03090158 CITY OF CUPERTINO
BUILDING DIVISION PERMIT '%CONTRACTORINFORMATION a
BwLDING ADDRESS' CURT FLETSCHER ROOFING INC PERMIT N0.03090158
Or" SIINR12R DR
OWNER'S NAME: 354 MONTICELLO AVE PERMITLSSIIE DATE
NE: (408) 267-2679 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT
iK PLUMB MEC0H
0
±oo n LICENSED CONTRACTOR'S DECLARATION
I1 heroby affirm the,I em licensed under provisions or Chapter 9(cam ram,ing lob Description
with SAm1Dn7 ))af Dtvfaidn 3 oft�e�si�a}�and Professions Code,and my license is
in full forced fee � JV
q? uanmclaa rLNE.g � REROOF 1LINALie
vF Dam CunRatnr 4�
ARCHITECTS DE A ON
1u and my plans shall he used Am Public mrnrds -
u� 1 2 2003
ep Licensed Pmfcasionel ,
Oat lam exILDERempt
tfr DECLARATION
COO1 heresy affirm Ian I Am eacmpt from are Convenor's License Law for ^�iI'NG
p 0O' following rooms,pearit t 7(131.5,Business and Pmfcatinili Coot:Any tiny or mmny
<$" which'quires•permit r Corms thealterit ror such
Permits nrrepair any stmnum
°=j, thanosl iennnec,also edpuruant to
oithe thnvisiappoeant the Con PcrmiuLicense ncJnatemcnt
EZptnalhetuaRnsedpuectionNepmviviomnfoftheBuiness Limnselaw(Charier odr)or Sq. F[. Floor Area Valuation
(cae F tat he s exempt
had the
Division ln(the eget Business And Professon.Any vi Cmlc)or
$ Nemo '31.5 bat thcrtfmmand Ne beaufor thectsth0exempntto Any violation of 35910037 . 00
not Section7031.56ye,ryreddmtfonpertnitsvbjccutheapplicanuoanvillemhydf APN Number ._ Occupancy Type.
not mora than fire nanamd dollars(ssoq). - - -- - - - —' - P Y YP ----
1,u owner of the progeny,or my employees with wages u Their sole cdmpenu0on,
will do the work,and the structure is not intended or offered for (Sec.7044,Business FRAME
and Professions Code:The Contractor's License Law does not apply to an owner or - -Required Inspections
,roPeny who builds or The
daemon,and who doessuch work himulfor through his 307 - INSULATION
Own employees,provided that men improvements are not intended droffmod for mile,If. 6O1 - ROOF TEAR OFF
however,the building or improvement is sold within ane year of completion,the owner
builder will have the burden of proving that he did not Guild or improve(or purpose of 602 - ROOF PLYWOOD NAIL
W.J. 603 - ROOF BATTENS
1,as owner ti the properly,.Business exclusively contracting with licensed mdnbaelors t. ---
conseLalnepmjenlSec.oin wneofrop Professions Co orJlMComemor,Li 604 - ROOF IN-PROGRESS
whoc law docs not apply m m owner of progeny who builds or Improves;Condon,and
who contracts for soca projects with a conuumr(s)licensed pursuant m We Comractdra
License Law.
❑lam exempt under See ,B&PCfor thiamuon _
1307M
ner Data _ _
WORKER'S COMPENSATION DECLARATION - -
I hereby aRr a under Penally of Perjury ane of the following deelamidm:
I have and will maintain a Certificate of Cdnscnuo seff-hro re for Workers Cum gem
on,Am provided for by Section 37W of the labor Code,for the performance of the _
k for which this Permit is issued. --
1 have and will maintain Workers Compensation Issuance.m required by Section
of Ne labor Codc,for the performance of the for which this perm it is issued.
rk<r's nm solid matt nimandPo 1nIAE ERT
P r o.:MM1��raW(7g//..60,-((
CE IFIC O PEN Pfd N FRA RKERS
COMPENSATION INSURANCE
(This section reed not rte completud little permit is random hundmddnllars(SIM)
less.)
�t
I certify that in the Performance of the work for which Nis Permit is issued,I shall nut
employ any parson in any manna m ss m heeome subject m ft Wudmro COMP i aalmn
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.After making this CC1611CA1e of Exemption,you should
become subject to the Worker's Compenmtion provisions of the Labor Code,you must
�Q roMwi in comply with such provisions or this permi l shall be deemed evoked.
vy CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency or the Performance of
x ti Nm work fur which tau permit Is issued(Sec.3(N7,Civ.C.)
YQ Lenders Name
z lender's Address
;J 0 I comfy that 1 have read this apphesu n end Arne that the above information is
y F torten.I agree to comply with all city and county ordinances and state laws retuning to
J U building convection,and hereby eudhorim amocientoom or thiuity to enter upon the
N G ahovomcmioned property for inspection purposes.
ti (We)agree to save,indemnify and keep harmless the City or Cupertino against
(,0 limbi linin,judgments,coati and mrenses which may in any way accrue against said Ctry s�
U Z in corvcquenec of she gaming of this permit.
"' APPLICA IfNDER ANDS AND WILL COMPLY WITH ALL NOPp
�`fINT Issued by: Date.
SOURC ;GW AM S. ss O)s1
/1 l �2f/ 5
Signature of Appl' n nor Re-roofs
pate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building decup.ra.m c or handle hexant material
As defined by the Cto erhno Municipal Code,Chapter 9.12,and the Health and Safety
Cuda,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will the applicant orf m building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
in haaardaus air contaminants as defincJ by the Bay Area Air Quality Management all new materials for inspection.
strict?
❑Yes `rd No
I have mad One haaallous materials mqutremcnu under Chapter 6.95 or the Califon \
nia Health&SofayCodc,Scedmu2M5.25533and25534.lundcraundthnif Nc Wilding `J" q—
do2�—Q�
es not currently hoc a tenant the it u my responihilidy m notify the occupant of Ne
rogvimin u h in at poor wi:aumecaracerulieamd acorea gnature of Applicant Date
o draathd ,r agent D,te All roof coverings to be Class "B"or better
Community Development Department
Building Division
etas
City of Cupertino
10300 Torre Avenue
4 CITY OF Telephone: (408)777-3228
UPEkTINO 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 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: Mry%/S
Job Site Address: D 6 7 G �f t fv-f
Roofing Company Name:
A plicanYs Signature: Date:
\N�O�
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
CITY OF CUPERTINO d3 o
40 REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Add res: 6 yG ��
O� ln, ,i'i S.
Owner's Name: Phone#:
Contragt � Phone#: License#:
a Vok— 16>�)0f 3-06
ntact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
O Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles % Asphalt Shingles
0- Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number 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 b Description:
Ze�
-7,1/f sQ� A4 a6al— 30 />/ �G Yt-1
Residential ❑ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planni
there are anrest ' ons:
Cost of&olec .�� rfype of Construc on: Occupancy gr p
Qty. if
AppliaaaFee 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
72,�