03020075CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOR INFURRI1 TIQN
,k
Bull But
ADVANCED ROOFING TECHNIQUESPERMIT
NO.
OWN ,:m7
1179 MYRTLE DR
APPLICATI A _
(408)249-4937
SANITARY 0. CO OL NO,
ARCHIIECf/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CO�R'S DECLARATION
1 he by aMo. Nat I em I ,tinder provisions of Chapter 9 (commencing
with Sc ti 7M1()af Divlaion3o( ass end Professions Cade. end my license is
lob Description
p
In full( andel t.
ucen tee.«SE OSM
Dale' — ARCHI'IEC77 ARATION
REROOF
REMOVE W D RgSH"I'NGI1E,(y ,.- C(MP. SHIN
�� r
I ndgn my planuMll he uecd public records
oAw
LIC" )fVCee on
OWNER -BUILDER DECLARATION
hereby affirm thatI um exempt from the Contractor's License Lew for the
rj[[• �1� I1 .
following moon. section 7131.3, Business and Professions Calc: Any city or county
1■r�g1
which requires A permit to construct. alter. Improve, demolish, or repair any structure
prior w its Issuance, also requires the applicant for such permit to rile a sign.. sutemcnt
Net he is licensed pursuant In the pmvisimta of the Contractm's License Law chnimr 9
Sq. Ft. Floor Area
(commencing with Section 7MM0 of Division 3 of the Business and Profession Code) or
that he is exempt therefrom and the beau for the alleged exemption. Any violation of
APN Number
Occupancy T
y yPe
Section 7031.7 by any applicant for a permit subjects she applicant to a civil penalty of
not mom than fon hundred dolun ($5W).p
❑I.aownuoffnpmpmy,ormyemployenwithwaguuNe'naolccompeuetmn,
36922036.00
Required Inspections _
will do the work and the amtmum isnot inteWW maQemd far We (Sec. 7W. Business
Pmfesslom Cade: The Contactors Liaoe Lew don w
and rat apply an owrcr of
propertywho bulldsor Improves lhemon,and whodoessuchwoh hireaelfortluough his
305 - FRAME
ownemployen, provided that such improvemenu tee oat intended warned for We. If,
307 INSULATION
however. the building or improvement is sold within one yen of completion. the owner
—
builder will have the burden of proving that he did not build u improve for purpose of
601 - ROOF TEAR OFF
Asia.).
602 - ROOF PLYWOOD NAIL
❑ I, As owner of the properly, am escluaively contracting with licensed contracm. w
construct the project (Sec.70Cd.Business and Profusions Cade:) The Contractor's Li.
603 — ROOF BATTENS
cense Lew does not apply to an mou of property who Wilds or improver thereon, and,
who contracts for such projects with a cantsetor(O licensed pursuant he Ntrac
e Communes
604 — ROOF IN -PROGRESS
LicenseLew,
-
❑Iameaemptunder See. ,B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
q/ 1
1 hereby AM, under penalty of perjury one of she following declarations:
/t i�s /
IMveend will mainulne Carinate of Consent to sel6ineum far Workeh Compen-
7 L/� /
O�
tion, a provided for by Section 3700 of the Labor Code, for the performance of the
work for which this Permit Is issued.
as netfhis Per by Section
❑ I have and will maintain Wo ltersodor ante of or ce,which
the Labor Code, for the performance of the or which Nis permit is issued.
My Worke Ca tpenullon Insumme c 'cr en um rare:
My Warier
.\i/' so
a..A {
CCCJ��Bsssm li o.: —.O
0 FROM WORKER
CEImFICA •PEs
ATI
COMPENSATION INSURANCE
"'], QL
(
(This mclim toed not McomPleted If the Permit Is fmoto hundreddollan (SI01t0
or lass.)
Net In the performance of the for which this Permit is issued. I shall
n/
/f.(
e ploy on
employ any person in any manner w as to become subject m the Warkcrs' Compcnsauon
to be
lewa of California, Dem
ApplIC
NOTICEof Exemption, you should
OT TO APPLICANT: If, after making this Ccrtons
become w the Worker's Compensation of Labor Code, you moat
pmvisiom of the
hsubject comp
forthwith comply with such provisions or Nis permit shall he deemed revoked.
orthis meed
CONSTRUCTION LENDING AGENCY
- I Nn thereto construction lending agency for the of
�j\lM1J- l 01/2'IO�
YV ( `
Forherebywhillithi Performance
wish for which this permit is luted (Sec. JVd7, Civ. CJ
/
Le
Lender's Name
Lender's Address
1 certify that I have read Nis application and sum that the above information is
correct. I agree to comply with all city and county ordinances and some laws mining w
building construction, and hereby sufnrlae representatives of this city to enter upon Ne
aWn-rumninned property for Impaction purposes.
(We) agree to save, Indemnify and kap hnmless the City of Cupertino against
Ilabilifies,judgmenu.coso and expenses which may in any way accrue against W d City
ry
//•-a
I. consequence of the granting of fir Permit.
APPLICANT UqDfRSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SO CEGU ONS.
Re -roofs C7 L
Tyof Roof
pe
esu AppltcanUCanusctor Dam
HAZARDOUS MATERIALS DISCLOSURE
III the applicam or fuwm building occupanuwm m Iundlc hvudous mamrial
rWhy
u de the Cupertino Municipal Code. Chapmr 9.17, and do Health and Safely
Code. Sectionn3533(e)7
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or (tet tiding occupant use equipment or device which
it Innardnu air contaminants u defined by the Bey Area Air Quality Management
all new materials for inspection.
I'MO
❑Yest
Iheva road! the henrdnusmeterlale myuimmcnu unticr Chepterfi of Ne Califnr
inHeal"& Safety" , 'o""I it And 25534.1 INA hailding
is my r
d A not cunemly hu a est, Net it is my responsibility In notlly the m t of Nc
to mmunthe
requl it sect peer w ismance ora Cotificste or Occu
I -0D
ture of Applicant Date
All roof coverings to be Class "B" or better
Owner
ore onzad Agent DAM
gg i
CITY Of
CUPS TINO
0
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 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:OSQ�� W w 4 ��
Job Site Address: l d`h�4
Roofing Company Name: d 1 n 9 _ _Oce
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date: R::L -_03