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BUILDING DIWSioN PERMIT
CO NT NT INFORMATION �.
BUILDING ADDRESS:
7c;1 RTTpMr)T4AT, IN
RESPONSIBLE ROOFING INC
PERMTr NO03090201
OWNER'S NAME:
MIKE VANNI
2882 SPRING ST
PERM"LSSIfE DATE
09/24/2003
NE'
(650) 969-6151
SANITARY NO, CONTROL NO.
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
LICENSED CONDECLARATION
1 hereby 1 licensed Chapter Y
Job Descri tion
p
affirm that ved under provisions of
em A , (rommcneing
wish Semioi7 7of Division Sof the Bu' sand Pmfcssiam Code. mtl mylicense is
mu tome As'.
''
REROOF V(:I �' 2003
Liccn a . N $y
Dao: C.s
CT" 717
ARCHITEURA I
I ndcrsund my plans fiall he uxdupuhlie records
BUILDING
w
Licensed Pmfastonal
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from Ne Contractor's Liecve Law for the
-
following mason. (Section 7031.5, Business and Prucssions Codc: Any city or county
which futures a Permit to construct, alter, improve, demolish, or repair any structure
Prior 1. its issuance, also requires the applicant for such Permit u file a signed statement
that he is IICAAsed Pursrmnuo the Provisions of the Contractor's License Law (Chapter 9
Sq. FL Floor Area Valuation
(commencing with Section 7000) of Division 3 on the Business and Professions Code) ser
37542038.00
Net he is exempt Nemfmer And da basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penally of
- -
- APN Number
Occupancy Type
P Y-----
not more than fire hundred dollars ($50B.
--
❑ I, u owner of the progeny, or my employees with wages As their sole compensation,
will do Ne work and the swaum is WI intended or offered (of ale (Sec. ]OSA, Business
And Profcfeions Cotle: The Conoaetoe, Lt.. Law dors not apply to an owner of
RReey i 1I11�� Inspections
propeny who builds or impm ca 0cmon,and who does inch work himself u though his
3 0 7 - INSULAT Vffd
ownemployou, povided for such improwmenu aunt intended oroffamd formic. If.
601 — ROOF TEAR OFF
however. the building or improvement is sold within one year of completion, the owner
builder will ban the burden of proving that he did not Wild of improve for pun.
602 - -ROOF PLYWOOD NAIL
m1`I.
603 - ROOF BATTENS
1, as owner of the property, am exclusively contracting with licensed convectors to
...-
'
construct the project (Sec.]tua, Business and Professions CMA:)That C.ARMtor"Li.
604 — ROOF IN—PROGRESS
cense Law docs not apply to an owner of progeny who builds or improves Ihem.n, and
who contracts for such projects with a consractor(s) licensed pursuant to the Contractor"
License law.
❑ 1 am cxempr under Sec. B & P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury on of Ne following declarations:
_
I baro and will maintain a Certificate of Covent to.1 r -in are far WorkefsCompen-
saion, As provided for by Section 37M of Bre labor Code, for the pedormauc of the
worA for which thio Permit is issued.
❑ I have and will maintain Workcls Compensation Insurance, As required by Section
)]OO of the labor Code. for the perfonc
rmae of the work for which this Permit is issued.
My Worker's Cnm Pemetion Ins Ace canner and Policy numMram:
Camicr a Policy NO:\
C IRTIFICAT• 'E(EMPfIONFROh KlE
COMPENSATIONINSURANCE
rfbh section need not W completed if the Permit is for one hundred dollars (SIM)
carless)
I unify Nat in the performance of the work for which this Permit is issued, 1 shall not
employ any person in any manner she As in become subject o the Workr f ComPcnudon
Laws of California. Date
Applicant
NOTICE TO APPLICANT: IL after making this Ceni reale of Exemption, you should
become subject to the Worker's Com N motion provisions of the Labor Code, you must
forthwith comply with such provisions or this Permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that Nene is a conswclinn lending agency lot the wrforman e, of
the work fur which this permit is issued (See. 3W7. Civ. C.)
Lender'a Name
Lender's Address
1 comfy Net 1 have read this application and sure that the above information is
comet. 1 agree to comply with all city and county ordinances and slate laws relating to
building conslmaton, and hereby anthorim upmSenlatives of thio city 10 enter upon the
Ah.w...Ationed property for inspection purposes.
(We) agree to sew, indemnify and keep harmless the City of Cupcnm Against
liabilities, judgments, cam and expenses which may in any way accrue against mid City
in Confirm... of the looting of Nis perntit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE ATIONS.
Re -roofs
Type of Roof
-lure of Applicant(Conmctor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or furore building Occupant stere or handle hawdous material
u defined by the Cupertino Muni Al, Code. Chapter 9.13, and the Health and Safely
ode, Section 35532(.)?
All roofs shall be inspected nor to an roofing material boon installed.
N/
❑Yes p
P P Y g g
If a roof is installed without first obtaining an inspection, I agree to remove
Will the appueaator future building occupant use equipment or devices which
it hvnNnos air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
uciet? 1
❑ Yes LU N.
I baro read the hvaNtms materials reyuiomenu under ChaPmr6.95 of the Califn,
nia FiA.th&Safety Code, 25ynoa3553a.1 understands the
the
wool, past
Joel not currently haw a tenant Nat it u my respovihiliry m notify Nr. aeupml of Nr.
oci tof
/
my Amounts teh must be me dorwissuvve fa Ccruficete of Occupancy.
Sign re of Applicant ✓ Date
All roof coverings to be Class "B" or better
mer .r..m red sten, „
ITY OF
CUPEkT1NO
Community Development Department
Building Division
City of Cupertino
10300 Tone 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
IMPORTANT:
1. Flat roofs must have a minimum of Y4 " 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: M I ke U A N N I
Job Site Address: 253 , 1ieiod ho /L AN -C
Roofing Company Name: A PSQMLi CQUI'J 1 2� .Z/1% C --
A plicant' Signatur2:'A Date: d,A6,03
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
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 Y4 " 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: M I ke U A N N I
Job Site Address: 253 , 1ieiod ho /L AN -C
Roofing Company Name: A PSQMLi CQUI'J 1 2� .Z/1% C --
A plicant' Signatur2:'A Date: d,A6,03
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
FJ
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CITY OF CUPERTINO
REROOF ').3 0
PERMIT APPLICATION FORM
=d.
A �+S•
APN #
Date:
Pcu uluu
BUILDING
BENERGY
Building Address:
BUILDING
nti
S, Sfen) A L L AN CJ
Seismic Fee Res
Owner's Name:
BSEISMICOM
Phone #:
BUILD_I_NG_
BPLANCHK
6
C tractor: Phone #:
BUSLIC
License #:
C
-5�1?f-)
Contact: V Phone #:
Cupertino Business License #:
►o5
Type of Roof Covering:
Existing'
.0� Built -Up Roof
Prop:
o�
40" Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings �_
❑ Provide I.C.B.O. Report #
p -'To be Removed
_
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu
ertino's Tear Off Polic
JobDescriiption: Terve off ^Nd Dispose. of
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2n V+ w i k 0,U,
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed wit anning Det. if
there area restricti ns: LJ
Cost of Project: Type of Con traction: Occupant group:
S113 S •Ot'
A6nlicable
Fpr TT)
-
BPERMFEE
uvu
Bldg Permit Fees
Pcu uluu
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILD_I_NG_
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
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