03030075 CITY OF CUPERTINO f
BUILDING DIVISION PERMIT 'kCV1\l.- VVIR IL\F lY1t1TIO
9a ,°WT+sa`r".. iv .aR, My si ,Tsk
BUILDING ADDRESS: PERMIT NO.
R E -ROOFING & CONSTRUCTION INC
1421 PPTMRnPR WY _
OWNER'S NAME: FERMTIssu_ {15230 CLYDELLE AVENUE
FER NEP. LNO.
E` (408) 925-9995
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
' BLDG ELECT PLUMB MECH
30o LICENSED CONTRACTOR'S DECLARATION
Job Description
9H1 hereby affirm Nal 1 am licenced under provisions of Chapter 9(mmmcming -
withSect0"': of v lona f oho Bminuaand Profeminm Co ,andmylicc..ia
n In full fora and eff
�'z LiU.mc '� LW.g 2'151iREROOF
Dam conlactm 1 REMOVE 2 LAYERS OF R00
ARCHITECTS DECLA ATION ; iNSALI�ASTM 'FELT .
I understand my planas�W he used a public records & CLASS "B" WOOD SHAKE �_
pg'�3
Licensed Professional MAR 3 12003
OWNER-BUILDER DECLARATION
Q f 1 hemhy affirm that I am exempt from the Conlnctera License I.I.for the -
%a o following won.(Scedun 7(131.5,Bualmaa and profession Cade:Any city or county
12E which roqulres a permit to construct,altar,improve.dco nlish,or repair my structure -
'�'E prior to its issuance,also requires theapplgemt for mch mrmit to rile a signed statement
�a Nal he Is licensed purmam to Nepmvtslnnof the Communes License Law(chapter 9 Sq.Ft. Floor Area aIUBIIOn .
$ (commenting with Section 7000)nf Division 3 of the BuNmasand Profusions Codc)m
..
that he Is exempt Merchant and the bull fm the alleged exemption.Any violation of
Section 7031.5 by any applicant for permit ubjects the apPlicanno•civil penalty of APN Number 99cVjjayw Type
not mom Nan B.hundred dollars(M). -
❑1,as owner of the propeny,or my employe$with wags as their sole compensation,
will do the work,and Ncswcturs boot Intended m offered for sale(Sec.7Wa.Business 36617050 . OO Required Inspections
and Prolamin$Cadc:The Cnna
vWUM-ra UM-law dna Inst apply m an owner Of q P
progeny who builds or improves thereon.and who deeasuch wmk himself m through his
own employees.provided that such Improvements are not Intended oroffered for sale.If, 305 — FRAME
however•Na bullding or Improvement is within am year of completion.Ne owner-
bundes will have the burden of proving that he did at build or Improm for purpose of .. 307 — INSULATION
sal.).
❑L m owner al Ne property,,B shast,v ad contractingain.with licensed ut ladmrs to 601 - ROOF TEAR OFF
coawct the proket(5ec.71W4,Bnloem ma Prornsians code:)T7te GonuscWra u- 602 - ROOF PLYWOOD NAIL '
mate law does not apply to an owner of propeny who tellds or improves Merton•and, 603 — ROOF BATTENS -
who contracts for such projmtJ With a con rnotor(s)licensed pursuant W the Contractor's
Licence Law 604 - - ROOF IN-PROGRESS
❑lam exempt under,See .B 9,PC for this won
Owner' Data
WORKER'S COMPENSATION DECLARATION
1 hereby a1N n under penally of perjury am of the following declanaliou:
luvcmd.11,a b. a.CeNficam orconsenl to self-Insua for Worker's Compen.
motion,as provided fm by Section 3700 or the labor Cade.for the performance of the '
cfat which thin permit is issued.
I have and will maintain Wmkcr's Compensation Insurance•u nqulmd by Section
J of the lather Cade.for the performance of the work for which this perm'.b Issued. _
My Wmkerss Compensation
�furmame canter and Policy nu -
Canter. UI/ RTI InANsV) "PoIIeY Nn.: 1'(�(�0410
CERTIFjCATE OF�E EM MON FROM WORKER5'
COMPENSATION INSURANCE -
(Thlssocllsm need nm hecompleted if the permit is froom hundred dollars($IDB
or tela) -
1 Unify that in the perfmmame of the work for which MI.permit Is Issued,1 Ntll not .
OMPlny any person In any mannerso as W become subject to the Workon'Compensation
Laws of California,Data
Applicant
NOTICETO APPLICANT:If,after making this Ceturtrate of Exemption.you should -
hceome subject to the Workers Compcwtlon provisions of the Lahm Code,you most
.,O Rolwlth comply with such pow ainss or this permit shall M domed revoked.
yCONSTRUCTION LENDING AGENCY
I•r I hereby alitrm that there Its eoawdion lending agency for the performance of .
!Y the work for which Nu permit Is Issued(See.3097.Civ.C.)
WM 0 Lenders Narm ..
,7 z Lemer'.Addw
O Q I certify that 1 have road this application and sum that the above informaliun Is
!+ cane"'I agree to amply with all Illy and county oNitwnes and tote law misting in „
OTU' building convection,and hereby authoda nomaxontallves of this city to cater upon Ne
W shave-mentioned propcny for Inspection Purposes.
Ly,gy (We)agree to ave.indemnify and keep hsrmlem the City of Cupertino against
:y w Ilabilllinjudgmentsd sts and expenses which may In my soy sterna against said Cly
L)7 Inconsequence ofthe gantingafthis permit.
F7 ICAZ UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU ER ONS. 7jl i�rlo3
Re-roofs
Sit o AppllanUCont gM Dam
H RD-US MATERIALS DISCLOSURE Type Of Roof
Will thasippilantorfuttem building Occupant mm orhandle hazardous material ,
a defined by the Cupeninn Municipal Code.Chapter 9.11.and the Health and Safely '
de Section 25531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs ' ,
Will the applicant or forum building occupant use equipment or devices;which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air contaminants as donned by the Bay Arta Air Quality Mmagemcnl all new materials for inspection.
isvin7
❑Yes
Ihave mad
non currently hannious rs¢rdtan Namaterials
requirements
rocpouihility Wunder CnhapMdhN95 th -
nieHUM&Safety Code.Sa0.25315,13533 and 255534JumkIhoiden
ceu othe
royu me soh" stun hem daft ..of.Comficm, (Occupeery. —Si`g Pp natureof-A licant Date
I 3 ll14 l b All roof coverings to be Class"B"or better
Ow or authonredspent' Data
i Community Development Department
�' Building Division
a� City of Cupertino
.Y R 10300 Torre Avenue
i
CITY OF Telephone: (408)777-3228
C, 1 P E n T I 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 the above stated policy on re-roofing.
Homeowner's Name: '�' IJ�.IaD fLM(l 1 J
Job Site Address: 7�l MR bwyv/K j1
Roofing Company e: �O� i° i(� 1 15iP�uC�i 31J
A plicant's Si ature( C �%�_ Date:
Greg Q eel
Building Official
Revised 1/30/03
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