03100140 CITY Or CUPER'1'INO ?:+Slbxcru� i�N` yr✓m�k?'�,e3+ N'-""-'
BUILDING DIVISION PERMIT CONTRACTOR INFQRMATI®N•
BUILDING ADDRESS: WILLIAMS ROOFING PERMIT NO.03100140
GLE AV
OWNER'S NAME: 4921 CABRILLOPOINT FERMITL45UEDATE
NE: SANITARY N0. CONTROL NO.
(408) 252-5120
ARCHITEC"UHNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Io0 LICENSED CONTRACTOR'S DECLARATION
itsa Ihereby 070)omthalamRttexaandeAndPi.mn.nfchapmryaommenang Job Description
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with Section 90 efficf Division 3o the Business end ProfcaiunsCMe,and my license is
d infell(omeanJcff 7� REROOF
o LicCost
CI -Lic.N /
IF Da¢ Con DECIr
ARCHITECTS DECLARATIO i 0/!j v/
1 unanJ in dcrumy plashall bd a records usepublic cns
> u
.0 Licensed Pmfcasinnel
OWNER-BUILDER DECLARATION
1 hath}affirm on 1 am exempt from the Contractor's :License Low for the
p O fallowing reomn. Pani,t 7f13 L0.Business and borrow,de ons Cnde:Any city ser roomy
1 which its iscs a permit to conswct,pahc�plic forsuh Permit,or repair any structure
f primmiuiensed p.alwrequihe the
ovisiosofnr xchpefmitmfiensle a eLaw(ned utemem
-�< that me cing wJ pSectio 7to 001 of Division
of she the Business
nd Professions
(Chepter9 Sq. Ft. Floor Area Valuation
2 $
(commencing Mals xempth Section]1100)of Dhersis far
of the,cd euand Professions Cnde)or
feat he is exempt therefrom and Ne bnsu(ser Ne alleged exemption.Any violation of
Section 7071.5 by any applicant for a pertnB subjects fee applicant to a civil penalty of APN Number Occupancy Type
not mom Nen five hundred dollars(S7o0).
❑1.As owner of the property,or my employees with wages As Heir sale compensation,
will do the work,and the strunum Is not intended of offend for sale(See.7014,Business
and Professions Code:The Commences License Law does not apply to in owner of Required Inspections
property who builds or improves Hereon,and who doessuch work himself or through his
own employee,provided Not such Improvements are not intended or offered for ale If,
however.the building or improvement Is sold within ane year of completion,He owner
builder will hive she burden of proving that he did not Wild or int pram for purpose of
ale.). -
❑1,as owner of Ne property,am exclusively contracting with licensed contractors to
construct the project(Sec.7W,Business and Professions Code:)The Contractor's Li.
cense law dues not apply to An owner of property who Wilds or improves daemon,and
who contracts for such projects with a eontracmr(s)Remed pursuant to the Cransto's
License law.
❑I am exempt under See ,B&P C for this noon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby from under penalty of perjury mm of the following declarations:
1371M
I have and will maintain a Canificate of Consent self-insum for Wurkefs Compon.
much,u provided for by Section 3700 of the laWf Code.for the performance of the
rk for which His permit is issued.
I have end will maintain Worker's Compensation Insurance,a required by Section
of the Labor Code,for Ne performance of the work for which this permit is Issued.
Worker's CompeneaOnnlnsunntt carrier end Policy numb♦er am:
rticr..�.�y��y��:. J'wst-W Polity No.: O TG
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
Cr ousection need not Imcomplated if the permit is fraoec hundred dollars(5100)
car less.)
I ternary that in the Performance of the work for which this Permit is issued,I shall not
employ any Person in any manner an As to become subject to the WoAtrri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Ccnilicate of Exemption,you should
become subject to the Worker's Compensation previsions or she labor Cade,you must
DO foMwith comply with such provisions or this Icrmit shall W deemed reveled.
E2
CONSTRUCTION LENDING AGENCY
I hereby affirm that there its convection lending agency l'onhe performance of
Y. > He work far which this permit is issued(Sec.3097,Civ.C.)
Y —
-Iend.e.Name
z Lender's Add.
Q I cenify that 1 have read this application and state that the above information is
y correct.I agree to comply with all city and county ordinances and slate lawa relating to
DU building construction,and hereby authorisn representatives of His city to enter upon the
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above-mentioned property ror inspection purposes
ti es ju agree to ave,indemnify and tech hay in m the City rs Cupertino against
N liabilitie,judgrento eons Indemnify
dnpensmdwhichocep may in she yaccmeagainst aigCity
j Z in consequence of fee granting of this permit.
LICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
r OURC ULATIONS. /o/4"I
J n
�4 Re-roofs
Signature of ApplicamuCansrsumr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Be applicant or future Wilding occupant Store or handle he�ous materiel
a do in by
the Cupertino Municipal Code Chapter 9.12,and she Health and safety
code.SectionYes x553xe)7 All roofs shall be inspected prior to an roofing material being installed.
❑Yon P P Y g g
Will
the
applicant or future building occupant use cquipmcm or device which If a roof is installed without first obtaining an inspection,I agree to remove
it heardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
inrict?
Dyes <Nu
Ihaw a&Secl HehmSeen.25505. 5533Adnns SP.Iu Chapmd!endifne,Calding
nia Hraldt chummily
a teams.
tat it
5 y r anJ 257}4.1 In hour,t e=up Wilding
Jars not cwrently hew a enanL Nu it is my responsibility m urdly the oceupan of the
�rymmmcnu whi/nth mustW met panonn issuance of a Ccnmcau,of cu ey. Signature of Applicant Date
\� U 2d0 2
Owner or aushorircd agent U Date All roof coverings to be Class °B° of better
Community Development Department
Building Division
awl",
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPERTINO
Building Department
Subject: Re-roofing policy for the City of Cupertino
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1. Prior to permit issuance,you must agree to comply with 1997 UBC S and®{ 2 0 2
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all ' n
and written approval from the building inspector. A final inspection a d
approval shall be obtained from the building inspector when the re-r of
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: AN azo C" ✓A
Job Site Address: 1W g� D �( fxc(� LE UZ .
Roofing Company Name: W u-,,t'►*S _ =L,
A plicant's Signature: Date: %0 2w Jo 3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
I S990 -ru,�, �� a•�E.iutz
Owner's Name: qA�� Phone#:
/-rvt r—Lo GG( VA 4OS- 263 - 569 /
Contractor: License#:
urns 2�0-�',�,� .414 o 't -F
Contact: 'T—D nn 4u8. 2-2-1- p
Cupertino Business License#:
11 z �
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
'g Asphalt Shingles "* Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Ti ❑ Provide I.C.B.O.Report q
To be Removed ❑ Provide Mfgr.Installation Specs.2 IK�Iyf-'
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: S-h h1 P_"v4t+,i Ma-Me *5' 1^07-& �P3Jpij „d'-F
UL,9 50^ R Corti
Residential -171- Commercial ❑
Fire Zone: Yes ❑ N�>a Confirmed withPI t. if
there are anres 'ctionS:
Cost of Project: Type of Cons tmcti0 1 Occupancy up:
-7, S&O.—
Qty. if
ApplicCe Fee 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