03100067 CITY OF CUPERTINO r vt t, %mkT € an
BUILDING DIVISION PERMIT Y'C0NTRACTOR INFORMATION
BUILDING ADDRESS: R E ROOFING & CONSTRUCTION PMtN003100067
OWNER'S NAME: 15230 CLYDELLE AVENUE PERMIT ISSUE DATE
TONY WADE & 2003
NE` (408) 925-9995 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+o p LICENSED CONTRACTOR'S DECLARATION
u 1 nrrehy affirm that l am licensed ander provisions of chapter 9(commencing lob Description
with See on TA(ah ofl) ro Sof NC Dusincssamfeluouo Code, nd my licenuis
+'� mraumneander@a �f 121y�i�1 REROOF
-amu,
a 0 Z Liccnu I s Lic.X
sFJy, Delc
begun
IARC Call
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ARCHTIEGT'S DaCLAnnn
I w 1 1 u Ocrs nJ my pshall M\uJ a public rt f��('�xT�=
e o
M Licensed Professional �\
�q OWNER-BUILDER DECLARATION v
1 brachy airrm that 1 am exempt room Ne Cnm...I.,',License Law for ftp O following mason.(Section 9031.5,Business and Pmre.ssi^ns Code:Any City or county
<S ff which requins s pemit to construct.altar,impove,demolish,or repair any structure - O O
a prior to its issuance.also mquima the applicant for such Permit file a signed statement
m that he isIicenseJpursuant uthe provisions orthe Contracwr's License Law(Ch wsr9 Sq. Ft. Floor Area Valuation
21.0 (commencing With Station 7")ofDivision 3^r the 9usineaand ProfeasionsCode)or 35910011 . 00
that he is exempt therefrom and the basis rot the alleged exemption.Any viouti,ofof
Section 7031.5 by any applicant for a Permit objects me applicant to a civil penalty of APN Number OT
not more than to.hundred delta,,(SSW). - �- - --- Occupancy Y YPe
——
I,As,owner of the property,or my employ=with wage,u their sole compensation,
will do the work.and me,wmum is not intended or offered for sale(See7044,Business '— gam❑ d InS ections
and Professions Code:The Contractor'.Liam Law docs not apply m an owner of 307 - INSULA'P IV P
property who builds or improves Neaten,and who does such work himsefor through his
own employees,provided that such improvements are not intended or offered far side.If, 601 - ROOF TEAR OFF
however,Ne building or improvement i,sold within one year or completion,the owner-
builder will have the burden of Moving that W did not Wild or Improve for purpose of 602 — ROOF PLYWOOD NAIL
am,). 603 - ROOF BATTENS
0 1,as owner of the property,am exclusively contracting with licensed contnemrs to —
construct the forget(Sec.t04a,Business and Professions Code:)The Contractor's Li. 604 - ROOF IN-PROGRESS
can=law does not apply to an owner of property who Indian or improves theater,and
who contracts for such pmjecu with a nmuaaor(s)licensed pursuant to the Contractor'.
Liccnu Law.
❑1 am exempt under Sec. B h P C ran this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
737.1
have and will maintain a CenifemC of Consent to sel6insu a for Worker's Cumpen-
n,as provided for by Section 39W of the Labor Code,for the performance of the
for which this Permit is issued,
hale and will maintain Wurkera Compensation Insurance,as required by Section
of Ne labor Code,for Ne performance of the work for which Nis permd is issued.
Worker'sCompensatio��n��Insurance carrier and Policy number am:er: UI/ISI% 1's1 V�1� Policy No.: ��l " Qla to jl
CERTIFICATE FEXEM PTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectim need not becompleted if the permit i,for one hundred dallaarSla))
or less.)
I certify Net in the performance of the work for which this Permit is issued,1 shall not
employ any penon in any manner As As to become nbjeeun the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL.flat making Nis Ctnibcam or Exemption,you should
become subject(a the Worker's Compensation provisions of IN labor Cadc.you must
�O forthwith comply with such provisions or this permit W deemed reined.
yy CONSTRUCTION LENDING AGENCY
1 hereby aRnm mat then is construction lending agency rnr the performance or
0: .. the.,it aur which this permit is issued(Sec.3097,Co,C.)
1 0 fenders Name .
z Lenders Address
J 1 certify that 1 have read this application and sore that the above information is
3. Hcorrect.1 agree to comply with all city and county ordinances and state laws relating to
Z) U building construction,and hereby euthoise representatives of this city m enter upon the
a Ahave-mentioned Property for inspection purposes.
ti (Wc)agree to ave,indemnify and keep harmless the City of Cupertino against
fA
liabilities.judgments.costs and silencers which may in ay way saes against aid City
:.3 Z in consequence of the granting of this permit.
(CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
OUR GfILT41 Ns.
' U Re-roofs
Sign ua of ApplicanUContaetar Data
_2` HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will'me aPPj.;m to
future building^ccupam store or handle haardons matelot
a defined by the Cupertino Municipal Code,Chapmr 9.11.and the Health and Safety
oda Fly..
sss3lca)+ All roofs shall be inspected prior to an roofing material being❑Ya, P p Y g g installed.
Will the applicant ser rumre building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haaaades nair contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
ntrict?
❑Yes ❑Nu
Ia&Safat Nchaardn..2555, m33AM1n534.lideEn(.95 ifine Cali r .—� _ x— �•
ria HcalN&Safetychaimedons8505,15quimme5534.1uChamndthwif the Wildi r.
t corm sly W e ac I mat it is reaponsihility m^nail the txeu hart or m
m mm ct�ta w6 -.1 t nort.'My A , cmBca o Occ an {$n�ure of 'pp �(� Date
'+.Owner; 3uNorinJagcm Data All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
CUPEkTINO 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.
/� 1 p r 5 � L�MJ
Homeowner's Name: 1(Z}�r VC(\1d�CJ'�+ 1 �'
Job Site Address: 2 U-J R O S�,o H
Roofing Com e: I k
A plicant s Signature: _pate: I U
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 7
00 REROOF o 3l
CUPERTINO PERMIT APPLICATION FORM
APN# C, Date:
t)�
Building Address: 20 f q� Su f ) iEL9 TR '
Owner's Name: `� 4 Phone#:
60 WADE,
Contractor• � Phone#: f License#:
Contact Phone#: I Cupertino Business License#:
GPlC�'I -6TTun_. 40�-H21 -IX113
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof I 1
O Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes '0� Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 2 ❑ Provide I.C.B.O.Report#
ATo be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: Gy, l STl r-J �- 2 1—A"46n UX UJ CxJn ?HA'
NS-fAIA ,lel 30'A- A5 g W00)) SgA-rC
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planni if
there are anrestric ' ns:
Cost of Proje 1 z qo W Type of Co on: Occupancy group:
/ UU
Qty. if
A licab 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
•