04040070t1
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CITY OFCUPERTINOm.t:R
BUILDING DIVISION PERMIT
-ON RACTORaINFQRMATION
BU I LDING ADDRESS:
MORAZAN ROOFING INC
PERMIT "004 04 0 0 7 0
OW NF.R'S NAME:
PERMIT L�UE DATE
GARY DINGER
740 SHAWNEE2004
)NE:
SANITARY NO. CONTROL NO.
(408)224-5785
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 E 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that 1 am licensed under p s or Chapter 9 (commencing
ov
with Scamn,arxr) of Division) ofNCBusinea`an ons mems,,
in fulm rite ek
REROOF
License Clan Lic, p
ale GanllBclar
RC..TE, DELI. /
I
undcrslanJ my plana shall he acs a ccards
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 em exempt raum the Contractors License Law for the
following mason. (Section 7071.5, Business and Professions Code: Any city or county
which requires a permit Int envoucl, alter, improve, demolish, or repair any structure
prior In its issuance, also recruires the applicant for such permit to rite a signed statement
that he is licensed pursuant a the previsions of the Convector's License Law(ChOptcr 9
Sq. Ft. Floor Area
Valuation
(commencing with Section 7") of Division 5 of the Business and Professions Code) or
that he u except thetefman end the basis for the alleged exemption. Any v101atlon of
I'
Section 7031.5 by any epplicml for a Permit subjects the applicant 10 A civil penalty of
not more (hen five hundred dollar ($5(111).
_ eiOO
i Occupancy
P Y Type
1 1 '
❑ h es owner of the propcny, or my employees with wages As Nair role compem"od.o.
offendfor san"accsnorApply 7D 41, Business
will dothe wons ands: hectureisnots License Law
and Professions Code: The Convector& Lew does nor apply m rI owner of
[ 1
(
t11tt111]�.+/ ,t1{u'I l e ilea In eC1J nS
propOwn enywho and who such workhimaelfor through his
vided
es, prods
own employca.pruvlactl@dl such improvements are not intended OraRered fO'Are.IL
tharveslhimprove are not
u l'
however, the building or improvement is sold within one year of completion, the owner
1
builder will haw the burden of proving that he did not build Or improve for puryase of
ale.).
❑ I. as Owner of are property, am exclusively contracting with licensed contractors to
Construct the project (Sec. 7044, Business and Professions COCA:)The Contractor's Li.
cense law does not apply to an owner of property, who builds Or he proves themon, and
who csmmets for such pmjecu with a contractor(s) licensed pursuant 0 the Contractor's
License Law.
❑ 1 am exempt under Sec. . B h P C far this mann
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby &Man under penally of pejury one of the following dochustions:
-
I have and will maintain a Ccnifcate or Consent I. ul6insure for Worker's Compere
ration, a provided for by Section 3700 of the Labor Code. for Bob performance of the
work for which this permit Is issued.
❑ 1 have And will maintain Worker's Campenatlan Insurance, a recruited by Section
3700 of the labor Code. far the perfarman. of Ne work for which this permit ie Issued.
'
' pent lion insurance carrier and Policy number am: / /
Ca r POliry
.: _
AN ORKERS'
CE FI TEOFOMPE
SATIO
COMPENSATION INSURANCE
(This section need not M completed If the rermll Is formic hundred dollars (51011)
or this.)
I ccnify that in the performance of the work for which this Permit u tssmd, l shall not
employ any pormn 1n any manner u a a bocoma 1Ubjam00 the Wofkent' Campeounim,
Law. of California. Date
Applicant
NOTICE TO APPLICANT: If, afer making this Cenifcete of Exemption, you should
become &Object to the Worker's Compensation provisions of the labor Code, YOU must
forthwith comply with such provisions or this pernall shall be deemed evoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there U a construction lending agency Or the Performance of
Ne work for which this pacts is issued (Sec. 31197, Civ. C.)
Under', Name
Lcnderi Address
1 certify that I haw read this application and star that the above Information Is
correct. 1 agree to comply with all city and county ordinances and state laws rotating to
horthyamhoaimmprcunwiwsof this city to error upon Be
ithavengeotioned ProenJ
ahme-mentioned Property for speeder Purlaxs
(We) Agree to vat damnify end k less [be City of Cupertino Agaiat
liabilities.judgmcn And, xpo I ey in any way eccmc against aid City
in
A PPLIC in acct rdT Ingo ILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOL)
Re -roofs
Type of Roof
xl�
t cent( Applicmt Data
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant ser future building occupantentreor aandleaNansmaterial
a definedthe Cupertino Municipal Cudc, Chapter 9.13, and the Health and Salary
rti ty
oJ
We. Section
n 235II(gl
r-1 Y. 1gNa
All roofs shall be inspected prior to an roofing material being
P Y g g installed.
q
If a roof is installs without 111$ airing an inspection, I agree t0 remove
Will the applicant or future building occupant use equipment or devices which
It havardous air contaminants a defined by the Bay Area Air Quality Management"'Iis0ta?
❑Yes aI
hew cad WuoMAWm menu unser CUBIC, 6,95 or the Calif.,alicalth,4 Y .Seeds 33 and 35534.1 undcratmthat ifJc building
A t'
ma Unify IhC nxupan, ar thewi
onot y
e a aaaneemocenife cep
Date
All roof coverings to be Class "B" or better
� �
cru thrreJ agent Oath
m
Lets,
CITY OF
UPEI�TINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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: i- /—
Job Site Address: 1#0 ASCO
Roofing Company Name:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date: T ��
•
t
CI
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
6t6 1(- x-11 7
APN # 2 —A,
g
ate: ' /
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Building Address:
Illy
Seo
r
Owner's Name:
O
Phone : s 15_ 6 3
.tel
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Contractor
7ZM
BUILDING
Mone #: –� License f rl'o
Con t: - �,/
Phone #: Cupertino Business License #:
ar /k
BUILDING
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
R( Asphalt Shingles
X Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
i ❑ Provide I.C.B.O. Report Ii
5k, To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and
Will Comply W'tt Cd ertino's Tear Off Policy:
Job Description: 'o ,Z k �ra'
¢.S a Y
sti' 1�1
Residential
Commercial ❑
Fire Zone: Yes ❑ No IS Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project-��
Type of st ction: Occupancy group:
Qty. if
AnnRi�alale
Fee TD
u
Fee Descrintion
Fee Grout)
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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