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03040099 CITY OF CUPEwrINO BUILDING DIVISION PERMIT CONTRACTOR�INFO RMATI®N B�uQD TYDNPtb:ODRIDGE CT T D ROOFING """'03040099la J COHEN 3540 MARGATE AVE. PERMIT L59UBD7 82003 (408) 892-8872 NE: SANITARY NUO.4 l CONTROL NO. ARIHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH !O tp LICENSED CONTRACTOR'S DECLARATION i 1 hereby affirm that 1 am 3.r the nu omens Provisions n Chapter 9(commencing Job De$C n m wishilrunc and ar nr Divinion3of dd Ousinanand Profcssinnn Cpdc,and myliccnu is _ in full fnmc and cf( t. �s7 pG,Z 2 ig3 ucenaeeiess 79 �q tic at REROOF p Da¢ Contractor i e ARCHITECTS DECLARATION Y afqq / 1 undersand my plans shall he titin as public rtcnrds !/ ?a :0 Licensed Professional OWNER-BUILDER DECLARATION Q COO 1hcmhy.Secton1ore eacmpthum dd Contractor's o Any Law for COO which ire reason.(Section IDconstruct,al eat end I'mim.d sioli Cnde:Any city m c unty cture < which reyutsea a permit re rthem¢a improve,demolish,or mash any noucntre YZY prior its issuance,also requires the applicant for uch permit to ie anigned sadmem : 0 that he is licensedrotsuanunthePmvistmuoftheContractoriLicenseLaw(CMpler9 Sq. F[. Floor Area $1(Y®l"ion Z (commencing with Section 101KB of Division 3 of the Business and Prafessinm Code)or $ that he is exempt therermm and the basis for Box alleged exemption.Any violation of Scallop 1031.5 by any applicant for a permit ubjects the applicant to a civil penalty of 3AANa,1sCn�Mf00 Occupancy Type not mom then five hundred dation(S 0). YYGG14l'"'�J11YY 1bC P Y YP ❑I,uowncr.Ne treatme ormyempleym wtlhwageathei(Sec. W,Business ' will do Newark end theswnure lariat intendedo Ls. apply 10 an what of 305 - FRAME and Prtywh obuilds is Code:The or ve&Contractor's and hw docs Out apply la an owner of Required Inspections Propenywyees.tlsided that such improndwho are does such tended lmulfodNr ugh ale.If. 307 - INSULATION own howempinyees,ping or i provehimprenmentsin net arty of dmor affered theownr. 601 — ROOF TEAR OFF however,the building or improvement is old within one yeti a!completion.the owner builder will ban the burden of proving that he did nor Wild or Improve for purpose of 602 - ROOF PLYWOOD NAIL alc.). . ❑I,as owner or the property,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS consumer the pmjoct(see.1044,Business and Fidesiaro code:)The Canuaemrt L6 604 — ROOF IN-PROGRESS come law does not apply to an owner of property who builds or improve thereon.and who contracts for such projects with o contractor(s)licensed pursuant o the Conerectoi s Lieenti Law. , ❑I am exempt under Sec. .B h P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby M.under penally of perjury ooe of in.following declualioa: 1 haw and will maintain a Certificate of Continuo til6insure for Wo Ian's Camper. _ ration,as provided for by Seaton 3100 of the 1aWr Code,for rhe performmce of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Imunnce,as required by Section 3100 of the Labor Code,for Be performance of one work for which this Permit is issued. My Worker's Corrmp��enurion Insurance carries and Policy number am- Carrier: Carrier: 9/InF �&,il Policy No.: IU Z y/ �s7b_ CERTIFICATEPTION FROM WORKERS' COMPENSATION INSURANCE (Thu it,.need nm W completed if rhe permit is fm ane hundreddnllan(SIM) Ica.) 1 cenlry that in the performance of the work for which this payout is issued,l shall not employ any person in any manner se As to become Subject o rhe Worked Compemarion Laws of California.Date Applicant NOTICE TO APPLICANT.If,alter making this Cenirleate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must 7z forthwith comply with such provisions or this pend it shall W deemed revoked. .z2 CONSTRUCTION LENDING AGENCY I hereby affirm Nat tbee its construction lending agency for the Performance of X 7 Ne work for which this permit is issued(Sec.3097,Civ.C.) Landcl4 Name D Z Linis',Addmss j Q 1 certify that 1 haw read this application and send that Om above iofooradon is y P correct,1 agree to comply with all city and county ordinances and add laws relating to DU building construction,and hereby authorve representatives of this city to enter upon the .he a-menlioncd property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against N liabilities judgments,costs and c.NO.which may to any way accrue against said City L)Z to consequence of the gmming ufthis permit. APPLICANT KUUNDD4'EDERRRSSTgANDS AND WI SOURCLLL COMPLY WITH ALL NON-PO1NT Issued by: Dale _ `REi / 'Vf SIPS Sigmmrc pIwam/C nlracmr � Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant stare or handle haamdous material a defined by the Cupertino Municipal Code.Chapter SAT,and the Health and Safety Code,Section 25532(a)? I-)Yes �� All roofs shall be inspected prior to any roofing material being installed. tics Will the applicant or future Wilding occupant use equipment in devices which If a roof is installed without first obtaining an inspection, I agree to remove mil hazardous air contaminants as defined by the Bay Area Air Ouality Management all new materials for inspection. District? ❑tics r5ayy I have mad the hounlnus madrialsmquimmcnu under Chapter 6.95 ofthe Calif., - meHealth&Sofety Code,Sectnew 25505,25533 and 25534.1 undersand tholifdd Wilding �q Or. ve o not cemently haa lenient,thm an it is my responsibility minty the amupml nil the D rcquiremen whichmustbe lnormiguana cr4fieateofoccupancy. Signal of Applicant Date2� V Owner or ambo' dagcm i Dad All roof coverings to be Class "B"or better Community Development Department i Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY Of Fax; (408)777-3333 C U P E k I N 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. Homeowners Name: Job Site Address: '>Z 62 (i(-(9b D �Ct Roofing Company Name: T_D 020 AplicanYs Signature: _ Date: ���3 \�ll¢61h1D�X1 Greg eel Building Official Revised 1/30/03 __Printed an Recycled Paper CITY OF CUPERTINO D REROOF CUPERTINO PERMIT APPLICATION FORM APN# 3 % 2— lS 0 ? O Date: Af-03 Building Address: 2 267- (ti40 f Owner's Name: Phone#: Contractor: Phone#:-z 104 Z License#: rtb f:2,i 6766zZ Contact: Phone#: h pq—( 4 I q Cupertino Business License#: e�rr- Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ 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: 6z©DF Residential R' Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are any restrictions: LLJJ Cost of Project: Type of Construction: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING J BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING