03050038 CITY OF CUPERTINO
BUILDING DIVISION PERMIT a,CONTRATOR'INF'ORMATION'' :
BUILDING ADDRESS: DAN ELLIOTT ' S ROOFING CO """"°03050038
1
OWNER'S NAME: 2669 COIT DR "En9/2003
IIIFI LEE
NE: (408) 559-7327 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
L o O LICENSED CONIitACfOR'S DECLARATION Job Description
8 C 1 Mrcby affirm Nal l am liemand under prom,ions of Ch Put,9(commencing IF I N A L E D
b cosh Satio t °f Divisi°nJof NC Buvrrev ofusi°m Coac dmy liccnu is
. �„ in run tone ere, ( //� REROOF
Lice
n E Lic:
°ate `°^°"' MAY 2 12003
ARCHITECTS DEG.ARATION
1 undersand my Plans atoll In used as public Menrds
NA
BUILDING
C Licensed Professional
OWNER-BUILDER DECLARATION
F 1 MmM1y.(Tiro o n 1 am ucmpt from tiro Gnamemre Code:Any c law for IM
no fallowing mason. crit t W13s r Business and n, um demolish.oAny city Stcounty
k—Sn which m9uirus a e,arm m uirsswe4 alar.improve, erittsere a Sig any sweetie
m m paoru)slim cc,alsu req.She lM ai,donsnfor Such permit Live asLaw(ned amment
tZ< monormcngwithuraumtmtimproviviovofof the ftBuinesslJrvclaw(Chapter9 Sq.F[.Floor Area $4 1o[ion
Icor he I,.g ptthco fropt and 0 hanstj0n3 til tideeged cerept and proon.Any
Code)or
Nat o is mumps mererrom and he Ener for he alleged uemant 10 Any violation of
Schon than five
airy applicant for a permit subjects the applicant m.civil penalty of 3]P�B13aU3�er0 0 Occupancy Type
not mote man fico handed dalWg(S500).
❑1.as owner of the pmpmy,m my employees with wages as their Sole compensation.
will do the work and theamcmm is not intended or o@rod for Sale(Sec.7W,Businev — Ired Inspections
and Professions Code:The Convectors Liave Lsw does not apply m So owner of 307 - IN SULA`r loth p
Property wM builds vindpowes hereon.and whudoessueh work himulforthrough his
Own employees,provided that such improvemmnu are net Intended unnamed for sat.It. 601 — ROOF TEAR OFF
however,he building or improvement is Sold within one yen of completion.the owner-
builder will have he burden of proving has M did rut build or improve for purpose of 602 - ROOF PLYWOOD NAIL
ade.). 603 - ROOF BATTENS
I,as owner of Ills property,am exclusively commuting with Licemed contractors to
construct me Project(Sec.7U14,Business arta Professions Code:)The Conmcmri Li- 6O4 — ROOF IN-PROGRESS
clove Law dose not apply m So owner or prop my who builds or improvas memon,and,
who women,for such prom with a eoniiumrts)licensed personas m the Conernmes
Liccou law.
❑l sum exempt undo Sm. B A P C for this Mason
0 oll Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of dte following declarations:
1 have and will mainuin a Certificate of Covent to self-inaum for Worker's Compen-
iion,as provided foe by Section 3700 of the Labor Code.lore the Performance of IM
work for which this pemit is iuved.
01 have and will maintain Worker's Comptr don Issuance,as uncoiled by Section
a
00 of f labor Code,for IM Were...of/he work nor which this permit is issued.
My Work scompewuon lnwo�c 'cisd Policy number e: 7—
F EMPTIO OM WORKERS' BP
COMPENSATION INSURANCE
(This Section need not MeompleWd if the permit is forom hundred dollars(1100)
or less)
I cmdry Nat in he perfumance of IM.,it for which Nis permit IS ivud,l shall wt - -
mmploy any Nese.in any manna,was to Income wbj.L to me Workefi Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:It,after making this Cedifca s of Exemption,you should
Income eobjcot On IM Worker's Condemnation provisions of IM labor Code.you most
�0 forthwith comply with such provisions or this permit shall W deemed revoked.
z� CONSTRUCTION LENDING AGENCY
I hereby SM.Nat Vert is a construction lending agcmy for he performamm of
C4 7 me work for which this permit is issued(Su.3097,Civ.C.)
lA'Q Lender's Name
6. Undefs Addloss
U O 1 certify that I ban mad this application and sure that me above infomation Is
U. F correct.1 agree to comply wit all city and county ordinances and note laws relating to
O U bmlldlmgconaWee ill and MMbmnify and
e p Indandles;due
hr city Cupc lCr mpna mC
rW alcove.Mmi..W NopenY for impaction purpuaa
F G (We)ague to ave,indemnify ens keep hay in m IM City of against sd.against
� linbihtiu,judgmcnu.cosu and expenses which they in any way accrue against said City
U z i conscqueuc°r he genu.,of t a Penrod, Date
713
PP A DERSTAND ND WILL COMPLY WITH ALL NON-POINT Issued by:
O ONS.
Re-roofs
L om
azure ofApplic HAZARDOUS MATERIALS DISCLOSURE Oak Type of Roof
Will he applicant or future building mediums SIM M Msidle lunrdous mamdal
as defined by the Cupertino Municipal Cum.Chapter 9.13,and he Health and Safety '
cod°.Section 25532(.)? All
All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will the ePPlicant r(.lure bunmog occupant tau cyuipmcnt or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
mit hairndous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District'
❑Yes _- -
Iban lead the hasaccdosmaueialsiey.ilemcnuunder dcouns ilmaifhc Califon- `
niaHalh&Salety cod e.Seetiomips, 25537 am125aJ4.I.ndcisand Nuifhe M;Iding
Jars cuoensl hew tenant rmy mspovihilitymnotify o tru, the
e.; nets n met I.iaumm.r.cealfica6.ra ey. gala re of Applcant Date
- S All roof coverings to be C ass"W or better
wthorised agent Da¢
n.
Building Division '
10300 Tom Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
CITY 0 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 rooting 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 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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: C L ef
Address: Z10 Pr(A n J r c c a n
Reroofing Company N —_ /J i O4� I r
Applicants Signature• e c Date:
Joe Antonucci
(Chief Building Official)
6125101
agsqz
CITY OF CUPERTINO o j S-a-0_3?REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# f Z� �� Date:
Building Address: _ a
[1 (D PIC on-Pt"Aa4u
Owner's Name: r Phone#: -2 S — b 10 3
i
Contractor: Phone#: icense#:
to 0��0 LAO & - SSeI=I N101k3%$
Contact: s Phone#: Cupertino Business License#:
t&2
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof V P11
el Asphalt Shingles Er Asphalt Shingles 1 r 1'��
❑ Wood Shakes ❑ Wood Shakes 3O y Ea'r`
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ±W 0 ❑ 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:
Residential Commercial rl
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construe tt n: 1 Occupancy group: r
Qty- .
App)1calfip 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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