03070198 CITY OF CUPEWrINO �s
BUILDING DIVISION PERMITCONTRACTOR-lINFORMATION
DUIIDINGADDRESS: [av7001OS ROOFING
PERMITN003070198
CIA PQT.T.TNCT)RTT. DR
OWNER'S NAME: 2179 STONE AVENUE STE, 22 PERMIT MUE DATE
3
ONE: (B31) 637-5576 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
.00 LICENSED CONTRACTOR'S DECLARATION - Job DCSCrI 10n
I U� 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
a� with Section 70)(Mm Divincro Sof Bm Business Pmfcssiom Cog Jmy licen is siV�►I�E®
n in full fntcc and CM3
t.
�= Liccnm�le� ✓`l ROOF
Dal 1]
'F�F
ARCHITECT'S DECLARATION SEP O 4 2003
IWu I understand my plans shall be used as public records
o Licensed Pndcseinnal
BUILDING
�� 1 � ^
9
OWNER-BUILDER DECLARATION �an/'�i/'�{a•
d<2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the Y
p o following reason.(Section 7131.5,Business and Professions Code:Any city or county
which requires a pnmit to construct.alcor,improve,demolish,or repair any strustructure 7196
prior to its issuance,also requires the applicantfor such permit to rile a signed statement
FFee` that he is licensed pursuant Sq. Ft. Floor Area ' Valuati
tion -
O+H (coencing with Section 7000)of Division 3 ofthe Business and Professions Core)or
BOOM.. Is exempt Werefrom and Je basis for Ne alleged exemption.Any violation of 35931041 . 00
Section 7031.5 by any applicant for a permit subjects On applicant to a civil Penalty of APN Number Occupancy Type .
net more Nan fire hundred dollars(5500).
0 1,u owner of the property,in my employees with wages a their sole compensation,
will do the work,and the awclum is not intended of offered for sale(Sec.1014,Business R r d Inspections
and Profession;Cole:The Conuactn's Liatue Law does not apply to an owner of 307 - INSULATlU p
property who builds or improves thereon,and who doessuch work himself or through his
Own cmployces,provided that such Improvements for not intended or offered for sale.If, 601 — ROOF TEAR OFF
however,she building or improvement is sold within ane year of completion,Ne owncr.
builder will have the burden of proving Net he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
"le')' 603 - ROOF BATTENS
❑I.as owner of Be property,am exclusively contacting with licensed comments to -
construct the project(Sec.]044,Business and Pmfessions Code:)The CmOsCtora Li. 604 — ROOF IN—PROGRESS
cense Law docs not apply to an owner of property who builds or improves lhemon,and
who contracts for such projects with a eomactor(s)licensed pursuant to the Conti®tars
License Law.
❑l am exempt under Sec. B k P C for this reaon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby a@sm under penalty of perjury ane of the following dedaatiom:
I hoe and will maintain a Cer ificae of Consent to self-imuto for WorkersCom mn-
7c'),
ion,ad provided for by Seniors 3]00 of Um labor Code,for the perfafmance of the -
rk for which Nis permit is issued.
I have and will maintain Workers Compenadon Insurance,M required by Section
00f We labor Cade.for the performmec of she work for which this permit is issued.
Worke 1C sal' InsvntWacarticnndPOlicynumM ate: ��mer, Policy NO.:;_
RTIF CATS OF EXEMPTION FROM WORK ERS'
COMPENSATION INSURANCE
(This section need not be complemJ If the Mani(is for one hundred dollars(SI00)
or less.)
I certify that in the perfum mance of the work for which this Permit is issued.I shall nut
employ any person in any manner an as to M1crome subject o the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:if.after making this Cenificate of Exemption.you should
become subject to the Worker's Compensation provisions of the labor Code,you most
Z forthwith comply with such provisions or this Permit mill Ise deemed minded.
�O
CONSTRUCTION LENDING AGENCY
1 hereby affirm Nal Were is a construction lending agency for Be Performance of
Ya the work fur which this permit Is issued(Sec.3097.Civ.C.)
31 AUnder'.Name
3Lz Lender's Address
J 0 1 certify too 1 have read this application and sato that the shove information is
1. Pcorrect.1 agree to comply with all city and county ordinances and state laws relating to
'U building convection.and hereby authorim mpresemulves of this city to cnNr upon the
6 ahovamenliuned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
.a y liabilities judgments.coats and expenses which may in any way second against said City
:J Z in consequence of the gaming of this permit.
^ APPLICANT UNDERSTANDS TANDS WILL C IPL:WITH A'L NON-P0 Issued by: Date
SOURCE R A ON r,(/jam 51
90 Re-roofs
Signalu of April plicanUConmisclof- D.
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant o,future building occupant store of handle halardous patinul
as defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Code,Section 25532007
Yci ew_� 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
tit haaamous air contaminants so defined by the Bay Area Air Quality Management all new materials for inspection.
wict?
❑Yea Rlw�
riaHealth
h;Safety
thCode,SScNeOuuusms 25505.2553immmal
eZ55)4.1 understand
55)4.1unMrstand thnoift the
e Willdin
dons not curtcnll Oce a mnanl @Nmyro.o gej (ylC — a
ihility to notify Ila cupvdt of Nc J
ayuircmcnu hmgstk I ' r muancc CcruEja¢otOccyttt Signature of Applicant Date
Owner or aulhprireJ agent I am
All roof coverings to be Class"B"or better
Building Division
4 10300 Torre Avenue
R� Cupertino.CA 95014-3255
CITY 0 Telephone: (408)777-3228
CUPEkT1N0 F (408)777-3333
Building Depar'6ent
Subject: Reroofing policy for the City of Cupertino.
I. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing is
completed.
3. All roofs shall be inspected prior to any rooting installation
4. To receive a final sign off from the City the following steps are required.
1) Preinspection 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.
ti. Any roofing which is applied without first obtaining an inspection,will
require the removal of all new material down to the sheathing so that the
proper City inspectiori 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.0. report is required to be on the job site at the time of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name ,} q
Address L2
Reroofing Company Name: _; � � S
Applicants Signature: 7M Date:—]2/2-:5- d3
Joe Antonucci
(Chief Building Official)
6e
p'.25!2pp� 12: 45 5105303262 LEGA'_ITIES INK PAGE p4
CITY OF CUPERTINO
0,10 � REROOF 6
9UPER,TINO P*.RMIT APPLICATION FORM
APN# Date:
Building Address:
7� c�
Owner's Name:/ Phone #:
Contract o : Pholie#: License#:
s41 410? 6 00 - 0803 3 ;2-.S✓3 1
Contact: �4 ' Phone#: Cupertino Business License#:
p`� Z C)
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
O Other(Specify) _ O Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
Have Read, Underst d a Will Com 1 With Cu ertino's Tear Off Policy:
ob Description: T D 9'
Residential Cornmercial ❑
Fire Zone: Yes ❑ No ❑ ' Confirmed with Planning Det. if
_ there are an restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
/ 9
Qty. if
Applicable Fee2ID Fee Description Fee Group
/ BPERMFEE B14Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
_ BSEISMICOM Seismic Commercial BUILDING
BPLANCHK _ Plan Check Fee BUILDING
BUSLIC Business License BUILDING
- 123 Z
22627
x /37 R�O