03070147 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING AD00.E55: AMCO TRU-TEMP PERMIT NO 03070147
OWNER'S NAME: 161 CENTRAL AVE PERbdIT ISSUE DATE
NE: 4082934313 SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Met,
LICENSEDCONTRACTOR'SDECLARATION - Ib DrI 1100
i I hereby affrm Oe$G
that I am licensed under provisions of Chapter 9(commencing ,.P n
< with Scaron701XB of Division Softnc Businessand Professions Cods.and mylicenseis
< in full fore,,,no off,I
qg license l s Lica a EROOF
z— oa¢ Can,ncmr
A HITECI-S DECLA0. ON JUL
< I undesund y plans shall he used u public remail, 0 2003
J U
3 G Licensed Pmfesommid
0WNE0.-BUILDER DECLARATION �11�LL/] g+al� a�
< affirm M I botchy arm that 1 am exempt from the Contractor's License Law V for the
p 0 following meson.(Section 703 1.5,Business and Pmfessimss Cade:Any city m county
E:
$ff which requires•permit caswcl,alvr,
t ermimprove,demolish,or repair any structure
prior to its issuance.also imurres the applicant for such Permit to fie a signed suumenl
hb'< that he is licensed pursuant to the provisions of the,Contractor's Lhmnsc Law(Chapter 9 Sq.Ft. Floor Area Valuation
rc�m (commencingwith Seelron70D)of Drvision3ofthe Busincasand Pmfessines Corde)ur
r3 9 Nu he is exempt Ineref ion and the basis far dm alleged exemption.Any violation of
Section 703 1.5 by any applicant fora permit subjects the applicant In a civil penalty of APN'Number Occupancy'Type
not marc than fm hundred dollars(5500).
❑1,As owner of the progeny.or my cmploycea with wages in their sole Compensation,
will do the work and Ne income is sol intended or offered foaa]e(Sm.7W.Buainnt 305
and Pmresuons Cade:no Composite.Lt..Law dors not apply to an owner of — �MF' Required Inspections.
propcny who builds or im,nows themon,and who dmesauch work himselfor through his 307 - INSULATION
own employees,provided that men improvements am not mmnded arartemd for nit,If. 601 — ROOF TEAR OFF
however,the building or improvement Is sold within one year of completion,the owner.
builder will have the burden of proving that he did not bur If or improve for pugmac or 602 - ROOF PLYWOOD NAIL
ale J.
O L as owner of the praMny,am exclusively contracting with licensed convectors to 603 - ROOF BATTENS
Conswcthepmject(Sec.7044,BusinessandProfesionsCaae:)TheConbaetar'aLi. 604 - ROOF IN-PROGRESS
came law does not apply to an owner of progeny who Wilds or improves themon.and,
who contracts for such projects with a comramm(q licensed pursuenl to the Contractor'.
License Law.
❑l and exempt under Sec. ,R&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 bereby affum under Penalty of perjury ane or die following declarations:
I have and will maintain a Cenrfesm of Consent to self-Mum for Worker's Compcm
sedan,as provided for by Section 37M of the Labor Cade,for the perfmmanm of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,ss required by Section
3700 of the Labor Code.for the performance of the work for which this pearth is issued.
My Work[rs Compensation]nsunnce came,end party,n�uymWAr are;
CaM,,'5T e `t/ r s l`AP Policy No..y
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Tlhis arelon need nal hccomplemd if the permit is rare.hundred dollars(Ill(y)
or lost.)
I certify that in the Performance of the work for which this permit is Issued.I shall not
employ any Person in any manner an as In become subject to the Workers'Compensation
Laws of Celifomra.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenifteale of Exemption,you thou];
become subject It be Worker'.Compensation provisions N the labor Cock,you must
wJO foMwi th comply with such provisiana or this permit shall the deemed revoked.
Z '-' CONSTRUCTION LENDING AGENCY
'H Ihcmhy offnm that there is construction lending agency lot the Performance of
!Yi the work fur which this permit it issued(See 3(197,Civ.C.)
M A Lender's Nemc
= z Lender's Address
V 0 1 certify that I haw read his application and sure that the above information is
contact.I again to comply with all city and county ordinances end auto laws relating to
0 U building conswction,and hereby authorise represenutrves of this city to chat upon be s
Q above-mentioned pmNrly for inspection purposes.
CL WC)III la cave Ind expenes fy keep hay in ant he City ofe CupertinoagainstCi
g'
y liebllitiea,judgments,ensu and expenses which may In any way eceroc against cold City t II
V Z in consequence Of the granting of III per L
'-' APPLICANT UNDERSTANDS A LL IPICOMPLY WITH ALL NON-P INT Issued by: Date
OUR G�HTION _ ^ / �8'
O-�� J Re-roofs
Signature pp]icanuICamostor Dam
HAZARDOUS M RIALS DISCLOSURE Type of Roof
Will the applicant car fuwre bat' Ing occupaitisme or handle hazardous material
ss dcfned by the C.Penlna Mume, Code,Chapin 9.13,and the HII and Safety
Code,Section 33533(,)?Y. All roofs shall be inspected prior to any roofing material being installed.
�I
Will the apPlrcolwr future W{Idingacupani use cquipmenl ordcvims which If a roof is installed without first obtaining an inspection,I agree to remove
ill ho'rardaus air cnnuminenb as food by the Bay Area Air Quality Management all new materials for inspection.
isvin?
❑Yes
1 have mrd die harardu.255 ialstequimmenu under Chapter b95 of the Wilding 6
Dia HrslN&Safety Coot,Sceuam 755115,]5533 and 25 C yEirandlndthuif.'r Wilding
dma not cu oily have a tenant Not it i ponsihi]ity m nndly the me pant of Ne
to
me "hmunW pion ' coraCcnifon.
ofC<cupap�y.' g�gna�Applican— tT�— Date
i
nmh 'red agent All roof coverings to be Class "B" or better
OwncruD
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
OUPEkTINO
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:
Job Site Address:
Roofing CompanyName:
J CA �,k—
A plicant s Signaft� Uate: a7
\il/�6WD�Xt `
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
CITY OF CUPERTINO 63 v 7014
0 ` , 7
ao REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 0 � �� Date: 07/1 '9 O;3
Building Addres . �J `� /?A)D
Owner's ame: tPhone
�, L,3 L!CZ-- �CR-— C_K
M M R5 ,
Co ra or: _ t Phon� #: �I 3 Licenssag
Contact: Ph ne#: Cupertino Business License#:
-r t.>. ,q.o8 803 -3ooa
Type of Roof Covering:
Existing: Proposed:
❑ wilt-Up Roof C3 ,Built-Up roof
Asphalt Shingles V Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Mt.-Y) ❑ Provide I.C.B.O.Report#
0,**'To be Removed SI Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Desc 'pti r- Ma oZ JCS GOt`A OS 1`Tlbht
s'j"pcc{�, �t_kt-SS `;�1•• '�YR� •� 3a R- �
sidential Commercial ❑
're Zone: es ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: Lf
Cost ro ect: Type of C tion: Occupancy gr
`� 68b
\19�r
Qty,t V
A ca.] 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