03110025'CITY OF CUPERTINO
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BUILDING DIVISION - PEI MIT
, �. t T
CON'I,PAXTOR' INT ORA.TIOMNt
BUILDING ADDRESS: _
TEOI S ROOFING
PERMIT NOD 3 110 02 5
OWNER'S NAME:
9710 RANCHO HILLS DR
PERMIT ISSUE DATE
VIJAY A
11/05/2003
NE
(408)279-8797
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am littnsed nJ p'visiaa' orchapmr 9 (w a caemg
with Se Divixion3 fth Ba' sand Profcssiens Code.antlmyliccnsc is
Job Description
in full c and f ca. C
REROOF FINAL
Licenaecl Lic.x 1
Dale q Contr ter
ARCHITECT'S D ARATION
e sand my shall a a uhlic recons
MAR 1 7 2004 "
plana
Lm ..d mfcsam ni
W NER BUILDER DECLARATION
1 hereby alarm that 1 Liccnsc Law for
exempt from the Cssions
BUILDING
maso 1. and o
aiom Code: Any tiny or wanly
following mason. (Section IIonstr
which requires In construct, alter, improve,
t, alter, improve, d repair any structurement
$14400
n e, also h permit t file
prior to its lensed p, also requires the applicant for such permit m lilt a signed (Chapter
thathe pursuant to the of the Cmlmcmr i Liccnsc Law(Chapter9
Sq. F[. Floor Area Valuation
of Division
(commcne xe with action ](IBD) of Division 3 of the Business and
vi Code) or
li and the basis for on. Any
alleged exemption. Any ululation of
Nen he is exempt tang
31623067.00
Section be
anyreddantrs(100 Permit subjecu the applicant acivil patent of
applicant
p y
APN Number
Occupancy Type
.of..]on.5ve
tat mom than five hundred dollars (Ss00).
1, as owner of in. properly, or my employees with wages as their sole compensation,
will do the work end the atm&uac is tat intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law does not apply no an owner of
Required Inspections
property who builds or improves thereon, and who does such work himselfor through his
own em ployets, pfovided that such improvemenes are not intended or offered for sale. If.
however, the building or improvement is sold within one year of completion, the owner,
builder will have Ne burden of pmving that he did not Wild or improve for purpose of
sale.).
1, as owner of the property, am exclusively contracting with licensed com uchas to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li.
cense Law does not apply m an owner of pmpeny who builds or improves thereon, and
who contracts for such projects with a contruror(s) licensed pursuant to Be Contractor"
'
License Law.
❑ I am exempt under See. ,B& P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
-
I have and will maimain a Certificate of Consent 1o.1r-insure far Workers Currier.
nation, as provided far by Section 3100 of the Ube, Code. for Ne perfmmonce of the
'
work for which this permit in issued.
❑ 1 have and will maintain Worker's Compensation Insurance, m acquired by Section
37M of the Labor Code, for the admittance of the work forwhich this parmit is issued.
My We it Cnmpensati.n�n l,n�sur,a�reGGamier and Policy number am;
�]�
'cr Policy N06:'—
CER' 1CC��ATE OF�—E%EMITION FRORKERS' 1WI
COMPENSATIONINSD NCE
(This section need not k completed if the Permit is for one hundred dollars IS 100)
or less.)
1 certify that in the performance of the work for which this Permit is issued, I shall not
employ any person in any marecrao as m become subject o the Workers' Compensation
Laws of California. Date
Applicant
-
NOTICE TO APPLICANT: if, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation previsions of the Labor Code, you must
'
forthwith comply with such provisions or this pannit shall be deem ul revoked.
CONSTRUCTION LENDING AGENCY
1 hereby .&M that there is a construction lending agency I'or the Performance or
But work for which this permit s issued (Sec. 3097, Civ. C.)
Lender's Name
Lender's Address
1 comfy Nat I have read this application and Stam that the above information is
correct 1 agree to comply with all city and county oN;nan"s and state laws relating to
building construction, and hereby au(horim representatives of this city to enter upon the
ahova-mentioned property for inspection purposes
(we) agree to save, indemnify and keep hafmleas Ne City of Cupertino against
camay in any way eccmc against Haid City
Iiaconsequence
esperof
m.the
f gralaing this mit.
in APPLICANTeUNDERSTANDS AND WILL COMPLY WITH ALL NON
Issued
-POINT
EGULATIONS.
by: Date
Re -roofs
Type of Roof
ignagurne, ofAppli naColluractor HAZARDOUS MATERIALS DISCLOi RE Danc
Will the applicant of home e building occupem sore or handle halm, material
as defined by the Cupertino Municipal Code. Chapter 9.12, and the Heald and Safety
oJc, Section 25532(a)?
❑Yes vtNo
All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future 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 deficit by the Bay Area Air Quality Management
all new materials for inspection.
ishim,
❑Yes
I have mad the hvallo/us materials requirements under Chapter 6.95 of thc Califon
Safety Code, kif
&So.yhawamoan.Nut0is553.d2534.5mnotifythe.LifMmofthe
do Hnot iti
does not co unam, that myrsnd25534"I wcoury beoccupantbe
acqu; cnmw''bmusnkmetpdortoiuumccofaCcnificamorOcpromy.
$Igo tllr pICs t Date
1
All roof coverings to be Class "B" or better
O%sadroraedagem �_
' h
CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408) 777-3333
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: f%y
Job Site Address: SQL WA
Roofing Company Name:
7__el::� r� 1 r1��
Aplicant's Signature: 'i�PRn A O n Date: �
Greg p'�
• teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
aCITY
CUERTINO
r]
CITY OF CUPERTINO v� 62�r
REROOF
PERMIT APPLICATION FORM
APN # � / � _ 6 �
Date:
Building Addr ss6:
/ c
Energy
�Cran u e, 7�hd
Owner's Name:
Phone #s
%� d
V-6,
BSEISMICOM
Seismic Commercial
Contracto :
Phone #:
V C OS S
License #:�
Contac
Phone #:
Cupertino Business License #:
BUILDING
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
Wood Shakes
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shingles
Cl Other (Specify)
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report # 4f(=t&0
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
eve
Residential [X_
Commercial ❑
TI
Fire Zone: Yes [�r, No ❑
Confirmed with Planning De t. if
there are any restrictions:
Cost ofPr ject:
Type of Co stiuction: ccupancy group:/
< CO.ae
c`b<� 7<d k/hr(
QtyJf�
A nnlSSMahta
Fee TD
Fee Descrintion
Fee Grouo
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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* 2 s�
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