03060149W,
�6
n1qq-
�W
30
O
c000
O
4
0z
Z0
a>
W G]
U0
0U
F4
U�
CITY OF CUPERTINO
.% Ird`t>,ow at, z ,Ka m a s - #^ave '•
RMATION"��'
BUILDING DIVISION PERMIT
�ONTI2ACTORANIF
v2 'c.sT#6=.0=t akY.°.-%':g!tk�'t' 4
BUILDINGADDRESS:
WOODS ROOFING
PERMIT N003060149
OWNER'S NAME:
2179 STONE AVENUE STE 22
PERMULiSUEDATE
XIAD LUD
Of;/24/200-4
ONE:
(831)637-5576
SANITARY NO. CONTROL NO.
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION'
Job DOSCTIptIOn
I hereby affirm that I em licensed under provision, of Chapters 9 (commencing
m
with Section 7M)) or Division J of the Business and Professions Coic.d my license is
- n!
irce
In mB force and rr.a)9 2 I-31
T/0 SHAKES & W/SHINGLE
License Lic. N
Dam / Comrmmr
ARC,UECTS DECLARATION -
ADD DECRA STEEL TILE p q
JUL O 8 Lao
I understand my plan, shall t used a Public rccmJs
'
Licensed Professional
OWNER -BUILDER DECLARATION
BUILDING
1 hereby affirm that 1 am exempt from tt Comrutor's License Lew for the
following reason. (Section 7131.5, Business and Professions Code: Any city or county
which requires a permil to construct, alcor, improve, demolish, car repair any nruemrt
prior to its issumce, also require, It applicant for such permit to file a signed statement
that he is licensed Pursuanuo the provision, nfdm Convacuo's License Law (Chapter 9
Sq. Ft. Floor Area
Valu$gop 000
(commencing with Section 7(X10) of Division3 or the Business and Professions Ctwk) or
that he is exempt therefrom and Ne basis for the alleged exemption. Any violation of
3 912'N2Qi fh0cr0 0 .
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom Nan five hundred della,, (5500).
❑ 1,. owner of the property, or my employee, with at. as their suit compensation,
Required Inspections
will do the work and thuvuelure is not intended or offered (orale (Sec. IDH, Business
and Profession, Cmc: The C.mouttor, Lt.. law does not apply to an owner of
3 0 5 — FRAME
such end who doeuch wort himselfor through his
property who build, uu Ddocs
own employees .Ad.dthatsuch tmprovmmsnts are not intended er off,.d for sale. If.
307 — INSULATION
however, the building or improvement i, sold within one year of completion. the owner.
time, will have the burden of proving that he did not wild or improve for purpose of
601 — ROOF TEAR OFF
,are.1.
602 - ROOF PLYWOOD NAIL
❑ 1, as owner of she property, am exclusively contracting with licensed convectom to
603 — ROOF BATTENS
convect tt propel (sec.70N,Business and Profession, Code:) The Comracmra Li.
cert¢ taw docs not apply man owner of property who,wims or improv. tenon, and
604 — ROOF IN—PROGRESS .
who contracts for such projects with • eonu entrou) licensed Whosmno the Convenors'
License Law.
❑ 1 son exempt under Sec. . B A P C for this reason
Owner Dam
WORKER'S COMPENSATIONDECLARATION
I hereby atTnm under penalty of perjury one of the following declarations:
I hale and will maintain s CeniReam of Cmuc nt to self- nsum for Workers Compere
s alum, u provided for by Section 7700 of the laver Code, for tin, pcofmor aner of the
,
.it for which Ni, permit is issued.
have and will maintain Wester, Compensation Inwrsna, as required by Section
700 of the lair Cmc, for due, Performance of the work for which this permit is issued.
My Worker's Insurance carrier and Policy numberam:
.Co}mimrsation
Curicr::;5 R &T Policy No.: �• " 6
CERTIF CATEI OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section ntttl not t completed if the Permit is forone hundred dollars (SIM)
or leu)
1 certify that in the per(„.... pf Ne .,it for which Ni, permit is tuned, I andl net
,
employ any person in any manner an as m tcome subject p dm Workers' Compensation
Laws ofcalifornia. Date
Applicant
,
_
NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should
become subject to the Worker', Compensation provision, of tt Labor Code, you must
Forthwith comply with such Inmentons or his permit hall t deemed revoked.
CONSTRUCTION LENDING AGENCY
I treby affirm that Vert its construction lending gcmy, for It Performance of
Ne work for which this permit Is issued (Sec. 3097, Civ. C.)
Londa', Name
L[ dens Address
I ceNfy that I have read this application and sum that Nc above information is
correct I agree to comply all oily and county
mor and sum Pew
oem ntati
and hereby euNon r Upon t e
rpose,emetivu of this city re enter upon the
Bix,ve-mennswd prof
etvc(Wti propene for inspectionpurposes.
p
V
(We) agmen to cove, indemnify and keep y a the City Cupc�rdmo
ag
in o card
Cityliabilities. ,judgmen,
expenses which mayinany wyaccrue egainn,eid City
rand
in oonsey.nce of Nc nhngo(thi Pcr
APPLICANT UN TAy S -COMP WITFi�ALL NO POINT
Issued by: Date
SOURCE R
Re -roofs
Signature of ApplicanVContranor am
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or (uI. wilding occePmt nom or handle haeardous material
a defined by the Cupertino Municipal Code. Chapter 9.I2. am tt Health and Safety
Code. en zss3zfa)7
All roofs shall be inspected prior to any roofing material being installed.'
b,. -
rl Yes ono
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or device, which
W haeardous air contaminants u defined by the Bay Arca Air Quality Management
all new materials for inspection.
isvin7
❑Yes LyNtr-
Ihave readJontaaNnu under ChaPmr6.95of Ne
thniDM willing
25505u3533an 255 I Wilding
Cot,unctionsutitimy
'r
diesout eumoulty InJcrsum
nordus5uityM.
Jou not curtcnJy hese a ¢„ant Nm it u my ruponsibility m noJ(y the occuPvnt of Nc
v
mquimmcnu which .ltmel bras' anamcf.9f'oricsturdoccopmecif
Signature of Applicant Date
N to
All roof coverings to be Class "B” or better
ownernr ..Date
�CITY OF
UPEIJTINO
•
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: X LAd
Job Site Address: /A)
l
Roofing Company Name: "o -o s 64 d-e�=
A plicant's Signature: Date:
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
r
is
CITY40
CUPEiTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
Bld Permit Fees
Date:
Building Address:
Energy
l/0 7
BSEISMICRE
Owner's Name:
BUILDING
Phone #
Seismic Commercial
BUILDING
0�k/-035Z
Contractor
Phone #:
License #:
Co _
Phone,
Cupertino Business License #:
98 —5
zap / o
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)
Number
❑ Other (Specify)
7
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: ❑
J� scri io o a —
Q��
Residential,�ET_ Con1mercial
❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
//6 a • cD
Qty. if
AnDlicable
Fee 1T)
Fee Iieccrintinn
FPP �r11�111
BPERMFEE
Bld Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING