03080134W,
CITY OF CUPEW1'INO
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BUILDING DIVISION PERMIT
CONTRACTORsINFORMATION
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BmLgwcnooarss:
CROWN ROOFING INC
PERMITND03080134
OWNER'S NAME:
3535 KIFER RD
PERMIT L$UEDAM
NE:
(408) 874-0784
SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
o
lb Description
1 hereby affirm that 1 am fumed under provisions or Chapter 9 (commencing
P
with Section 7=)) of Division 3 of Ne Cytlttess and Pmressinns Code, and my license is
in full mtaEaptletfee1�a
Lice OL�75 L
✓rseNr
REROOF PINALED
ARCHITE( DECLARAT ON 0
L
I undctstand my plana shall M used as public records
SEP 5 2003
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from Ne ContraCmea License Law for the
,
BUILDING
following reason. (Section 7031.5, Business and Pmfef ions Code: Any city nr county
• �
which requires a permit m commoct, alter, impmw, demolish, or repair any structure
polar to its issuance, also reQlliRs the applicant for such parmit 10 file a Signed statement
FL Floor Area
Valuation
that he is licensed pursuant to the pmvisimm nNhe Contracture License Law (Chaplet 9
Sq.
(commencing with Section 7011(1) of Division 3 of the Business and Professions Come) or
36222002.00
that he u exempt therefrom and the, basis for Ne alleged exemption. Any violation Of
APN Number
Occupancy Type
Section 7031.5 by any Applicant for a permit subjecta the applicant to a civil penalty of
not more Nan rive hundred della. ($500).
I. es owner of the property. or my employees with wages as Ncir sole compensation,
L.'
Repuired Inspections
will do the wore, and the structure Is not intended or created far,.]. Sce. 7014. Business
and Profeasions Cadc: The Contractor's License Law does not apply to an owner of
prepenywho buildlmimproves thereon, and who does such work himself or through his
307 — INSULATION
ownemployees, provided Nat such improvemenuarenal intended or Offered (orale. If.
601. — ROOF TEAR OFF
however, the building or improvement is sold within one year of completion. the awwr-
builder will haw the bumen Of proving that be did not build or harrow for purpose of
602 — ROOF PLYWOOD NAIL
am.).
603 - ROOF BATTENS
❑ I, as owner of Ne property, em more. And contracting with licensed canv¢tars to
construct Profesoum Co deUThe Character'stheme,
604 — ROOF IN -PROGRESS
end
Law door or impro and
ens taw docs not apply m an owner 9f property, who sed
apply to
me Contras
whocontractsLa ts for such projects with a camrater(s) licensed pursuant m Lha COnuamM1
p
Law.
� 1 am exempt under Sac. , B & P C for Nis reason
0 1 son
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby aRrm under penalty of perjury one of the following dedar Flom:
1 haw and will maintain a Contrition of Consent to al( -insure for Worker'sComplm
action, a provided for by Section 3700 of the labor Code. for the performance of do
work for which Nis permit is issued.
.
1 have and will maintain Worker's Compensation Insurance, As required by Section
3700 of the Labor Car , for Ne performance of tire work for which this permit is issued.
My Workers�Snyyry�1�'Lps'atlon/-tsun—ntts,gdrtier end Policy n�umjb�er�art/:��
'
`/
Ca r. L.%/'W= '�W ta/1 Polity a
U(p
CERTIFICATE OF EKEMPTI MWORKERS'
COMPENSATION I URANCE
(This section need not MCOMPICLed if the permit Is format hundred dollen ($100)
ar less.)
1 certify Nat in the performance of the work for which Nis permit is issued. l shall not
employ any person in any manner s9 ss to become subject to the WOrke.' COmpAAsAdOa
Laws of calif orru. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions or the Latter Cook. you must
forthwith comply with such provisions or Nis permit shall M deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby off rte that dere A • COMMCLIOO Lending agency for the performance of
Ne work for which this permit is issued (Sec. 3097. Civ. C.)
Lender's Name
Lender's Address
1 cenify that 1 ben read this application and sum that Ne above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building cons uction, and hereby authorino tepmunkmiwa of thio City re enter upon the
Abovcmentiuned property of harACtion purpuras.
(WA) agree to ave, indemnify and keep harmless the City of Cupertino Against
liabilities, judgments, costs and expenses which may in any way acme againat soil City
in conmrlu me. of the gaming f,his permit.
APPLICANT NDERSTANOS AND WILL COMPLY WITH ALLNN�PO•INT
Issued by: Date
S L
Re -roofs
Type of Roo(
G cpT$NS. 'V
Data
wfApplioHAZARDOUS
77 HA2ARDOUS MATE RIALS DISCLOSURE
Will theapplicant(munebuilding st9.1orand
e,occupant
Health And
as de, the Cupertino Municipal Code, Chapter 9. 12, and the Hcailh and Sefcty
the
COJe, Section 25332(9)9
Section
io
All roofs shall be inspected prior to any roofing material being installed.
❑Yea No
�
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant ter Ire building Occupant use equipment or Jcvices which
of hazardous tie mmmmants As dolmeJ by the Bay Arca Air Quality Mangemint
all new materials for inspection.
Wrier?
❑Yes No
Ihaw teal Neha Nnusm riab reyuimmcnts under Chapter 6.95 of Jur Califon-
a Health&Safety Code,Secdum 15.25533and25l34.IunJerstvWthelifthe Wilding
0
not currtn aw, a emoo, Nn n u on respoosIbIjUy m bury the ecu ant of Ne
yui 'hue met pnormis anttofYlc ream0rOc 5
Signature IApplicant to ,
All roof coverings to be Class "B" or better
ncr ora orizeJ agent _ _ Date
�CITY OF
UPEI�TINO
C1
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408) 777-3333
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:
cal C r I !
Job Site Address:
Roofing Company Name:
A plicant'rs Signature:
Greg teel
Building Official
IM
Revised 1/30/03
Printed on Recycled Paper
GM CITY OF
CUPEkTINO
CITY OF CUPERTINO v
REROOF /
PERMIT APPLICATION FORM
APN #
1
Z 7'
Date: ry
2S
Building Address:
Energy
BUILDING
BSEISMICRE
Owner's Name:Phone
BUILDING
#: nn,,
Contractor:
h ne #:
g
License #:
BUILDING
BUSLIC
Business License
BUILDING
Contact:(,
P one #:
Cupertino Bu 'ness License #:
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
Wood Shingles
❑ Wood Shingles
Other (Specify)
1 Other (Specify) f0—
Number of existing coverings
Provide I.C.B.O. Report #
KTo be Removed
Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: T -W _
a _ V&1 C,) �W
Residential
Commer al ❑
Fire Zone: Yes ❑ N
Confirmed with Plannin if
there are anrestric ' s:
Cost of Pro' ct:
304.0 O
Type of Construction: Occupancy group:
r
Qty
ADdlicab)e
Fee ID
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FrP oPcrrintinn
Frr r.rnnn
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