03090083 CI'FY OF CUPERTINO r �w b5A,
RUILDING DIVISION PERMIT CONTRACPOR INFORMATION 4
BUILDING ADDRESS: T D ROOFING PERMIT NO 03090083
a OWNER'S NAME: 3540 MARGATE AVE . PERMIT ISSUE DATE
NE: (408) 892-8872 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+oo LICENSED CONTRACTOR'S DECLARATION JobDescri tion
U I hereby affirm shat 1 em Iieenxd i n ss ndpronu ors C.da. 9(commencing p
with Section 70fX1)of Division 7 of the Business and Pru(cssinh Colo.end my license is
] Pct Dfullforteand efflicg a-a�- REROOF
l�? License Class
31„ Dao: contncmr
eCIIIT:C SDECLARA �,•
L 1 underat uad my plans,hell w used a Pulibe memda
>�V
eo Licensed Professional
OWNER-BUILDER DECLARATION
<E 1 hereby affirm that 1 am excran'from the Contractor's License Law for the
OD following mason.(Section 7031.5,Business and Professions Code:Any city or emnuy
5 m which requires A permit tis construct.alter,improve,demolish,or repair any structure
-iy prior an its issuance,also requires theapplicant for such Permit o Nc a signed statement
sexa thatheisliccnsedpursuanttotheprevisimtaoftheContractor''sLicenseLaw(Chapmr9 Sq. Ft. Floor Area Valuation
(commencing with Section 7000)of Division3o(the Businessand Pr6coatom Cnle)ur
$
at he is exempt therefrom and the basis for the alleged exemption.Any violation of 34215062 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of Type
not more -APN Number Occasane Nan five hundred dollars(SSW). — "' -- - -- - Occupancy -- -
❑ I,ee owner of the property,or my employees with wages As their sole compensation,
will der the work.And Nesnet..is not intended or offend for salc(Sec.7(Nt4,Busircas Resquired Inspections
and Professions Code:The Contractor's License law does not apply to an owner or 307 - INSULATION
p
property who builds or improves demon,and who does such work himself or through his
own employees,pravtded that such improvements Are not Intended or offered for sale.If. 601 — ROOF TEAR OFF
however,me building or improvement is sold within one year of completion,me owner.
builder will nave dre harden of proving that he did not wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
sal`) 603 - ROOF BATTENS
❑I,a owner of the Sec.7property,.Business sia nil conmeProfessi ns C d:)ceheC convectors to .. . . -
construct ameLawMornotaSec.7o in
who
hds or i Them Ra on,Li. 604 ROOF IN—PROGRESS
eche law doe notapplypor a an owner of property who wilds or improve Corton,and
Lwho ica.LacLL for each projeN with ecamm�or(s)liccnxd pursuant to me Contractor's ,
License Law.
slam exempt under Sec. ,B&PCfor thisrtuon
Owner Dam
WORKER'S COMPENSATION DECLARATION .. .
1 hereby affirm under penalty of perjury one of she following declar amus.
I ban and will maintain a Cenificate of Consent o self-insure for Worker's CumPcm ,.
cation,As provided for by Section 37110 of the labor Code,for the performance or the
work for which this permit is issued.
11�1 have and will maintain Worker's Compensation Insurance.as acquired by Section
3700 of me labor Code.for the performance of me wed for which mix pennies is issued.
My WorkelsC mpenAation 1 gramce eater and Policy number an:�
Cartier. Policy No.; 14-� I1
IS
CERTIFICATE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mils section need not Ire completed Kthe Permit is phone hundred dollars($11X1)
or Icss.)
1 certify that in the performame of me work for which this permit is issued,I shell not
employ any person in any manner an u at become subject to the Workers''Compcnau:on
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificm of Each,pilon,you should
become subject to the Workers Compensation previsions of the labor Cade,you must
= O forthwith comply with such provisions or this permit shah be deemed revoked.
Z N CONSTRUCTION LENDING AG ENCY
1 hereby affirm that there is construction lending agency for the Performance of
$ Ca' the work for which this Pmrnll is issued(Sec.3M7.Civ.C.)
iQ Lender's Name
z Lender's Address
I cerefy that 1 have may this application and state deet the above information is
yF coned.l agree to comply with all city and county ordinances and sntelaws relating to
�O building consuuaion,and ecrcby awhorim mprocmmatives of this city to color upon me
U above-mornomed property for imPecdon purposes.
y (We)agree to save,indemnify and keep harmless the City of Cupertino against
rat
liabilities judgments.costs and expenses which may in any way some Against said City
J7 in consequence or the granting of this perm it.
r^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplicaDAM
HAZARDOUS
US MATERIALS DISCLOSURE Typo Of ROOF
Will the applicant tar forum building occupant some or handle heruduu material
As defined by the Cupertlne Munici at
Code,Chapter 9,12.and the Health and Safety
otic,So❑clYt'23532(a)? N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant a fawn building axeupam taw equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
P hmaJnus air comsminAn def ncJ by she Bay Area Air Quality Management all new materials for inspection.
unnet7
❑Yea ❑No
I bout read be hammdoas materials mquiremcnts under Chapmrf.95 of me Ca:ifer. /L
nix Halm g:Safety uJ Sc bats 25AI5,23533 anJ 25534.1 unJcrswnJ mat if the willing
darn nm aurrcn0y aw a k am,met it is my respohihi:ity m nndfy the aeup t of Ne
requlremcnts whi o ua trance oft Ccnif¢a¢of Occas�;
f �� ! i' p? Signature of Applicant Date
'
Owner or sothaiyea agent f ,Dare 1 All roof c Brings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
W
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408) 777-3333
UPEkTINO
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: i 2.1 i n a kik ck j
Job Site Address: a a S 4 3 [Al n,, do 9k C r
Roofing Company Name: T 1) R 00,A 11 a
A
licant's Signature: 7 _ Date: `l 3
e teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
n
CITY OF CUPERTINO o 3 6 0
REROOF !�
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
3yatS 0GP- cql „ o3
Building Address:
2 1 5 4- 3 1n� traz� u',c�cj.e
Owner's Name: Phone#:
Z�� it1 Nlnw 4og '7fo5 � 02Uq
Contractor: Phone#: License#:
( D QOoo, yog aNq t 6 T G6lJ
Contact: Phone#: Cupertino Business License#:
�vkV\ 0c )I 4Q$ G4G 8350
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles jQ Asphalt Shingles
)d Wood Shakes ❑ Wood Shakes t
❑ Wood Shingles Cl Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs. k'
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
re,,,ove wood S4c.Le
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are an estncttons LJ
Cost of Project: Type of Const/ructiot�� Occupancy group _
9 Rx Wool
'1
Qty. ifI
A l' abl 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
it