03070173 CITY OF CUPERTINO
BUILDING DIVISION PI✓RMIT CONTRACTOR4NFORMATIO
BUILDING ADDRESS: A L RESIDENTIAL/COMMERCIAL PERMITNO03070173 _
1062() SANTA
RD
OWNERS NAME: 14893 E HILLS DRIVE PERMIT ISSUE DAM
NE: SANITARY NO.
(408) 729-6100 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECr PLUMB MECH
u00 LICENSED CONTRACTOR'S DECLARATION O O O O
I hereby a ban that I am licensed under provisions of Chapter 9(commencing Job Description
with Section 700 of Division Sof Ne Bminesand Profcadion,Code.and my license is
in full force and crier ,
yhz Lnm.002 —3 Lm.« REROOF
n DatejC.-I—I.r442
ARCHITECPS DECLARATIO
U1understand myplans shall he used mpublic accords AUG i 2003
t; Licensed Professional
3 Oat lam exempt
UILDER mptfrmDECLARATION BUILDING
0 f 1 hereby maso affirm ober 11. cBusin from Nc ContractorsoCo :License law for the
❑O following oesnn.(Section 7031.5,Business and improve.
eioli Code:Any drymcounty
K which tcyuires a permit m construct,eller imprnw,dcmnlivh,or repair any suuemrc
r�tl^ prior on its issuance,also requires the applicant far such Permit o rile a signed statement
u< that he is licensed pursuant inthepmvisionsm
oftheComaln'sLice selaw(Chaplm9 Sq. Ft. Floor Area Valuation
a (commencing wi at Section 7")of Division 3 of the Busineu and Professions Cnle)or
that he is exempt therefrom and the basis fm the alleged exemption.Any violation of 34216061 . 00
Section 7031.5 by arty applicant for a pemtil subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan Esc hundred dolls.($AID).
❑I,unwner oftlie pmpcny,or my cmployce with wegeu Noir sole compensation.
will do one work.and am net..is not intended or offered for sale(Sec.7W,Dusi=, 3 05 _ FRAME
and Profeulons Coda:The Connscan's License law does not apply to an owner of RCgaired Inspections
pansy who builds or improves thereon.and who doesauch work himselfor through his 307 — INSULATION
own employee,provided Nu such improvements are not intended oroffercd for male.If. 6O1 — ROOF TEAR OFF
however,the building or improvement Int told within one)esu of complcuon,Nmn
e ow
builder will have Nc burden of proving that he did not mild or improve for pun.of 602 — ROOF PLYWOOD NAIL
sale'). 603 — ROOF BATTENS
EI 1,as owner of the property,am exclusively contesting with licensed contractors m
mase La the project(Sec.o an wroroasandrty who wilds
Code:)The sthe ton.Li 604 — ROOF IN—PROGRESS
cease law Coea noupp r to ts owner or property who builds or improve Nemoic and
who contracts far such projects with a conuactogQ licensed pursuant to doe Contnnoh
License law.
❑I am exempt undo Sec. .B,4 P C for this..an
Owner Date
WORKER'S COMPENSATION DECLARATION
I hemby air.under pmi of perjury one of dm following derclaeoimle:
I have and will maintain a Cenifimm of Consent to aelf.im d,for Worker's Compcn-
.itom,"provided for by Section 37M of the Labor Code,for are performance of the
work for which this pemb is issued.
71 1 have and will maintain Wurkari Compensation Insurance,as ordained by Section
3700 of the labor Code,for the performance of are work for which this permit is issued.
My Workx'¢C Nnmaonittsuranay carrier and Polity number art:
Carrier. /�'TI L_'/K� '4U fzs Polity Nd,j�LY9-03
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This season need not be completed Mine permit Is for one hundred dollars(Slot)
car Mss.)
1 certify that in the performanm of the work for which this permit is issued,1 shall not
employ any pta n in any manner an as m become subject o the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenificale of Exemption,you should
become subject to the Worker's Com remotion provisions of the labor Code,you must
J O fonbwiN comply with such pawminu m this permluhall be deemed minted.
Z�" CONSTRUCTION LENDING AGENCY
'[+^ Ihereby(a,whaffom Net there lised IS ,construction lending agency for the performance id
rix•7
he work fur which this permit Is issued(Sec.J(yll,Civ.C.)
CQ Lcndcr's Name
M z 1<ndcr's Address
V Q I eenify Nn I hoe read this application and sate that the show information is
It, P correct.I agree to comply with all city and county ordinances and sum laws mining to
building contraction,and hereby amhorin representatives or this city to enter upnn Ne
C above-mentioned property for inspection purposes.
(We)agree to eve,indemnify and keep harmless the City of Cupertino against
y Iimilides,judgmen0.costs and expenses which may in any way accrue against mid City
V z in consequence of the Standing of d is permit.
^ APPLIC UNDER NDS NO WILL COMPLY WITH ALL NON-POINT Issued by:9 Date
SOURCE ULATI0
Re-roofs
"'nemred App1. nt/Comal Oem
HAZARDOU ERIAIS DISCLO RE Type of Roof
Will the applicant or future Ilding omupam store or handle hnudom material
as defined by the Cupertino Mu ciNl Code.Chapter 9.11,and the Health and Safety
Cale,Section 255311e)? All roofs shall be inspected prior to any roofing material being installed.
�Yca 14Nn
Will the applicant or future building occupant use equipment or devices which If a roof is install without IT obtaining an inspection,I agree to remove
It haurdnua,ir contaminants as defined by the Bay Area Air Quality Management all rte materials 0 Inspec on.
rouser?
❑Yes
s I have read the hamrdaus materials mrommicnts under Chepmr6.95 oldie Califon, 712 03 w�
ilia HelthXSsfedyIsecuran,25S uni15,15533 and 25534.1 understood Nat if the building /`
it o cutmntly tnant ,titrcyu cots whichbem p' nolau mofaCcnlfic cof ccupan '.7 Signature of Applicant Date
Ow rot cut rived agent 7 2 p,to All r f overings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
aMM* CITY OF Telephone: (408)777-3228
U P E kT 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: l
Ll X /_ / ' /'
Job Site Address: 0(///l -2-(2 L50_z )k 44L4 44
Roofing Company Name: �/
A plicant' Signature: Date: ( 2_ 03
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 6 3 6 o ��
CJ REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 Date:
Y2, � 16 06/ �7Z2 0z
Building Address: C ��
Owne 's Name:
Contractor: P ne#: License #:
L 5 B 7Z —lv DCS
Contact: Phone#: Cupertino Business License #:
8 7 —
Type of-Roof Covering:
Existi P p d:
Built-Up Roof Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes Cl 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:
Residentffi IFComme ci 1 ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: Lf
Ct of Pro'ec� Type of Construction: Occupancy group:
Qty. if
A licable 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
3
S127- 70