04020084 [ ITY OF CUPERTINO
BUILDING DIVISION PERMIT RA CRINQA�IOL r
BUILDINGADDREss: ADVANCED ROOFING TECHNIQUESPERMRNO04020084
942 REGNART RD
JARCHITECTIENGINEER:
NER'S NAME: PERMIT MUE DATE
ONE: SANITARY CONTROL N0.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
il mm p LICENSED CONTRACTOR'S DECLARATION O O O O
M1 hominy affirm that 1 am licensed under previsions of Chapter 9(commencing Job Description
with Smtio 7 )of Division 3 of the Busier Prolemon Code,md my license is
in full force c cL
npz LlcmscC LIC.
IsBa�lo 7`7 `JSS— RER&OF
Jq D ARCHITECTS DED` ATION T/O EXIST. SHAKE/INSTALL 40 YR. COMP
a 1 understand my plans shall M used as b c rttnrds
�Le
5� Licensed Prefcoionl
OWNER-BUILDER DECLARATION
1 mean .(firm on 11. exempt fare the Conim nts Co License Law for she
2O following means.permit
)onstru Business andtirmfesaion Code:Any city or county
$ which requires a pmmil re cores the,phut.plic imfor such
h Permit
t m mpmr any awment
F i fn that heor its coned p else m m the Novisio s o for nch ructor m cense Law pCha anent
(crommncilgxd parsaanl to the provisions 3Ne CnpaKnlfandProfsso(Chopter9 Sq.Ft.Floor Area Valu
Ed"500
$ thammenc Ept Section 7000)or basison 3 th al Buseged wend on.An vi Code)or v`+
Nes heti exempt therefrom and the breis for the alleged uemptim.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil penally of APN Number Occupancy Type
not mom than five hundred dollars(M).
P y YP
01,uowneroflhepmpeny,mmyemployeuwiNwagau Neirxlecampenution, 35623040 . 00
and da Newark,ands: o Contr dors Liceedoraw do s not apply 7044,Business
of Required � acids ��
and Professions wh ora Code:The Convecmr's Liaise Law docs not apply lf an owner of q '19114A
LED
who buildsorimproves dtemoR and who me not
work himself.,far Ih(sale his
own employee,pmvidcd Nm such improvementsin not(mania..lRemi for ole.If.
however.the building u improvement)e sold within one year of mpro a for Ne owner
builder, will have the burden of proving that he did not build or improve for purpose of MAR
R -g 1 O q 2004
❑I,as owner of the property,am exclusively contracting with licensed contractors m I'l/i rt L
came La the project(Sec.7044. mer of and IYofeM Wi Code:i The Convenor's rad BUILDING
cease Law docs not apply b an owner of protons who builds or Improves thereon,and
who seLacufor such projects with acontraClrr(q licensed pursuant[a the Comrsemr'a
0 1 son Law.
❑I ore exempt under gee. .B&P C for this moan
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRmt under Penalty of perjury one of the following decloadou:
1 have and will maintain a Ccnificote of Consent self-inaum fm WorkerYCompen-
xtion,u provided for by Section 3700 of Ne Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,u nxluimd by Section
3700 of Ne labor Code,for the performance of Ne work for which this permit is issued.
My Wmke/b Compensation Inman.candor and Policy number am:
Ca r.G -� () Policy Tq ry��-7�
CERTIFICATE OF EKEM410N t$9 1 WORKERS'
COMPENSATION INS ANCE
(This section road not hx complcwd it the Permit is for one hundred dollars($100)
or lea.)
1"wry Nat in to performance of the work for which this permit is Wood,l shall not
employ any person In any manner so as to become subject to the Workers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of Ne labor Code,you must
Z forthwith comply with such provision or this permit shall be deemed revoked.
'Z O CONSTRUCTION LENDING AGENCY
[r 1 hereby alTtrm Nat then is a convection lending agency for the performance of
!Yi > the work for which this permit is issued(Sec.3097,Civ,C.)
QLender's Wme
r7 z Lender's Address .
U Q 1 certify Nal I have mad this application and aux that the above information is
ver correct.1 agree to comply with all city and county ordinances and sum laws relating to
oU building construction,and hereby authndx mpruenutives of this city to enter upon Nc
W above-mentioned property for inspection puryaxs.
g5a (We)agree to save,indemnify and keep hamoteu the City of Cupertino against
liabili®REGU
crew and expenses which may in my way game against mid City
V rr777 in con &rantin&gDD'
iL /A
APPLRSTAILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURIONS.
Re-roofs
Silemium ofA Ica uContracmr 1, Date
HAZARDOUS MATERIALS DISCLOSUkE Type of Roof
Will the applicant or future building occupant store or handle harardon material
as degrod by the Cupertino MunicNu i 'Code.Chapter 9.12.and the Health and SafSafetyCode,Section 25372(a)?
us All roofs shall be inspected prior to any roofing material being installed.
�
Will the applicant or talon building occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
it h.omnus air contaminants o dofined by the Bay Area Air Quality Management all new is for in action.
District? / -
❑Ycs �O
Ihavem haoNousvmaxrialsmyvimmenwundcr Chepmr6.95 ofLha Cather
nice Hmith& csyC .Sccuons25 5,2 33and255MAunticrsNndthmifNc building 2�(r_.mye
draw not c mly he a tenant. my responsibility m unify the occupant of the 7
re
which st be me o Women or a certificate at Occupancy. Signature of Applicant Date
`rf–a All roof coverings to be Class"B"or better
0 u,mOthmeedagcnl Dow
Community Development
" 10300 To venue
; Cupe A 95014
Telepho 08)777-3228
CITY OP ax(408)777-3333
UPEkTINO
Building De artm t
JOB AADDRESS� PERMIT #
OWNER'S N
GENERAL CONTRACTOR: FAX #
I am not using any subcontracto . :7 �—, - �/-
Signature Date
Please check applicable subcontractors and complete the followinginformation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
S eet Rock
Ti e
Owner/Contractor Signature to•
10/28/03
{ Community Development Department
Building Division
" City of Cupertino
10300 Torre Avenue
4CITY OF Telephone: (408) 777-3228
UPEkTINO 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 state olicy on re-roofing.
Homeowner's Name: �/ SD
Job Site Address:
Roofing Company Nam
t s Signatur
A plican : Date: 2 - I I
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO0
REROOF J
CUPEII; TINO PERMIT APPLICATION FORM
APN # Date:
BuilAddress:
ding rr /
2, Te v�o�rT
Owner's Name: Phone#:
yt
COXnrPhone#: License#:
d✓a� ` „ �4 �- ug3r7 �� iS�
Contact: t0 Phone#: Cupertino Business License#:
3q_ opt o t
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles *---Asphalt Shingles
_0--Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description• 1 /
� t��S .v` �i � nSF�� "7O f Cm..
to
Residential ❑ Co rcial ❑
Fire Zone: s ❑ No Confirmed with Planning De t. if
there are anv restrictions: LJ
Cost o rcjec • cam_ Type f Cons cti Occupancy group:
-.'.
q . t
A Able 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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