03030022 CITY OF CUPERTINO �
BUILDING DIVISION PERMIT C6,, �
BUILDING ADDRESS: ABOVE ALL ROOFING PERMIT NO,
7779 R B
s OWNER'S NAME: - 700 NORTHRUP ST PERMIT.ISSUE DATE
RUSTY LEWIS
NE: (408) 292-4188 SANITARY NO. CONTROL NO.
BUILDING PERMITINFO
ARCHITP.CT/ENOINEER: - O ELECT' PLUMB - MfOCH
30Zo LICENSED CONTRACTOR'S hmDECLARATION
vd'� . I oby aflUm that 1 em Imenaed under provisionsof 0repter 9(commencing - JobDescription
FIN A
wish Section] of I Itl n afthe Busineua�nd ofculnns Cm and mylienmb
in full fn ttmn� REROOF -
Liann CI . k.. MAR 3 12003 comrwtor T/0 - COMP. , INSTALL 40 YR. COMP. _
RCNIRi(.r DECLIkRxnON
1 undermmd my p env atoll w used
As public records
;o Licensed Professional BUILDING
h OWNER-BUILDER DECLARATION -
F . I hereby sinrm that 1 em exempt from the Com atmes Lima.Law for the
EO o fallowing reason.(Section 70313,Business and Pmfumms Code:Any city or roomy
$ which requlma a permit to construct.ehor,improve,demolish,or repair any structure
prior in Its Issuance,also requires the spplicant fusuch permit N rile a signed amount
< that he IsRunmdpursuant tothe provisiomoftheCantrwtor'sLicense Law(Chapmr9 Sq.Ft.Floor Area Valuation
(commencing with Stolon 701)0)of Doullon3 of Ne Businessand Proressinns Coda)Or 6 0 0 0'
33 Nat he Is exempt Ncmfwm bed the bub fm lie alleged exemption.Any violation of
Section 7031.5byany applicant fora Permit subjects the applicwt N,civil penalty of APN Number .Occupancy Type
not mom Nan five hundred della.($500).
❑Loa awnes of�w propcny,ormy employes with wagessa Neo-rule rmnpenutim. 36221022 . 00. -
willdoNewoh,andtheswcmm is notimendedmolli edfornm(See.7044,Busircua Required Inspections
and Prefessons Code:The Connectors Llmn tun law domat apply to an owner of 305 — FRAME q p
propenywho builds arimproveashemon,and who does such work himself or through his
awnemployeu,provided that such lmprevemeru am not inculed wortend forsam.If. 307 — INSULATION
however,the building or Improvement is old within one Year of eompleon,the owner. -
builder will haw Ne burden or proving slur he did Out wild or Improve for whom of 601 — ROOF" TEAR OFF -
.10.). 602' - ROOF PLYWOOD -NAIL
D 1,as owner of the property,am exclusively contracting with Ilansed contras.to 603 - ROOF BATTENS
construct the pmject(Seo.7044,Business and Professions Code:)The Contractors U.
more,law deo not pply to an mm of property who bunds orImpmw,Nemm,and. 604 - ROOF 'IN-PROGRESS '
who ommacu for such prujum with a untranor(s)licensed pursuant to Ne Contoemra _
License Law . . `
❑Iamemmptundor Sea ,Bk PCforthistexacen
Owner DauAm '
WORKER'S COMPBNSATON DECLARATION
1 hereby elBto under pl ulsy or perjury arc of the following declarations:
I lave and will msinmin m Ccnlfmteof Consent towlf.iuum for WorkersCompcn-
ution,as provided for by Swoon 3700 of the labor Cade.for Ne performance of she
work r which this permit is Issued.
- ve and will maintain Workers Compensation Insurance,u required by Section -
W fNC Labor Code,for Ne performance o(Ne wodr far which Nia pennil la luued.
ork cc�to,ro.a e�vOoTTn��ln��wrwattartier -71
and Policy nfumwr art: -
GNv. iWTY_T—(/h(/\ Policy No.:J
CERTIFlCAT3OF EXEMPTION FROM WORKERS '
COMPENSATION INSURANCE -
(This acctinn need raw becampletod tribe permit Is fortune hundred dmllan($100) -
1 unify that in the peffnrmm m of the work for which this permit Is Wood.I shell not
employ any person In any manner an As to become subject to the Workers'Comper udon
laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ceniream or Eaemptiaa you Should _
become subject to the Workers Compensation provisions of Ute labor Code,you mute '
.,zz forthwith comply with such provisions or this permit mall he deemed mvnked. ,
tiCONSTRUCTION LENDING AGENCY "
I wreby srtirm Net ft.is a construction lending agency far rite perrmma.x of
ai
the work for which this permit b bmcd(See.3097,Civ.C.)
Qlammes Name
D z Lender'sAldm.
V Q 1 certify that I low read this application and sum that the move Information iv /01
F canoe I Agra to comply with all city and county ordinanannd mute laws mining to
QU building comlruction.And hereby mourn representatives or Nb city to enter upon ft
til abovmmentioned paternally for inspection purposes.
LL (We)agree to taw,indemnify and keep harmless 0te City of Cup
S=ONS. cnino apinst
N uabBWes,judgmentAcosu bed expenses which may In any way accrue gsineuld City
U In consequence of Nerm
e Starting of this pit
APPLICA NDERSTANDS AND WI L COMP WITH ALL N9 -P INT Issued by: Date
/
� 7 U� Re-roofs
Signature of AppliaanI/Cnn for DT
HAZARDOUS MATERIALS DISCLOSURE I Type of Roof
Will tho applicant Of forum wilding Occupant mom orhandlc haxodoes material
as deRned by d¢CupeNI A Municipal Code.Chapter 9.13,and the Health and Safety code. rl ion23532(e)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu No
Will the mppliam or future building Occupant um cyulpment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Is harmdmuv oil unuminwu defined by the Bay Arca Air Quality Management all new materials for inspection.
DYea No
(have num the hvraNnuvmvterials requimmcr s under CMpter 6.95 of Ne Califon
nlefieslN&SmfcsyCode,Scctions 255(15,35533 and25534.1 undcnuM thuif the wilding
-
daor ,c lylow caw that It b my maponsibllhy w noufy Ne ouupant mf dw _
reyulm whl wmetPrior toisa OraCcruf woroccuuppw���U} SignatureofApplicant Date
Ownerarsathonmde ant '� ` C D,te All roof coverings to be Class "B"or better
S01xy-
Community Development Department
Building Division
10City of Cupertino
300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
ICUPEkTIN.0
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: �f,U yI- Lew1 1J' 1
Job Site Address: I f�f)Jl✓1 �� wGw (1
Roofing Company Name: pebytll j I U�llIzj
A plicant's Signature: Date: S 0
Greg eel
Building Official
Revised 1/30/03 .
Printed on Recycled Paper