03080064 CITY OF CUPER'1'INO
BUILDING DIVISION PERMITaCONTRAC�°T(lR'INFORMATION::
BUILDING ADDRESS: PERMIT NO,0 3 0 8 0 0 6 4
1 625 RALYA CT
OWNER'S NAME: PERMIT ISSUE DATE
CORNER STONE PROPERTIES 03
NE:
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0 0 0 0
±OQ LICENSED CONTRACTOR'S DECLARATION ]Ob Description
w 1 hereby affirm that 1 em liansetl unJer proviso a of Chapter 9(commcneing P
?iW with Section 7B% f Division 3 alibi BusincssandP ions Cedc.andmylicenuis
< '"fall( to REROOF
j�i Licenu Cl L- Lica
i Date CnmracmrNor CONTRACTOR: M C ROOFING PINALF0
ARCHITECT'S DEC
t m l undersa my Plans¢hell be used es puhl nrJs
°;G Licensed Professional AUG 2 7 2003
OWNER-BUILDER DECLARATION
<f 1 hereby alfrm that 1 em exempt firm the Contract.,'.Liecnu Law for the
O O Billowing moon.(Section 7831.5,Business and Pr nasions Code:Any city or coumy q
m which m,ilm.a permit to ennswct,afree impmvc,demolish,or repair any structure tri
prior to its issuance,also mquims the applicant for such permit to file a signed statement
��xx6 that he is licensed pursuant o the pmviaions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuat"200 ,
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or
$ Net he is exempt therefrom and the bud for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of ber 0 0 Occupancy Type
not more Nan five hundred dollars(SSW).
Ei L as owner or the property,or my employees with wages u their sale compensation,
will do the work,and Ne auunum is not intended or offered for sale(Sec.7044,Business Required Inspections
end Professions Code:The Contnclors License Law docs not apply to an owner of 305 - FRAME q P
progenyw ,
hobuilds mimprovesubmes and who does such work himselr.r through his
ownemployses,provided thatsuch improvements are not intended or offered Certain.((. 307 — INSULATION
however,Ne wilding or improvcmcnl is sold within one year of completion,the owner-
builderwiilhawmeburdenorprovingmathedidnutWildorimprove for purpouof 601 - ROOF TEAR OFF
tale') 602 - ROOF PLYWOOD NAIL
❑1,as owner of the properly,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
construct Ne project(sec.7044,Business and Profusions Code:)The Cortactor's Li-
amelawdoesnotApplytoanawnerofpropenywhoWildsorlmpmvesthemon,ane 604 - ROOF IN-PROGRESS
who contracts for such pmjem with a contractor(a)licensed pursuant to the Contracloh
License Law.
❑1 em exempt under Sec. .B&P C for this..on
13CM111
ner Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one or the following deAarmions:
1 bass and will mainuin a Certificate of Conssm m ulf-m ure for Workers Compcn-
inn,m provided for by Section 7788 of the labor Cotic,for the performance of she
rk for which this permit is issued.
I have and will maintain Workers Compensation Insurance,as required by Section
0 of the labor Cade,for the performance of the work for which Nis Permit is issued.
Worker's Compensation Insurance eaninre P cynumMrare:
rtll{ N o icy No.:
S6 '
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
This section need not be completed Kthe permit Is foronc hundred dollars(51 W)
or las.)
1 certify that in the performance or the work for which Nis Permit is issued,I shall tion
employ any person in any manner so arm become subject to the Workcri Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's ComNruslo on previsions of the Labor Code,you must
.J O forthwith comply with such provisions or this Permit sh lI m deemed invoked.
Z = CONSTRUCTION LENDING AGENCY
Ihereby nu irm that Here is a construction lending agency lot the Performance of
gY. Ne work for which this permit is issued(Sec.3097,Civ,C.)
Wh Q Lender's N.M.
7 z building Add.
U 0 1 certify that 1 have read this application and state thin the above infmmmiun is
w (•-' correct.1 agree to comply with all city and county ordinances and state laws relating to
0 U abovenmentioneConstruction.and horcbyamhonp rposes. ulivcs of this city to enter upon the
W abovmmcmioned property for inspection purposes.
Q. (We)agree to save,indemnify and kap harmless the City of Cupertino against a.
lin liabilities,judgmenu,costs and expenses which may in any way accrue against said City /
U Z in consequence of the granting of this permit.
APIECANT UNDERSTANDS AND WILL COMPLY ITH ALL NON-POINT Issued by:9 Date
��SOU¢ R ULATIONS
z fS�yl 3 Re-roofs
gnomic pplica
HAZARDOUS MATERIAISDISCLOSURE Date Type of Roof
Will the applicant or(.IYre building uce.pat smic or handle havard.d.material
az defined by the Cupertino Municipal,Code,Chapter 9.12,and the Health and safety
IDiOrieL?
do.section 25532(.)? / All roofs shall be inspected prior to any roofing material being installed.
❑res �,N�
Will ete applicant or future building decaliter as equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
III hazardous air contaminants as dcrined by the Bay Area Air Quality Management all new materials for inspection.
�Yex .�
I have mad Ne luuaaNms maurialsuquir.mom under Chapter 6.95 of the Cal*Signatuyof
0 4
ce Health&Safely Code,Sections 25515,25533 and 25534.1 orokoetand thin If the buil
cs nil currently base a unanL tMt it is my rcsp.nsiM1ilitY to nntily lbe mcupanl quiremcntswhich musbcm dor a Bora cmfeauof cup cy. Applicant -' _� Date
$ All roof cover 14 be Class "B" or better
inns or rtycd agent Date
Community Development Department
Building Division
r City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U����I�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:
Job Site Address: U'(5-2-S CA
—
Roofing Company Name: e-n e,_1�.0 C
a plicant's Signature: NJ Date: /</03
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
i
CITY OF CUPERTINO0
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 / / Date /
5 - � !
Building Address:
I
Owner's Name: Phone#:
N Y a 0(
Contractor: Phone#: License#:
-Z 3 3
Contact: Phone#: Cupertino Business License#:
qQr 6`,13-6760
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles shalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) TiN4 F q J &U C.-\ ❑ Other(Specify)
Number of existing coverings \ Q ❑ Provide I.C.B.O.Report#
Eo be Removed Cl Provide Mfgr.Installation Specs.
•• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
J Job Description: 1)oub1c 3o L6 k 3a I ",( Co m
t= -
Residential Commercia ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
E o
Qty. if
Applicable 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