03020003 CI'T'Y OF CUPERTINO VA , - " ? •= '_- `� - v,
Ruu,nlrvc DIVISION PERMIT "CONTRACTOR INFORMATION 'r�,
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nmLDINGADURESS; AMCO TRU-TEMP PHRMIFNO.
' 6247 SHADYGROVE
OWNER'S NAME: 161 CENTRAL AVE APPLICATION SUB DATE
LUDWIG MARCIA A TRUSTEE 02/03/2003
ONE 4082934313 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MECH
0 0 0 0
uO�lOp LICENSED CONTRACTORS der'S DECLARATION
u+ 1 hereby allirm that I am licen:cd under prow arms nl Chnpur 9(cnmmem:ing Job DCSCTIPLIOn
CC with Seetlnn]INNI)nf Dlvishm3uf�r cBusincssand fesainns CnJe, Jmy lift
t <U
F m to 1.BmmearyI�rap f(' p REROOF
an Li Ga S9 2 FINAL.,E®
qr Date amtroN, J URO-LAST ROOF
-�4a crstrod my plans shat M CHITHuvdaasELPubMliw Orr ods
ye.0yu - FEB 14 2003
tdLLQ Licensed Pmles.41ona1
j OWNER BUILDER DECLARATION
K <Y I hereby affirm that I am exempt from Ne Condanors License Low for the BUILDING
u 6 00 following mason.(Section]03 1.5,Business and Professions Cole:Any city or county
a�$is which requires a Permit in construct,alter,improve,demolish.or repair any structure
FZa prio,1.its issuance,alsO reunites lhcap,hcant I such permit to file a signed statement
QQxx that he is perused pursuant to the provisions of the Contractor's License Law(Chnptcr 9 Sq. Ft. Floor Area Valuation
'rZFO (commencing with Section 7000)of Division 3ofthe Business and ProfessiomCodc)or $12865
$ that he is exempt therefrom and do,basis for the alleged exemption.Any violation of
Seedon 7031.5 by any applirandfor a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than fiwhundred douam(S500). 37540022 . 00 P y YP
C] 1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the sductme is not intended or offered for sale(Sm.7044.Business
snit Profcasimts Code:The Contractor's License Law fires not apply to an owner of 305 - FRAME Required Inspections
property who milds m improves themun,and who does such work himself Or through his
Own employees,provided gnat such improvermusam notimendedorortened fiasale.If. 307 - INSULATION
however,the building or improvement is sold within one year of completion.Ne owner
Wilder will have the burden of proving Nat he did not build or improve for purpose of 601 - ROOF TEAR OFF
sale')' 602 - ROOF PLYWOOD NAIL
0 1,as owner of the property,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
conswn the project(sec.7044,Business and professions Code:)no Contractor's Lt
cruse law Nes not apply to an owner Of property who builds or Improver thereon,and 604 - ROOF IN-PROGRESS
who conducts for such projects with a contracto0s)licensed purvano to the Contractor's
License law.
0 l am exempt under Sec. ,B&PC far this nation
Owner Dade
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent las sclbinxum for Wmker'sCompen-
a ded,u provided for by Section 3700 of the Labor Code,for Ne performance of the
work for which this permit is issued. .-
❑1 have and will maintain Worker's Compensation Insurance,as mquired by Section
37M of Ne Labor Code,for the performance of the work for which this permit is issued.
MyW a sCom pc sidion Insurance carrier and Policy no er r
Polity
CF. jrJCATE OF F.%EMPI'IONF WORKERS'
q!hkTION INS RANCE
(This section need not be completed if the Tcrmlt is I'nnm,hundred dollars($IN))
or less.)
1 certify Nat in the performance of the work for which this permit is issued.I shall not
employ any peruse in any manner an as to become subject o the Workeri Compensation
Laws of Caliromia,Date
APPlicand
NOTICE TO APPLICANT:If,after making this C,nilicale of Exemption,you should
become.suhjecd In the Worker'a Compensation provisions of the Labor Code,you must
O 0 forthwith comply with such provisions or this permit shall rte deemed revoked.
z ^ CONSTRUCTION LENDING AGENCY
t:IZ) I hereby affirm Nal there is a construction lending agency for Ne performance of
IYd 7 the work for which this permit is issued(Sec.3097,Ci,C.)
W Q Lender's Name
fY Lender's Address
=1z
U 0 1 certify that 1 have reed this application and sure that the above information is
W (•' cormet.I agree tocomply with all city and county ordinances and stole laws relating to
DU building construction.and hereby authorise mpmsendaturs of Nis city to enter upon the
W ahove-mentioned property for inspection purposes.
(We)agree to save,indent or fy and keep harmless the City Of Cupertino against
lobi lities.judgments,costs and expenses which may in any way scrod,against said City
I.
of the granting(if this
U aZ APPI:C uNTCUNDERSTANDS AND W permit. COMPLY WITH ALL NON DINT ssued by: Date y
OURC LATION `�CJj` V—J21. 3
Re-roofs
nature of eiranVCmumelor lam
I IAZARDOUS MAT IALS DISCLOSURE Type of Roof
Will the applicant or fuuu building Occupant Wore m handle hazardous material
as dermed by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
,dale.S,edon 25532(a)7
❑Yea 1`4u All roofs shall be inspected prior to any roofing material being installed.
roCN
Will tMapplicamor�future building onupamuse equipment nrdeviceawhich If a roof is installed without first obtaining an inspection, [agree to remove
it hand ous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
O Yes o
I have mail the hmoa std us mmenals requirements under Chapmr6.95 of Ne Califon
nice Health&SafcryCtxk.Sections 255115.25533 and 25534.Iunderstand died if Ne building ? `�'rvt �. og
dsxa do curtest I haw a unanl.Nm it is y mibilhy m notify Ihe m,up ort of the _ C ' 1
uiremems ustMmet pdunn' oraCMdOca of 4cupancy. t� Date
ct
Signature of pplicanl
�`n
0 ncr nr author •J agcm Date
All roof coverings to be Class "B" or better
Community Development Department
y, Building Division
Ia' City of Cupertino
Y�" 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax:. (408) 777-3333
CUPEkTINU
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?/a " 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 " 71 1 a �I�C J
Job Site Address:
Roofing Company Name: I —
A plicanYs Sign �Date: 0--9-/03
\�1IP61/001X1
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper