03090052 CITY OF CUPERTINO +t n»;p wwx•4k�; 'TM�* > ^ .' ' „-
BUILDING DIVISION PERMIT a"CONTR'ACTORINF®RMATION:
BUILDING ADDRESS: DAVE SMITH ROOFING PERMIT No.O3090052
OWNER'S NAME: 1052 KELLY DR PERMITLSSUEDATE
GATIC) JOSEPH P TRUSTEE F_ FT AT
NE: (408) 973-9427 SANITARY NO. COMROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
0 0 0 0
!00 - LICENSED CONTRACTOR'S DECLARATION Job Description
u 1 hereby alOrm that I am licemed m 0
under provisions of Chapter 9(com
cneing p
? with Section 7000)of Division Sof the Businessland Prbfcaahmr,Coda-ted yhear.is w
s
infulla erred ' REROOF
j = License Cl LIC.g
art Do Contractor
CHITECTS DECLAR.p N OL:I 0
SKu IundcraunJ my plans shall he used upuhl d. 1 1 OoOrg
:o t; Licensed Poressinnal G ,7
3 OWNER-BUILDER DECLARATION
<I I hereby affirm that 1 am exempt from the Contractor's License Law for theBUILDING
p O following mason.(Section 7031.5,Business and Professions Code:Any city or county
<S ff which requires a proof to construct,alar.improve,demolish,or repair any structure
uZ prior to its issuance,also mquims the applicanlfor such permit 10 Ila a signed statement
s< that be u licensed pursuant ns the provisions of the Contractor's Licensc Los(Chapter 9 Sq. Ft. Floor Area Valu tion
eI-p (commencing with Section 7000)of Division 3 of the Business and Processions Code)tar
$
that he is exempt therefrom and the basis far Ne alleged em.pdor.Any violation of '15622012 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than rive hundred dollars($500).
0 I,as owner of the property,or my employees with wages as their ante compensation,
will do the work.and fee swctum is not intended or offered for safe(See 7004,Businass 3 05 — FRAME
and Professions Code:The Contra tor's License Law does not apply to an owner of Required Inspections
property who builds or improves thercon,and who does such work himselfor through his 307 - INSULATION
own employees,provided that such improvements are not intended reoffered mrsale.If, 6O1 — ROOF TEAR OFF
however.the building or improvement is mid within one year of completion,the owner-
builder .will have the burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
aala).
0 1,as owner of the properly,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
consumer the project(Sec.7004,Business and Pwfeavons Code:)The Conumtors La- 604 — ROOF IN—PROGRESS '
cane law docs hot Apply to an owner of property who builds or Improves themon,and
who contracts for such pmjeets with a conlrmtons)licensed pursuant to the Contractor's
License Law.
0 l am exempt under Sae. ,B&PC for this mann
Owner r Data
73070WORKER'S COMPENSATION DECLARATION
1 hereby afritm under penalty of perjury am of the following declarations:
I haw and will maintain a Cenifcate or Co..,to self-insure or WarkchCompen-
0
.n,u provided for by Section 37M of the labor Cede,for Ihc perfmaname of the
rk for which Nis permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
or the labor Code,for the performance of Ne woefrwhich this parent is issued.
Workels Cnmpe nrrie. Z 6 3 PO r.:.ZL1LSaGa��
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ihisseetim teed not heeononcre l Ir the permit is for one hundred dnllm($101))
less.)
I certify that in the performance of the work for which this permit is Issued,l shall not
employ any person in any manner m As las become subject to the Wofkers'Companation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Ceni0cam of Exemption,you should
become subject to the Worker'.Compensation provisions of the labor Code,you must
z forthwith comply with such provisinas or this permit shall be deemed mvnked.
zCONSTRUCTION LENDING AGENCY
[—t 'A I hemhy affirm that the re is a construction lending agency for the performance or
gY, 7 the work for which this permit is issued(Sec 3897,Co,C.)
W Q Under's Name
= z Lcnderi Add.
U Q 1 comfy that I have mad this application and sate that the shove information is
II. P correct.1 agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorise represenmieal or this city 10 enter upon the
W above-mentioned property for inspection purposes.
yt (We)aSme to marc,indemnify end keep harmless the City of Cupertino against
w`L"i N liubilitin,judgmental,cam and expenses which may in any way accrue against mid City
U m nttgmncc ofthc gaming ufthia permit.
ICANT UNDERSTANDS AND WILL COMPLY WITH A ON-POINT Issued by: Date
GUL N5.
Q-g Re-roofs
Si nature of ApplicanVCommelor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle mezrdoos malarial
as defined by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
Code.Section15532(a)? ID All roofs shall be inspected prior to any roofing material being installed.
OYn ON.
Will the applicant or future building o¢upam use eyvipmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
r r h....oes air cnnmminanal as defined by the Bay Area Air Quality Mana men new-materials for inspection.
istrict? ` '
CYca Ne
I have mad the hanniousaudrials requirements under Chapter 6.95 of the Caliror-
maHealth&SafetyCah:.Section,25585.23533 and15534.Iundsommdthmifthe Wilding
rely have a nnanL Nat it u my whipamibility to nod the arupanl of the
mquiw cnnv 1111 usLW. 'arulismanccofaCerdfca¢of Y' SI atureofApplicant Date
9 -4
0 ernramthrrizedasenl Dam All roof coverings to be Class "B" or better
Community Development Department
Building Division
/- City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST 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: /—zo-<_QCk/ ) 6
Job Site Address: Z ) b 2 ( Q,\ h C eq- Ccs
Roofing Company Name: vw—
A plicant'sSignature: Date:
Greg teal °
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF 03 7
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
3y-6 2zo1Z
Building Address: Z( �p Zh
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Owner's Name: D n I Phone#:
Contractor: er�one#: License#:
Contact: ' V 2 Phone#: Cupertino Business License#:
a
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ 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: off__ S"C h��q� l � Zo
�e.42. S yj Y, O's
Residential Commercial
I ora
Fire Zone: Yes Ate- ] Confirmed with Planning Det. if
there are anrestrictions:
Cost of Project: Typ Cons ctio Occupancy group:
COO � 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
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