04060174 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR TNF(?;;MAT116Nz°-:.,
BUILDING ADDRESS: KEVIN SULLIVAN ROOFING PERMITN004060174
1201 WEYMOUTH DR
OWNER'S NAME: PERMIT LSAM DATE
ah CHARLENE ARCHIBE UE 1696 VALLEY
NE: SANITARY NO. CONTROL NO.
(408) 842-1057
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Loo LICENSED it. itCI do DECLARATION
Lhergby affirm Nal I em Ilanud a der rovi¢ions of Chapter 9(commencing JOU Description
with See 7IX110 afDivision Sof the Budin dPro(essium Cate,end myliccnu la
PlAl
4 Ivan anderrttt. 67 �0 3� )� REROOF W/COMP. SHINGLES zt®
Z g License Clew _ Lir,R �y
�e qqg Dem Cum ter (�
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ARCHITECTS
1 under a n'liahalll W used u Ile.corns
3 G r^ tccnu DE TION
�U rC�a- ?pQ4
3 OWNER-BUILDER DECLARATION /��i
<8 1 hereby affirm that I am exempt from the Conlmcmra License Law for the
t es O following mason(Section 7031.5,Business and Profeuians Code:Any city or county
m which requires a Permit m construct.alter.improve,demolish,or.pair any sound.
t-Zty^ Prior m its issuance,ala.requires Neapplimst for such permit to file signed statement
that W is limnscd pursuant to the provisions of the Commons Licorice Law(Chapter 9 Sq.Ft. Floor Area Valuati
9S (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
Nat he is exempt therefrom and the bssis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of
not mom than five hundred dollen(MM. 8 Occupancy Type
❑1,as owner of the property,or my employees wide wages as their sole compensation,
will de the work and the suuaure isnot intended or offered for ale(Sec.7044,Business
and Predications Code:The Canuu.es License Law done not apply to an owner of Required Inspections
property who builds.r im proven thereon.and who dos such wmk himu If or through his
own employees,pmvided thmuch impmmmenuare notintended.,offered f.rsala.lf.
however,the building or improvement is sold within one yeti of compl.don.the owner.
builder will have dee burden of proving that he did not build or improve for purpose or
sale)
❑1.as owner of the property,am exclusively contracting with licensed conoucmn to
construct the project(Sec.7131 Business and Professions Crede:)The Contractor's Lt.
cause law does not apply to in owner of property who builds or improves thereon,and,
who contracts for such projects with a contractar(s)licensed pursuant to dee Contractor's
License Law,
t]I am xicap,under Sea .B k P C for this reason '
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby salon under penalty of perjury one of dee following declarations:
1 have and will maintain a C.Bifrcme of Consent to ulNumm for WorkcrSContras.
anion,as provided for by Scotian 3700 of the labor Code,for the performance of the
work for which this permit is burned.
0 I have and will maintain Worker's Compensation Insurance,as acquired by Section
3700 of the labor Code,for Ne performance ofdan work forwhich data permit is issued.
My Workers Compensation Insurance carrier and Policy stockinet:
ri
'ice �� �C)r�.l{(• CPoliey No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This scedon need nonksompli and if the permit isforone hundred dollars(SIM)
or lcI
I mnily the in the perfnmuse.of the work for which this permit is issued.l shall not
employ any III in any manmru m to become subject to the Workers'Compensation '
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.IL after making this Cortifrmm of Exemption,you should
become subject to the Worker's Compensation previsions of the Lodu r Code,you must
.J O foMwtth comply with such provisions or this permit shall be deemed coveted.
z " CONSTRUCTION LENDING AGENCY
[r ► I hereby affirm the,there in is contraction lending agency far dee perform...of
ai > the work for which this permit is issued(Sec.MITI Civ.C.)
OWi Q Lendcr9 Nam.
= z Lender'Address
fJ Q 1 certify that I have mad this application and stste that the above information is
[l. F correct 1 eg.s to comply with all city and county ominantts and suite laws miming to
V building construction,and hereby authorizemPru.matiws of this city to enter upon the
fTa above-ms,judg d minoritycosts
dor impaction purposes
gy (We)agree to save.indemnify end keep harriers the City of Cupertino against
h liabilities Judgmentseeosmand of thisnswhich may inany way attmc against said City
fJz Inconsequence of DERSTANof this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
K
SOURCEft ULA NS. 3 �
"a Re-roofs
S' use tion.. Date '
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store orhandlc hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25332(¢)? All roofs shall be inspected nor to an roofing material beim
❑Yn �.No P P Y g g installed.
Will the apphcaul or mom building occupant we equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit havardow air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes P�N.
Ihave.ad the hvardnusmatcrials requirements under Chapmr695 ofthe Collins. /
nia Health&Sateyyhim aSecdonshatit i my rospd25534.I in
de occurfft ht ofine
r.smat &Safiy haw.tenant.Natitamy3 it 2i5i .1 unnotify theaecupantofthio
requiremen he rest be mel prior.issuance of a Ceruficam or Occupancy. I -'gnaru Date
wo tri mad egcnl Dam All roof coverings to be Class "B"or better
I
Community Development Department
f� Building Division
iX+j City of Cupertino
ig, 10300 Torre Avenue
CICTY OF A I Telephone: (408) 777-3228
U P E Q1 'N O 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:
Job Site Address: j,zni IVe, 4
Roofing Company Name: �f,Y} 5�(��/� Lt-�(E—ye&
AA12plicanes Signature: Date: (0 —Z�— Q(—f
Greg teel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF 6 ,T
CUPER INO PERMIT APPLICATION FORM
APN# Date:
( � CO ZI - O
Buildin Address:
* tZ UP
Owner's Name: Phone#c ,j0
C 1ST C
Contractor: Phone#: License#:
yZlO
go 3z?-16-
Contact: Phone#: Cupertino Business License#:
.� 0alR I Z35 (0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
WL Asphalt Shingles ff Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ?_ ❑ Provide I.C.B.O.Report#
li) To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: iZt /�lalEl+iKl�i�ESya<to u�vc•t SN«tlic�y� �r,nc�t ! ' �t3 �<ywo t
30yiz cOM(� 5u VC�Glfj
Residential i6 Commercial ❑
Fire Zone: Yes ❑ No Confirmed with ning Dept if
there are an st 'ctions: LJ
Cost of P 'ect: Type of Construction: ccupan gro
Qt . if
A lic 1 Fee ID Fee Description Fee Grou
BPERMFEE BldgPermit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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