03110011 CITY OF CUPERTINO v^• $++ - .sem mom; -� ;
BUILDING DIVISION .PERMIT x�CONTRACTOR INTORMATION
BUILDING ADDRESS: T D ROOFING PERMITNOO 3110011
61R (;l4Annwi4TT,T, TA
OWNER'S NAME: 3540 MARGATE AVE . PERMIT ISSUE DATE
DON & VIRGINIA DAUGHERTY 11 /04/ 003
)NE: (408) 892-8872 SANITARY NO, CONTROI,NO,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
C�
+00 LICENSED CONTRACTOR S DECLARATION Job Description
1 hcechy affirm that 1 am 17theBd sensor and
Pr provisions ofChapterCode. 9(commencing p
with Section ddefecDivision3of the Business and Pofosainm Code.and mylicense is
m ren Co.and erred. RER00 F -
Datem Class Lac.N
,FnDaCarol.,DELL
ARCHITETS DECLCARATION
1 understand my plans shall W used as public rcuuW
£�u ®
sL.
pG Licensed Pndcssional ILFIC ed VA® F®
3 OWNER-BUILDER DECLARATION
q I hcrchy affirm Nat 1 am exempt from Ne Contractor's License Law for the
00 following moon,(Section 710L5,Business and Fr inmCode:Anycityorcounty 2�U3
e m which requires a permit us construct.shot,improve,demolish,ur repair any structure
aspooro its issuance.also requires the applicant for such permit to Glc a signed at won nt
xx that he is licensed pursuant to the proviaurs of Ne Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
zFp (commencing wi th Section 7")of Division 3 of the Business and Professions Code)or
Nat he is exempt therefrom and de basis for the alleged exemption.Any violation of 3 6 2 2 4 0 2 6 . 0 0of III giluo
Section 7071.5 by any applicant fon permit subjects the applicant m a civil penalty or
not mare NAPN Number Occupancy an five hundred della.(5500). - --- P Y Type
1,as owner of the property,or my employees with wages as Weir sale compensation,
will do the work,and We structure is not intended or offered for sale(Sec.7044,Bminms
and Profusions Cade:The Cont actor's License Law does not apply to an owner or Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is to within one year of completion,we owner. -
builder will ban the burden of proving that W did not Wild or improve for purpose of
sale.).
1,as owner of the property,am exclusively contracting with licensed contractors to ---
o wet the project(Sec.7044,Business and Professions Cmi The Conmacmr'a Lt.
cense Lew does not apply to an owner of property who Wilds or improves thereon,and
who contracts for such projects with a contncaer(s)licensed pursuant to the Contractor,
License law.
❑lameacAmptunder S/eee.. / ,B&PCfm ise on
,4✓.-tiJ's.� Date
MPENSATION DECLARATION
I hereby stairs under penalty of perjury one of the following d imdlom:
1 haw and will mainain a Cer iGnm of Chnsent m Ulf-insure far Worker's Compere
moven,as provided for by Section 3700 of Ne L aW,Code,for the performance of We _
work for which Nis permit is issued. - ..
I have and will maintain Worker's Compensation Insurance,as required by Section
3700 pf the Labor Cale,for the performance of Wo work far which this permit is Issued.
My Worker's Compensation hummoe carrier and Policy rummer am:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed If the permit 0 for enc hundred dollen(2100)
or was.)
I cent fy that in the performance of We work for which this permit is iaucd.I shall not
employ any person in my manner an as to become subject to the Workcn'Compensation
Laws or California.Doc
Applicant
NOTICE TO APPLICANT:If,after making this Coni ricam of Excm prion,you should
became subject to the Worker',Com pen,ation provisions of the Labor Code,you most
Qforthwith comply with each provisions or this permit Mall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
I optithat d
m then iso construction lending agency for the performance of
:4 We work for which this permit is issued ISee.3097.Civ.C.)
11 p lender's Nor.Name
z Lenders Address
J C) I Camfy Net 1 have read this application and sort that the above information is
.� F correct.l agree 10 comply with all city and county ordinances and sore laws relating to
�U building commuction,and hereby autharies moosenutivu of this city to enter arch We
>W a ahovc(we)a ree to s w for indmnify an keeses.
y (wc)agrte to ssve,indemnify and keep harmless the City of Cupcnino against
V) liabilities,judgmeno,costs and expenses which may in any way accrue against said City
J7 in consequence of the granting of this Permit -
t� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR -zsIOf�.S.
/ Re-roofs
Sign of App HAZARDOUS
RDOUS MATERIALS DISCLOS RE " Type of Roof
Will the applicant or future building occupant stare or handle hanolous material
as defined by the Cupertino Municipal Cada Chapter 9.11,and the Health and Safely
come.Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
❑res h;Nn
Will the applicant or ffuture building occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haaaedous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
istri ? 1''
❑Yes IQNd
I have mad the hanrdousm'atcriab regoimments untler Chapter 6.95.(do Calif., /
nix Health Code,Sectors 25505,25533 arta 25534.1 unJenond thuiflW Wilding
does not currently hoc a moan that it u my mspeadded ty m notify do emiment of the
re,toomcnts which must W mol prise to iss enc,ofe Certificate of Occupancy. SS gait ofA IC ret Dat
Ow ser amWo'red gem ate All roof coverings to be Class 'B"OC better
Community Development Department
,; Building Division
[la City of Cupertino
10300 Torre Avenue
CITY OF
Telephone: (408)777-3228
OUPEkTINO 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 mspection 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 Na ✓//11/ .ai o;r -1��/ l
Job Site Address
Roofing Company Name: Yom` ,voIC//7_ 4 \,41u
A plic" Signa e: 4 zi- ' I�at�/
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t .
CITY OF CUPERTINO " C�l I
REROOF
CUPEIITINO PERMIT APPLICATION FORM
APN# 9 Date:
Building Address:
A-
Owner's Name: Phone #: }W$
n
Contractor: Rom �, pati Ph ne#: License#:
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
13 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings—',�A -- ❑ Provide I.C.B.O.Report#
• )K To be Removed ❑ Provide Mfgr. Installation Specs.
�t
I Have Read, Understand and Will Comply With Cupertino's Tear Off Polic : ❑
Job Description: &�?l l( 1 W
/
Residential lCommerdial ❑ J
Fire Zone: Yes ❑ No ❑ j Confi ed with Planning De t. if
there are any restrictio
Cost of Projof Cons con Occupancy group
Qty
A is a 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
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