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CITY OF CUPERTINO'•-
BUILDING DIVISION PERMIT
CONTRA.CTOIi,INEORMATIONic
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❑mLDING ADDRESS:
RESPONSIBLE ROOFING INC
PERMIT '904010135
OWNER'SNAME:
PERMIT ISSUE DATE
NE
(650) 969-6,151
SANITARY N0. CONTROL No.
ARCH=CT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
M 0 0 0
LICENSED CONTRACT'OR'S DECLARATION
Ihereby affirm Thal l am licensed under provisions of Chapter 9(commencing
Job Descri do
p INA SD
INA
with Section 701 of Division 3 of the Business and Professions Code, and my license is
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LED
in full force and cf cT.
REROOF
Liccnu Clazs C."O
Dam COnlncwr�Q
1 � LDO4
ARCHITECTS DECLARAT N
-FEB
1 understand my plans shall he used as public records
BY'LnyNG
Licensed Professional
OWNER -BUILDER DECLARATION
Y �s/�
1 hereby .('firm That 11. exempt the fessin, License Law for the
Co
following mason. (Section ](131.5, Business and Professions Code: Any citys county
s an
which requires permit construct, alma imp, demolish, or repair any structure
re
Poor It) iceissuance, also requires the inion o for such Permit m Olessigned swmmem
(comm islicensedwd pursuant In the provisions of the
Sq. FL Floor Area
Valuation
(commencing Section 7") of eBuinessnd Professions Code) or
of The Business andon.
(cat
he Any vaCndo)of
Net he is exempt thertfrom end the baso for the alleged exemption. Any violation of
basis for
'
3 5VV NftR:r0 0
araC OQeD
Occupancy Type
Section 7031.5 by any applicant for a Moth subjects to applicant to a civil penalty of
not mom Nn five hundred doll... (5500).
❑ I. m Owner or the property, or my employees with wages az their sole compensation,
will do the work, and the structure is notimended muttered tarsale (Sec. 7(A4. Business
Required Inspections
and Professions Code: The Contactors Lieene Law does nut apply or im no, of
_
property who builds arlmprows thereon, and who doessuch work himse((orthrough his
own employees, provided thatsuch improvements are not intended mastered fanatic. If.
however, the building or improvement is sold within one you of completion, the owner.
builder will have the burden of proving Nat he did nal build or improve for purpose of
ulcJ.
❑ 1, as Owner of Tho prepeny, am exclusively contracting with licensed convectors To
construct the pmject (See. 7044, Business and Professions Code:) The Convactari Li
-
cove Law does not apply to an owner or property who builds or improves Merton, and
who comencm u
far such projects with a conversant) licensed pusmano the Contractor's
License Law.
❑ I am exempt under Sec. , B & P C for this reason
Owner Dna
WORKER'S COMPENSATION DECLARATION
I hereby affum under penalty of perjury one of the following declarations:
ave and will ..Irwin a Certificate of Covent To self-inaum for Workers Campion -
n, as provided for by Section 3]00 of the Labor Code, for the performance of the
work for which Nis permit is issued.
❑ I ban and will maintain Worker'. Compensation Insurance, as required by Section
37W of the labor Code, for the performance of the work for which Nis permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cann to{C YL.xr-/ Policy No.:'?/ 3 75W O-3
CERTIFICATE OF EXEMPTIONFROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dullam ($10)
_
or ksa)
-
1 certify that in the performance, of the work rot which This permit is issued, I shall not
employ any person in any manner an as to become subject to the Workers' Compensation
-
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making This Cerificam of Exemption, you should
become subject to the Worker's Compensation provisions of The Lahor Code, you must
forthwith comply with such pmvisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm door there is a consunction lending agency for the performance of
the work for which Nis permit is issued (Sec. J 197, Civ. C.)
Lender's Name
t
Lenders Address
1 c.nify Net 1 Mw read this application and sow that dre above information is
-
correct. 1 agree to comply with all city and county ordinances and awe, laws relating To
repmsenutives of this city m moms upon Ne
above-mding entioned
.cavo -mentioned propene for inspection purposes
pro and hereby inspection
(Wc) agree to cense, indemnify and keep harmless the City of Ga against
costs and expenses which may in any way accrue against said City
against
inconsequence fth,
Aconsequence of the granting of This permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE REGUL
CUL T
Re -roofs
`!TI/ONS.
� i NI / ¢ei-6
Signature OfApplicianisContracuor Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of ROOF
Will the applicant Or future building Occupant atom or handle hasardous material
as defined by the Cupertino Municipal Cade. Chapter 9.11, and the Health and Safety
Code, section 25532(e)?
All roofs shall be inspected to any roofing material being installed.
F7 Yes Nu
prior
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
huaandrus air corwromms u didEncd by the Bay Area Air Quality Management
all new materials for inspection.
let, �m�
C] Yes Ct
I have mad the haamdous materials requiremmot under Chapter 6.95 of the Califor-
.is Health& Safety Code Seetians 25505.25533and25534.1undeneac Noifthe building
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does not currently haw a tenant. War it is my responsibility w notify the occupant Of Ne
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requomcnu which most be poor toissuance ora C,mr of Occupance.
Signature of Applicant L- ate
All roof coverings to be Class "B" or better
o rauthon.edasenT once
s Cin flF
CUPE�T]NO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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 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: lL11r.
Job Site Address: l0/ff-1 We s fer n �n
Roofing Company Name: A,2f �
A plicantesSignature: ` fL Date: l-2.9-09
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
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CIT O
CUPERTINO
n
CITY OF CUPERTINO d ( C,
REROOF
PERMIT APPLICATION FORM
APN #
Date:
3S - 11- 00
un 2�,z�4
Building Address:
BUILDING
1 e l(
Seismic Fee Res
Owner's Name:
MBSEISMICOM
Phone #:
Mr. Schroeder
BPLANCHK
C 3�I I -223
Contractor:
(Ze5 �oc
Phone #:
License #:
BUILDING -
32-ES490
Contact:
Ed Pel�q
Phone #:
Cupertino Business License #:
C(a5c)Stn� 5980
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
[Asphalt Shingles
Or' Wood Shakes
❑Wood Shingles
❑ Wood Shakes
❑ Other (Specify)
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings 2
ti'�To be Removed
❑ Provide I.C.B.O. Report #
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply
With Cu ertino's Tear Off Policy:
Job Desc 'ption:
1 r 52 1(I
/k nVyhn r -
Residential Commetcial
Fire Zone: ,YaET
Confirmed with Planning Dept. if
--- — —; there are an restrictions: 5
Cost of P ojectype of Construction: Occupancy roup:
41
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BPERMFEE
V LVJlilf LfUll
Bldg Permit Fees
ree Urou
BUILDING
BENERGY
Ener
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
MBSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING -
#21�3�09--