03100187 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACT�OVJNFORMATION:',
BUILDING ADDRESS: R E ROOFING & CONSTRUCTION PEEMCNO03100187
'i 226
OW NER'S NAME: - 15230 CLYDELLE AVENUE FERMIT ISSUE DATE
SCHULZ WERNER AND CAROLYN 10/27/2003
ONE: (408) 925-9995 SANITARY NO. CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLOC ELECT PLUMB MECH
100 LICENSED CONTRACTOR'S DECLARATION G7 O O O
1 hereby affirm that 1 em licensed under pmviama of Chapter 9 Wrommucing Job Description
with Section 7000)nf D' i 3o cBusincsa and fc.ionsCity�a Tyliccnseis
?=y in full force and effect. d� � o—l" J REROOF �'��L !�®
>�,? License 7SDECLARATION
F p Datc Contractor
� Wya ARCHITECTS blitC Q
U lundcraan my plans shall he used as public rccnNs 1 02003
o� Licensed Professional NOV1,
S OWNER-BUILDER DECLARATION
ay I hereby affirm that 1 am cacmpt from the Contractor's License Law for the BUILDING
a O following reason.(Section 7031.5,Business and Professions Cade:Any City or county
3which requires a permit to construct,alter,improve,demolish,m repair any structure $11800
it,
prior in its issuance,also requires the applicant for such Nonitm file axigned stammer
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
2� (Commencing wi in Section 7")of Division 3 of the Business and Professions Code)or 34218025 . 00
Nal he is exempt therefrom and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of APN Number OCCu anC-Type
not more Nan live hundred delta.(11500).
P y YP
❑ I,as owner of the property,army employees with wages as their sole compensstioe,
will do Ne work,end the structure is not intended oroffercd(or sale(Sec.7044,Business
and Profession Code:The Contactors License Law docs not apply to an owner of Required Inspections
Property who builds orimpoves themon,and who daes.Och work himself or through his
own employees,provided that such improvements are notimnnded or offered for sale.IL
however,the building or improvement is sold within one year of completion,the owner.
builder will have d,burden of proving Nat he did not build or improve for purpose of
salt.).
❑1,as owner of dart properly,am exclusively contracting with licensed conlfectoa to
construct the project(Sec.7044,Business and Professions Code:)The Contractors U.
cense Law does not apply to an owner of properly who builds or improves Ihemon,and .
who conow a for such projects,with a comracmr(s)licensed pursuant to thO Conu emf's
License Law.
❑ 1 am exempt under Be. .B&P C for this reason
Ownef Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insum for Worker's Compen-
sation,m provided far by Section 3700 of the labor Code,far the peRmarmen of the
work for which Ni.Permit is issued.
1 have and will maintain Worker's Compensation insurance,as required by Section
00 of be labor Code.for Ne performenec of be work for which Nis permit is issppped.
My Workers nmrensa�n Insurance Carrier nd Policy nuu/mbbeer�am�: l u�(��
CERTIFICA a0F EX' PTIONFROM ORKW ERS' o
COMPENSATION INSURANCE
(ThHseminn need notMcompleredif the Mrtnit is forone hundred dollars(Slap
or less.)
1 certify,Nat in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner so as At become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after mast ng this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the labor Code,you must -
,Z forthwith comply with such prnvisions or Nis Permit shall be deemed revoked
ENCY
ti O CONSTRUCTION L.30G,Civ.C.)
1 hereby affirm Nal there is a construction lending agency for the Performance of
La NO work for which this permit Is issued(Sec..)097,Civ.C.)
Q Lender's Name
D Z Lcndefa Address
J C) 1 certify but 1 have read this application and sste that the above information is -
y correct.I agree to comply with all city and county ordinances and state laws relating to
DV building conswction,and hereby authorise rcmtive
preains Of this City to enter upon the
W above-mentioned property for inspection purposes.
r P. (We)agree rasa,indemnify and keep hermlcu Nme City of Cupertino against '1 _
y vi liabilities,judgments.costs and expenses which may in any way acec against mid City
Zin consequence of the A'
J z APPLICANT UNDERSTANDS L
STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Da[ V
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of ApplicaDate
HAZARDOO US MATERIALS DISCLOSURE Type of Roof
Will
ytapplicant n forum build cupantstorcor handlelanzadousmatorial
A
&rued by the Cupertino Munic' Code,Chapter 9.12.and the Health and Safety
.do,Bccdon 255320? All roofs shall be inspected'prior to any roofing material being installed.
❑Yes
No
If a roof is installed without first obtainingan inspection,I agree to remove
Will Nc applicant or future building occ ant use equipment or device.which P g
It hazardous air contaminants as define the Bay Area Air Quality Management al new materials for inspection.
— District?
C3❑Yes
have read Ne haaaNnus materiels reyuircmens under ChaPterb.YS of the lifnr- i� �� I
nit Health&SafetyCodc,Beedons25505.25533and25534.1undersand Natif dac Mmi tling
not cunen0y M1ave a maser Nat it i.my rcaponsihilitY m nodly the w.cuPanl of Ne-,`
C
menta. ich. usa W, m rtoissA ire oft Ccnifcateirop panty. I n tura eofA Plica t Date
Allroof coverings to be Class "B" or better
r r.au"ormc Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
It
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
IUPEkTINO
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: V Val QUX' �H �1_'5 '
Job Site Address: _ 2446 SA)4 A �o kD
Roofing Company-N e:
Aplica Ys S _!ignature: , Date:
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO 6
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 6 �� Date:
Building Address: (4 b 5,t04 Ju A-�4 o AV
Owner's Name: Phone#: I '
GI5 0j uL`ItJ ��ltu� I ACU — T20 4211
Contractor: l N Phone#: License#:
'R O1Tf- Caw w( I TN I c . 2
Contact: Phone#: Cupertino Business License#:
��I� ''1 Rtsz 'AGK_ 621 - 1320
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof 'Cl Built-Up roof
Asphalt Shingles �sphalt 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: Tckow 11,A A'En 0 (°OKP t INSTALL KIM
o# fAs Fly S u-W . CUM P
Residential Coniniercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project l I w Type of Construction: Occupancy group:
Qty .
A c le 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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