements vent intended orortenJ formic. it.
601 — ROOF TEAR OFF
however, the building or improvement is sold within one year of Completion, the owner.
builder will have the burden of proving that M did not Wild or improve for purpose of
602 - ROOF PLYWOOD NAIL
sola.).
603 - ROOF BATTENS
C:] 1. as Owner of the property, am exclusively contracting with licensed crnlrumrs to
...swct the project (&a.7lW4, Business and Prefessiorrs Code:)Th. Comncbh Li.
604. — ROOF IN -PROGRESS
cute law does not apply to an owner of property who Wilds or improves Ihemon, and,
who contracts for such projects with a contrumr(s) licensed pursuant to the Convectors
License Law.
❑ 1 am exempt under Sec. . B h P C for this reason
Owner Data
WORKER'S COMPENSATION DECORATION
1 hereby affirm under penally of perjury ria or the following declantians:
I he. ad will maintain a Conifcae of Consent to seir.lowre for Worker's Compcm
Ton, -provided for by Section 3700 of the labor Code, for the performance of the
mi
work for which this pert is hued.
1 have and will maintain Workers Compensation Insurance. as required by Section
A00 of the Labor Code. for tW performance of the work for which this Permit is issued.
My Wrrkc' nazi I nc/C�c icy endnd P art:
C 'a,. /V Pylic N
n '1 IC TEOFEKEMP I M RKERS'
COMPENSATION INSURANCE
(TTI. uuin need not W complued If the Permit Is for one hundred dnlhn 15100)
or less)
1 certify that in the perfnnence of the work for which this Permit is Wood, I shall not
employ any person in any mummer sa as in become subject m the Workers' Compensadon
Laws of California. Doc
Applicant
NOTICE TO APPLICANT: If. after making this Ccni beam of Exemption, you should
became subject to the Workers Compensation previsions of do IaWr, Code, you mum
forthwith comply with such provisions or this Permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is construction lending agency, for Jia perfurmauc of
the work fur which this pnmit is issued (Sm. 3W7. Civ. C.)
Lander', theme
Lender's AddrCm
I cenify that 1 have read this application and state that the above information is
correct. I agree w comply with all city and county ordinances and mate laws relating to
building convection, and hereby amhorin reptescnmi.as of this city to enter upon dm
ahovementioned pmperty for impaction Purposes
(We) agree to save, indemnify end keep harmless the City of Cupertino against
`02KA
liabilities, judgments, casts and expenses which may In any way acerae against mid City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINM
Issued by: Date
5 URCER^ UU TL�
Re -roofs
Type of Roof
_fm
s ran l'App¢anUCComa Date
HAZARDOUS MATERIALS DISCLOSURE
Will we applicant or future Wilding occupant nom or handle hrmneuus material
es defined by be Cupani no Municipal Code. Cbapter 9. 12, and the HCahb and Safety
Code. Section 23532(a)? a
All roofs shall be inspected prior to any roofing material being installed.
'PINYe,
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or fawn building Occupant use equipment or devices which
it hamolnus air contaminants a Jc(ncd by dta Bay Area Air Quality Management
all new materials for inspection.
El Yes �U
I have read the havndous materials requirements under Chapter G95 of the Califon
a' - s-'�
A.
.isHealth k Safely Code, Sections 25505,25533 and 25534.1 undersand that ifthe Wilding
1
Jres mol currently have a anent. Out it is my responsibility w madly the oaUpant of Ne
. requiremcn mu a �ortw' a,,�geyrrf F, amafDec. a S/
x
ature of Applicant / Date
%(/ ,
All roof coverings to be Cryay?s 13 or better
no or..tbunwd gem a
i
�CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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 the above stated policy on re -roofing.
Homeowner's Name: yWOA f 4 /V b
Job Site Address:
Roofing Company Name: U&
A plicant's Signature: Date: �r/0 3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
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CUPERTINO
CITY OF CUPERTINOD 3 F D/ 3
REROOF
PERMIT APPLICATION FORM
APN #)71A1,-?79Da
Bldg Permit Fees
BUILDING
3
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
Buil ing Kdr ss:
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
C
Owner's Name•
BUSLIC
Business License
BUILDING
r
ontr c
Phone .
Lice se :
cQ'!Ns
Cont ct:
Phone #:
Cupertino Business License #:
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shakes
❑ Wood Shingles
Other (Specify)
❑ Other (Specify) _
tuber of existing coverings �_
❑ Provide I.C.B.O. Report #
To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Und rstand Will u
e i o' ear Polic ❑
J b escription
Residential
Commercial ❑
D
Fire Zone: Yes ❑ No ❑
Confirmed with Pl g�Dept. if
there are antrictio IIJJ
f Pr 'ec 6"D
Type of Constru
'o Occupant grow
Qty. if j
Anolic� k 1 Fee M
Fra rlacrrintinn
Frr (:rnnn
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