03070178 CITY OF CUPEWI'INO
BUILDING DIVISION PERMITCONTRACTOR INFORMATION t,,
BUILDING ADDRESS: PERMIT NO03070178
OWNER'S NAME: PERMITL%UEDATE
ONE: SANITARY O. CONTROL NO.
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
o t� 0 0
uo0 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provision or Chapter 9(commencing Job Description
with Section 7000)of Division 3 niche Business and Professions Code,and my license is
in full force and effect. AL
jLqi Li Class Lie.0 REROOF Rem
n' Oao Contractor
ARCHITECTS DECLARATION
fqq- p q
I understand my plans[hall be citeda publicrecnNs Str1) 9 2 [O
DkU
;p Licensed Pmmimmal
OWNER-BUILDER DECLARATION
'�<E 1 hereby affirm that 1 am exempt from the Contractor's License Lew for the BUILDING
E p D following reason.(Section 703 1.5,Business and Profeuinn Code:Any city or county
s�m which oe,di a pcmois so ennatmm slot.imonwo,demolish,Or.pair any atntture
PHot to in issuance,.h.mquiresthe applicam forsuch Permit nfit atignedsutement
Sm< that he is licensed Punuemtothe Provisions nf,mContractuhLicen.Li.(Chapmr9 Sq. Fl. Floor Area Valuation
C�. (commencing with Section 7")of Division 3 of the Business and Profcesinns Code)at
..
that he I.exempt therefrom and the basis for the alleged exemption.Any vi id.firm of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not mom On five hundred delta.($500).
❑1,as owner of the property.or my employee$with wages as their sale competition,
will do the work,and the ancient is not intended or offered fonde(Sec.7061.Bulinus 305 - FRAME Required Inspections
and Professions Cade:The Conuanor's Lim.Lxw don nut apply to an owner of nsP
property who builds or improves thereon,and who dmessuch work himself or through his 307 — INSULATION
own employees,provided that such improvements are not intended oroffered for ale.If. 601. — ROOF TEAR OFF
however the building or improvement i[sold within One year of completion,the owner.
builder will have the burden of proving Nat he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
alc.). 603 - ROOF BATTENS
I,as owner of the property,am exclusively comncting with licensed contractors to
construct the Project(Sec.704A,Business and Professions CWe:)no Contractor's Li. 604 — ROOF IN-PROGRESS
came law does not apply to an owner of property who build[or improv Ihe.on,no
who contracts for such prudmu with a contractor(.)licanad punnnnm the Cmi n uld's
License Law.
13 I am exempt A"sec. B e P C f rt. thio rqunn
te I llI I fto�3
RK ENSATION DEC6A TION
7 Ihereby affirm erpcnelly of ijury motor the following declarations:
1 have and will maintain•Cerormate of Conserv to al6inau.fo Wurkeh COmpem
I. tion,a provided for by Section 3700 of the Labor Code,for the performance of the
1M37rri00
ork for which this pc.it is issued.
1 have and will maintain Worker's Compensation Insurance.as required by Section
of the lib,Code,for the performance of the work for which this Permit is issued.
y Worker's Compensation Insurance earriu and Polity number a.:
er: Policy No.:
CERTIFICATE OF EKEM PTION MOM WORKERS'
COMPENSATION INSURANCE
obd action need not be completed If the PVmil u for one hundrod dolim nlOY,
Its")
1 minify that in the pc,(..anee of the work for which this Permit ts issued,l shall nor
employ any perms in any manner an as to become[ubjecuo the Workeri Compensation
lawsor Califomia,Deo
Applicant
NOTICE TO APPLICANT:If,after making this Cenificm of Exemption,you shnuld
become subject to the Worker's Compensation provision of the Libre Code.you must
,JO forthwith comply with such Provisions or Nis pamotahall W deemed revoked.
Z''-' CONSTRUCTION LENDING AGENCY
'W I for by Which
thi that thiol isacm!(Sec.nnit. agency l'nr the Performanen of
W the work for which Nis permit is iuued(Sec.J(Yi7,CO.Civ.C.)
W O lender's Name
fY Lender Address
U Q 1 cenify that I ban read Nis application and sus:that the Above information is
U. F-, correct.)agora.comply with all city and County ordinances and sou laws relating.
0 U building construction,and hereby aushome.preanuslws of this city to enter upon the
W ahovomonftmod property for inspection purposes.
D. (We)agree to save,indemnify and keep hamnless the City of Cupertino against
(n liabilities,judgments,costs and expenses which may in any way scout against said City
U Z his Permit.
APP CANT9OUNRSTANDS
of the gramong of tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG IONS. Z O/
Re-roofs
Sin umm ApplimourC clate
HAZ DO S MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle hamdous material
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health And Safety
Code.Section 25532.)7
❑ys PO No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant orfuture building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
it hazardnus air contaminants as defined by the Bay Arca Air Oual ity Management all new materials for Inspection.
uict7
❑Vet No
I have rad the hamNnus meterialsrec.ireoenu under Chapter 6.95 of the Califnr. /1
tie Health K Safety Code,Sections 25515.25533 and 25534.1 understood this if the Wilding � w � �1 J'L3 / (JZ
does not c fitly hew a.vnr that i is my.[Ponsibility to morly the Occupant of the �-r4 C/YI/e'g/t ttt_lJlP�� // l
o uircm which mustMmct +issumcenfat CeniOcate of Occupe cy. OT Signature of Ap Date
r car 7 D. ! 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
UPEkTINO 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 fust 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 Name4 l /t,/A —Nrt, a1 � rh 0 I.(
Job Site Address: �� G w S Cv?.v 5r,,w' Pias Pr
Roofing Company Name: ]�
A plicant' _'71 Signatur _s� _� Date:
tGreg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO � 3 ,, 7 v � 7 S'
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN#
b(❑ 7 � 3 � 3
Building Address:
Owner's Name: Phone#:
Le — YumCAO u 7 3 01
Contractor: VPhone#: License 4:
0
Contact: V P one#: Cupertino Business License#:
C 411 u n C o �FatF �7 3 P 0-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles M' Asphalt Shingles
* Wood Shakes - ❑ 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:
Ae kk 0V f R Af u
Residential �] Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plannin t. 'f
`—� there are anrestric ' ns:
Cost of Type of Construct n Occupancy grou
Qty .
A le 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
9
7, 5V