03070097 CITY OF CUPERTINO " � "`�'' '
BUILDING DIVISION PERMIT ,CON TRATOR TNFORMATeION, .
BUILDING ADDRESS: T D ROOFING PERMIT NO 03070097
OWNER'S NAME: 3540 MARGATE AVE. peRMrtlsuB DATe.
NE: SANITARY NO. CONTROL NO.
(408) 892-8872
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Y00 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed un��dy]C.{��-ap'ytr.,visions of Chapter 9(commencing Job Description_�
Z with Stenon 7000 fafD' ision 3 ofthe Bus Professions Professions Code,Ind my liccnsco
<< in full farce tett. / ,2 a- REROOF
LicenmG Lie.. JUL 2 12003
wZFZ Da¢ A CHITECPS scpuhORncnrds
C understand my plans shell M use BUILDING;LL] LiccnsedPmfcisinnel BUILDING
O
OWNER BUILDER DECLARATION
2 1 hereby orf rm that I am exempt from the Convenors License Lew for the
S:00 following reason.(Section 703 1.5.Business and Professions Code:Any city or county
u�B which require a permit o,cmomme.she,improve,demolish,or repair any struaun
prior In its issuance,also rt toms the applicant for such permit to rile a signed Statement
Nal he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
y �
(commencing with Sectio 70M)or Division 3 of the Butinesa and Professions Code)or
that he is exempt therefrom and v¢bub for the alleged exemption.Any violation of
Section 7031.5 by any applicant for.permit subjects the applicant to a civil poutly of APN Number Occupancy Type
not mom man fin hundred dollen($5001.
❑1,Is no,of the properly,or my employees with weds.Is lttcinole compensation, -
windothework.and the structure is not intended at offered for tale(Sec.7M4.Business 305 — FRAME Required Inspections
and Professions Codc:The Contractors License law don not apply to.n owner or p
Property who Wilds or improves Chercon,and who doessuch work himmlfor through his 307 — INSULAT ON
Own employees,prodded that such improwmenss are not intended Or ofrcmd for sale.If, 601 — ROOF TEAR OFF
however,the building or improvement it sold within one year of completion,the Owner-
bu0der will have the burden or proving that he did not Mild o,improve rte pmpom of 602 — ROOF PLYWOOD NAIL
aleA 603 - ROOF BATTENS
❑h as owner of tot property,...elusively contracting with licensed eontncmn to
convect the project(Sec.7oaa,Business and Proresaions Code:I The Contractors Li. 604 — ROOF IN—PROGRESS
const law does not apply to an owner of progeny who Milds or improves thereon,and,
who contracts for such projects with a eonvanor(s)licensed pursuant to the Convector's
License Law.
❑1.exempt under See. B,k P C for this naso.
Own Date
WORKER'S COMPENSATION DECLARATION
I hereby air.under Nosily of perjury one of the following dcclmtions:
I have and will maintain a Certificate of Continuo mlf-insure for Worker's Compere
etion,a provided for by Section 3700 of the labor Code.for the performance or the
workforwhicbibispermiti.iuued. '
0'I have and will maintain Worker's ComPensation Insurance,as required by Section
3700 of the labor Code,for the performance of the work for which this permit is issued.
My Wnrkeh C1nmpensetionn_nsurances trot/ nd Policy number aa: ,
Ca�twT S l Ck ♦k_ryT policy No.: I
✓✓ CERTIFIC TEOhEf(EMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not W completed Ifft Permit is for one hundred dollars(SIM)
or less)
1 cenify Nut in the performance or the work for which this permit is Issued.I shell not
employ any person in any manner an as to become subject to the Wo linos Compensation
Laws of California,Date
APpltcant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you most
.,,Z forthwith comply with such Political or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a comomninn lending agency for the performance of
C' Ne work fur which this permit Is issued(See.3097,Civ,C.)
W Z Lender's Nam.
2 Lender's Address
U Q 1 cenify that I have read this application and stave that the above infotmatlon is
U.f" correct.I agree,to comply with all city and county ordinances and state laws relating to
C)U building coawmion,and herchy authorim representatives of this city to enter upon the
}a .hove-mentioned property for inspecuon purposes.
(We)agree to ave,indemnify and keep harmless the City of Cupertino against
f+N liabilities,judgmems,euts end expenses which may in any wry accrue against aid City
U z in consequence
Te of the
ERSTANDStANhis D WILL COMPLY WITH A L N T Issued by: 4Dat
S E E ATIONS.
`I o Re-roofs
Signamrc or App troHAZARDO Date
HAZARDOUS MA IALS DISCLOSURE Type of Roof
Willy teCotent.rfmur ipal upantrhandle Health
material
u defined by the Cupeninn Mu icipel Code.Chapter 9.11,and the Hcelth end safety
Code,Section zsSuan All roofs shall be inspected prior to any roofing material being installed.
I ❑Yes No
Will the applicant ter rwvrppp{building occupdm usd cyuipmcnl ter Jcvicvt which If a roof is installed without first obtaining an inspection,I agree to remove
it havrdnus sir conlaminanerks Jcrined by the Bay Arta Air Quality Managcmcntovict? all new materials for inspection.
tIm
0Yes No
I have mad the h.ohmstmocri.ls requirements under Chapter 6.95 of the Calif.,
nis Health Y Sxfety Code,Secuom15505.15533 and 25534.I understand matifthe Wilding 7 j i/ /(03
ns not curt dy o e tenant met it is my responsibility m nn'ly the occupant of the —uiocmcnk est aprionoissuanceor.Certificama =y SignatureofApplicant Date
M4¢ All roe verings to be Class"B" or better
Owner m authorized egem Dmc
'i"' Community Development Department
�wttv
Building Division
. City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
4UPEkTINO 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
ppabove stated policy on re-roofing.
Homeowner's Name: ZYL a w a
T,
Job Site Address: k CJ
Roofing Company Name:
A plicant's Signature: j" Date: 4 /V) 3
\iI/QSlJl1DCXt
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF 03 J 7 ? 7
CUPERTINO PERMIT APPLICATION FORM
APN# _�U ;L _ + S ro 6 Date:
II Iv ( 03
Building Address:
4` 9- S $ 3 1Nooclv; cl e �{ C, etkl��o
Owner's Name: Phone#:
T,,_ �� C., q u s ass - 1 6 8°I
Contractor: /� Phone#: License#: 6 6 6.a 2
1 D 1Z a cz � 11 V\ y .)'& I- y Ql l 0 4-a
Contact: ( S ��yt Phone#: o Cupertino Business License#:
Q
1 Yoh Fs t. S8�a
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up RoofBuilt-Up roof
El ❑Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential Commercial ❑
Fire Zo : No Confirmed with Plannin if
there are an restric ' ns
st of Project: Type of Constructn: Iq Occupancy grou .
Qty. if .
A li e 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