04070076 CI BUILDING DIVISION
PERMITCfy�V'I't�ACTOR I1V'F6MA.TIU1 "" .
BUILDING ADDRESS: T D ROOFING PERMITNO04070076
2941 WC)0T)PTT)r_F6 2T
• OWNER'S NAME: PERMITISSUEDATE
RICK MURRAY 1174n mAP AT7. Aim r /,)n a 4
ONE: SANITARY 0. CONTROL NO.
ARC" CDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1�
tion LICENSED CONTRACTOR'S DECLARATION
to❑ I hereby.(firm that 1 am licensed under provisions of Chapter 9(commencing Job Description
with Section 7")ofUivision 3 of NC Business and Professions Code,and my license is
"o Ei It ren rmree ana err t. G 6 Po 31 REROOF ✓(/ o�
5 License Clsss t Lie.N q
n F p Dam ' Gonu
DEC 2� vjo04
yq ARCHITECTSu bur I - G
Y a I understand my plans shall M used ra public records
3u,y� Licensed Professional
C 3 Out I am exempt
DECLARATION
1 hereby.('firm on I a1.exempt from the Comrns Co License Law for Ity
XgO fallowingmeson. emits 7(01.5,Buainer. and improve.
demolish.
Code:Any city ore county
K$E which requires n permit re ennsweL alma impmw,h Permit t or repair any structure
rZi Prianoits issuad purse requires the applicant fordic sucCon actor' Licenso File ae
Law statement
£ the,heencingeedPursuanunthe pmvivions 3ofthe titins andPreclsw(Chop¢r9 Sq.F[. Floor Area Valuation
Ik $ (cat he
(commencing therefromom and
of Divialon3 of theeged exemption.
Any
Code)or
that he Is exempt therefrom and the beau for Um alleged exemption.Any violation of
Section 7031.5 by any applic.,for a permit subjects the applicant to a civil penalty of 3 47AI.gd31Mer 0 0 Occupancy Type
not more Nan five hundred dollars(5580):
❑I.asowmrofthepmpeny,mmycmploynmwithwagesn ti rmlecomp rewthn,
will do the work,and Neswctuac isnotimemisd oroltmed for sale(Sec.1044,Business
and Professlona Code:The Convector's License Law does not apply m in owner of Required Inspections
property who builds orimproves thereon,and who deessuch workhimselforthreugh his
own employees,provided that such improvements are notimmnded confirmed forsals.It,
however,Ne building or improvement is sold within one year of completion,the owner-
builder will haw the burden of proving that he did not Wild or improve for internee of
sal..).
0 1,as owner of the property am exclusively contracting with licensed mmmous.m ,
convect the project(Sec.104x,Business and Professions Code:)The Contractor's Li
cense law docs not apply to an owner or property who builds or Improws themon,and
who contracts for such projects with acrommmr(s)licensed pursuance de Contractor
License law. -
❑ I sm exempt under Sec. ,B&P C for this...a
Dwm, Dale
WORKER'S COMPENSATION DECLARATION
I hereby arNm under penalty of perjury one of to following dedantions: '
1 haw and will maintain a Certificate of Consent(t selFinsure for WorkersComfen-
sation,m provided for by Section 3700 of the labor Code.for the performance of the
work for which this permit is issued.
I haw and will maintain Workers Compensation Insurance,as acquired by Section
1 of the labor Code.for the Performance of the work for which this armit is issued.
My Worker's Compensation lnsmance carrier and Policy number' p
Cartier. S Policy Na.: I�w_
CERTIFICA OF EXEMPTION FROM WORKERS' -
COMPENSATIONINSURANCE '
(Thu section need not becompleted if tW permit is forms,hundred dollars(5180)
or los.)
1 certify that in the performance of the work for which this permit 1.issued,l shall not
employ any person in any manner an as be become subject to the WorkersCompensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cenificale of Exemption,you should
become subject be the Worker's Compensation previsions of the Labor Code,you must
Q forthwith comply with such provisions or this permit shallW deemed revoked.
rY CONSTRUCTION LENDING AGENCY
[—t I hereby alarm that there is a convection lending agency for the Performance or
�✓ the work fur which this permit is issued see.3091,Civ.C.)
W�Q Lenders Name
Z)z Lenders Address
V Q 1 certify that 1 have read this application and slats that the above infoormun is
D,F corms.1 agree to comply with all city and county ordinances and state laws muting to
OU Wilding convection,and hereby suthodna representatives or this city to enter upon the
.hove-memionenou.center
for inspection purposes
(Wer)agree to sew,indemnify and lump homeless the City of Cupertino against
tiN in conequnce of thegronandof this Permit. may inany way acemC against said City
V 7 in consequence of the Stunting of this permit.
r� APPLICAa����a{{''''Tff,UND FRSTANDS AND WILL COMPLY WITH ALL NON- DINT Issued by:
3
SOURCE R�GU A IONS.q - _
I�u Ar - I �`� Re-roofs
Signmurc picaH HAZARDOUS
0m
HAZARDOUS TERIALS DISCLOSURE Type of Roof
Will the applicant or rumre building occupant emre or handle hewrdous material
az defineby the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
otic,S`7 Yes,cd
cd tion 25532(.)? Nm All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haotormse air conumtnanu dcM
as cd by me Be,Area Air Quality Management all new materials for inspection.
DistrinT ttt//J
C]Yes pp Nu
I have mad the hammous`materials requirements under Chapter 6.95 of the Califor.
nim Health&Sorely Code,Sector 25505,25533 end 25534.1 understand matif the building
docs not cu ti A ve a renank Nat it is my rsponsiM1ility m nosily tie recti ant Of the
to netcnu hi us(bcmelpnormissuan<cmfaCcrtiBcalc Ocmpm,' Signature of Applicant Date
Al 9, j Old
Owner or authorized agent Dmi. All roof coverings to be Class"B" or better
aCITYF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #
�2 a. 6 y S W o cri -C 0 u "
OWNER'S NAME: PHONE # S b 5 '9 r
GENERAL CONTRACTOR j P Roo N FAX #
I am not using any subcontractors: 1 S o
S gnature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
r
7 61
Owner/Contractor Signa Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
' Telephone: (408)777-3228
CITY Of
14U P E IST I 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: 2L dk 111 air V-y
Job Site Address: q a roW 3 o dd u—cc� Q
� a
Roofing Company Name: P 2 0o V� C-i
igAplicant'
Date: 7 t J 1pl.r
eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3yDate:
a IS o �- f /
Building Address: I y
.Id64 -3 ge � V
Owner's Name: Phone#:
2-S a S $ 6 $
Contractor: Phone#: License#:
i D ate u1 t o `{ 1
Contact: Phone#: Cupertino Business License #:
Q s le NoG U 99.2 oh-'
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles AI Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
XTo be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: In
Aemove wc� S�na L4 Ire acs w'IVV%
Residential Commercial ❑ 16 d S
Fire Zone: Yes ❑ No Confirmed with Planning
there are any res ' ton .
Cost of Project: Type of Con tructio Occupancy
oO--_
Qty.,if
A is 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
2
170 • S"6