03030085 (CITY OF,CUPERTINO "" � `'� ''
BUnAINa Di VISION PERMIT 'war"CO
NT C OIt I1V10 MAT ONp
BUILDING ADDRESS: SIGNATURE' ROOFING INC PERMIT NO,
SNAME: 1190 MIRALOMA WAY PERMIT LSSU .. _
MONTANEZ JOS
PH E: (80.0) 644-7410
SANITARYN C OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
.. BLDO ELECT PLUMB
'z
0 LICENSED CONTRACTOR'S DECLARATION Job Description
1 bercby aEirm Nu 1 am lim,uetl under pervWoo Of Chapter 9(mmmenciny
with Section 7((IO)af Division 3 of the Business aM Pont its Cype cad center is
in full force andt@tte39 �j b (5 �d ,REMOVE COMP 'ROOF AND INSTAT-a- I 0OF
3 u«nxe clan" 1 ere.r
m De¢
D GOalaLm .
A0.CHITECTSATI
5a nEersund my plena shell be used as public records MAR. gy a 803
�p5 Licensed Professional -
q .] OWNER-BUILDER DECLARATION p
ay 1 hereby affirm that I em exempt from the Comranor's License law for tar BUILDING
i a o following reason.(Scetiun 7031.5.Business and Refeuions Cox:Anycity or county
1$� which requires a permit to construct,alter.improve,&ONIM.or repair any stmetum
in prior to its issuance,also requires the applicant fofaaeh permit to File a signed statement
bo that he isllcensed punu.nun me pmviamas of the Comnnuri Licener law(Chaplor9 - Sq.Ft.Floor Area. $�I�I on
(commencing with Section 7000)of Division 3 nnx Businexeand Pofenimm OWe)or - -
Nat he Is exempt therefrom and the basis for the alleged exemption.Any violNon of
Section 7031.5 by any appllant for a permit subjects the applicant to s civil penalty of w �r 0 0' Occupancy Type .
not more Nan Ove hundred dollen($500). -
01.uownuofR pmNny,mmyemployeuwlthvnguuftkwleeommnudon,
will do the work and the strunme 1.notimewled cluttered forsade(Sm.70th,Business 305 _
Red Pmfessimts Cox:The C.nuuor'.Licener Law does wt appy to..sane.,Of
FRAME Required Inspections
property who buildsur improves thenen,and whodoesauch workhlmselforthmuyb M. 307 - INSULATIONS
own employees,povidedORRwh impovemems are not Intended@offered for sada if. 601 — ROOF TEAR. OFF
however,the building Or lmpmvement is sold within ON year of enmpletion,the owner-
' builder will love the bold,.Of moving Nal llo did not Wild ear improve for prepare of 602' — ROOF PLYWOOD NAIL
"In'I' 603 - ROOF BATTENS ' '
0 L ea ownu of the pommy,.m exclusively contracting with licewd contraction to
conotruct the project(Sec.7W,Buslotax,and ponfoctions Code:)Too CmatnucMe,1.1. 604 — ROOF IN—PROGRESS
clan law dao mal pply re an corner Of property who bullar Or improves Nemo.,and, -
whocontractsforsuchprojectswithammraelor(U lieewd Function to the Convanxem '
License Law. -
emesemptunder Sec. ,B&P C for Ni.reason ,
Data ..
WORKER'S COMPENSATION 131 LLKATION
I hereby REN,under pcolty of perjury one Of tie following deelw0ou: _
❑I haw.od will mr.1malo a CeNOate of Coven(o self-Nsura fm Workee'sCompm-
urian,u proAdcd fm by S,nlOn 3700 of the labor Cox,far the performance of the
wah for which this permit is Issued.'
0 1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labol Cage.for performance of the wor for which this permit is Issued.
My Wortoo don once emu and Policy number are: - -
CERTIFICATEOMPE SATION70N FROM WORKERS'
COMPENSATION INSURANCE
finis aeetim need not be completed If permit is fmo.e hundred dollar.f$IM) _
-
or Icer.) -
1 certify that in the performance of Ne work for which this Permit Is issued.I.hall not -
employ any proton in any mannerw as in n wrow subject to Ne Wohcri Compeasather
Laws of Calif..;-,Dem -
Applicant
NOTICE TO APPLICANT.If,after making this CcnlOate of Exemption,you should
become subject o the Worker's Compensation pmvleoo of the labor Coda you mot
,JO faMwith comply with such provisions or this permit shall be deemed revoked. - -
'Z CONMUCfION LENDING AGENCY
H4 Thereby affirm that[here ler eonstructlnn lending agenry,for the performance of - -
fyi;> the work for which this permit Is Wood(See.31197,Civ,C.)
Q Lander'.NamO
Z)z Lender's Address
U 0 1 certify that I have rad thisappliation and sum that ON above Oformuiun is
B. torten.I agree to comply with all city and county oNlnanma and sum laws mining to
p building cartawction,and hereby authoria reprwntativcs of Nis city to color upon the
shove-mentioned pommy for inspection Pdrpoer.
Ie
(We)agree to ova indemnify and accept Inamorata the City of Cupertino again[ -
,AA liabilities Judgments.costs and expenses which may In any way accrue against said City i.
(„) Income,vencer, Negnnllncofthispeonl.
APPLICANT UNDERSTAND$�7�N WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE LAT[ (/-j/v - ]
•4 Re-roofs
Srplku o Banucontrutor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
I Nc applicant or future building Occupant ow orbandk haysrtloo material
,Wkcaned by To
Cupemn. amt Cox,Chapter 9,11,and the Health and Safety _.
section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya
Will the applicant or future building omupent use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hauMous sir contaminants as d5jmcd by the Bay Area Air Quality Management all new materials for inspection.
District? -
0Yes
I he.reed the haraoousmaarials requirements under Chapter6.95 ofthe Celifor- 4ignaof
/L.� � ? �/ ) c),3�,
nla HeaW,@ Safety Coda Sectiou25505,25533 and 15534.1 undco Nulldte hulWing !✓'),..��((��" , J
duce not current y am a tem L that rc.povihilhy o nod',t .pant of the
requinter, whi asst Ipdo ante tufaCcniOamofCk rye Applicant 'Ha[e -
wncr or auNa'ed agent Date , All roof coverings to be Class"B"or better
t
+ Community Development Department
' Building Division
11 aN
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPERTiNO
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: JU O &/ O5 Ecact `finn e z
( �l4wr7(
Job Site Address: r
Roofing Company Name:
A plicant's Signature: ?�G�" - Date: 3 -� 2 U
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper