03070049 CITY OF CUPERTINO .. "Pawapa$ " Ik " Z'�=`'��
BUILDING DIVISION PERMIT CONTRACTOR-INFORMATION 2
RU I LDI NO ADDRESS: TEO ' S ROOFING PERMIT ND.03070049
0224 SCRNIC
OWNER'S NAME: 691 Ice] SAN CARLOS PERMIT LSSUE DATE
ONE: SANITARY NO. CONTROL NO.
(408) 279-8797
ARCHITECPENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O O O O
LOo LICENSED CONTRACTOR'SDECLARATION Job Description
1 bamby affirm that 1 am licensed under provisions Of Chapter 9(commencing
With Section 7"l of Division 3 of the Business and Professions Code.and my license is
in retire-and
pt2Z License Clava y —� ) Lic.X !oS/ REROOF
Dem Comracter
�e—
q ARCHITECTS DECLARATION
y$ Iunderstand myplans ehall beused aspublic
oceoohs JUL 2 9 2003
0�u
,t; Licensed Pmfcssioml
Oe OWNER-BUILDER DECLARATION
MJy BUILDING 1 bunchy affirm that I em exempt from nB
the Convenors License Law far the UI L,DI1 VG .
S e O following much.(Seel un 7031.5,Bu.inesaand Professions Code:Any city on county
9 E which requires.poll pt construct.eluc improw,demolish,Or repair any structure
rZa prior ba its issuance.also requires the applicant fon such permit I.file a signed statement
ss<
in.[he is licensed inesamm 1.the proaishinsof the Chruractm's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
aFn (commencing with Sectio 9(10Oof Divpaidn 3 of the Business and Pndc,ai...Cnde)ur
'ESR that he u.%maN therefrom and out basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not I ..than 0w hundred dollars(S500).
❑L as down of the property,or my employees with wags as their sole compensation,
will do Ce work,and Ce structure is not intended or offered for sale(Sec.7044,Business 305 — FRAME
and Professions Code:The Comm�rrs License Law don not apply to an owner of Required Inspections
property who builds or improves Nereon,and who does such work himulfor through his 307 - INSULATION
own employees,provided that each improvements are notimended oro0crtd(orale.If. 6O1 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the or
wne
builder will have the burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
ram.). 603 - ROOF BATTENS
Co I,as owner of set Stupors,amusine exclusively and
convening Cod:)The Ccontnnoss t.
ConstructmLa theprojectnotapply tooaowne noesand Pty,who ids or improves
Comrkmn,Li- 604 — ROOF IN—PROGRESS
cerise law docs notapplym an noon of property,who Wilds or improve Centro,and
who contacts for such projects with a eomnnnr(s)licensed Pursuant o the Convanlor'a
License
[3I.m attempt under Sec. ,B&P C for This reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penally of perjury,one of the following deelmtima: -
1 have and will maintain a Cer ifinm of Consent o wif-ineum for Worker)Comperr
-.tion,ss provided for by genion 3711(1 of the Labor Cnde,for the Performance of the
work for which this permit is)sued.
0 I haw and will maintain Worker's Compensation Insurance,as acquired by Section
37of CC labor Code.for Ce performmceaf the ooh for which this Permit is issued.
MyWorkerpren pmenin T art `�.ier and Policy number see:
Cartier. / � ! Polity Ne.:OO O 9
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This srclion need nol be completed i(the Permit is(ostia hundred dollars(Slip)
or loss.)
1 cenify Net in the performance of the work for which this Permit is issued.I shall not
employ any proton in any manner an as to become ubjectto the Worker)Compnssation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this 0murcae of Eacru tum,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
.JO forthwith comply with such provisions or this permi i shall he deemed mvnked.
zCONSTRUCTION LENDING AGENCY
(-+� I hereby affirm Banthere is a construction lcndingegency for the performance of
Cliff the work for which this permit is issued(See3097,Co.C.)
WUnder'.Name
Z) Z Lender'sAddress
V Q 1 eenify that 1 have reed this application and state that the above information is
D.F correct.l agree to comply with all city and county ordianns and sale lawn notating to
C7 V building construction,and hereby aulhorim represcmseiws of this city to enter Open the
a abovomentioned property for inspection purposes.
(Wo)agree m saw,indemnify and keep harmless the City of Cupertino against
.Fi y liabi:itieajudgruu u,costs and eapenses which may in any my act.gdnat said City
C)z APPL CANTUNDERSTANDSAND Cof the gooling or onsequence
Permit.
COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE TIONS.
/ SignemrcofAppticenVCnntrumr pate Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the app:icant car future building occupant store or handle harardous materia:
as definetl by Ce Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Sectioe l]�9/n 25532(.)1 All roofs shall be inspected prior to any roofing material being installed.
❑Y
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
nil hmothims air coulnmin.ha a defined by the Bay Area At Quality Management all new materials for inspection.
istrin?
❑Yes gM
Iban reet the WnrAnmmeni5. re33and 3534,1under Chapmrd.95 dobe Caldinr- \ -- O ( Op. cV�
niaHwlN&Sdny Cede,STdues255115,25S33 end 2553a.l undcnsaM CuiUlre Wilding OYY
docs not curremly new a¢nem,Ce it is my resNesh my Canonry Cc rccuPent of the
rryuimmcntsw' mclpriormissuencenfeCcnifcamof n rr• (Signature of Applicant Date
wk-rmrTwdosed agent Date e All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
4 CITY OF Telephone: (408)777-3228
U P E 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 wit a above stated policy on re-roofing.
Homeowner's Name: qac?/ o WQ 0Czl a-k
Job Site Address: l6 Z 3
Roofing Company Name: -? L2z irle2"uZ1"5
Applicant's Signature: Date: 0 4•01
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO b3 p 7o v !�
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 7 (D {a Date:
V G�• a • G�
Building Address:
cr(,
O ne s Nam / Phone#t yds
e:
C alor: Phone#: /°,� License#:
Pi[c�—= �'�C�-G
Contac Phone#: 510 d Cupertino Business License#:
2
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof '
Ci�sphalt Shingles B--Asphalt Shingles
p Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings_k!:� ❑ 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 Descri tin: /
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: LJ
Cost of Project / Type of Cons tic Occupancy group:
Qty. if
Applic 1 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
7 7 S-o