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03060196 CITY OF CUPERTINO BUILDING DIVISION PERMIT UC0NTRACTOR INFORMATION A' BU 11-DING ADDRESS: T D ROOFING PERMIT N903060196 ,OWNER'S NAME: 3540 MARGATE AVE. PERMIT ISSUE DATE ONE (408) 892-8872 SANITARY NO. CONTROL NO. .RCI IITECf/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH (� 0 X00 LICENSED CONTRACTOR'S DECLARATION lob Description ry U I Mmby affirm that I am licensed under provisions of Chapter 9(commencing P with Section 70!X1)of Division 3 of the Business ual Profcsooa�Code,and my license is in full farce and c( ct. 'a_ uantia . Lic.X 1 REROOF ��® Dem Contractor E 2 I understand my plans hal W used a pu tic me AT JUL 17 2003 5aU s Licensed Pmfrssinnel OWNER-BUILDER DECLARATION BUILDING pp y i I 1 hereby affirm that 1 am exempt form he Contractors License Law for the BUIL®I I p,V G C e O following Mason,(Section 7101.5,Business and Pmfe.shuns Code:Any city or county 5 m which requires a permit to consumer,alien improve,demolish,or repair any structure onn -iy pdono its issuance,also requires the applicant for such permit to file a signed statement E < that he is licensed pursuant to the provisions villa Comracmr'%LiocneelAw(Chapter 9 Sq. Ft.'Floor Area Valuation y�D (Commencing with Section 70(y))of Division 3 of the Business and Professions Coda)or i $ that he is exempt hesefrom and the basis for he alleged exemption.Any violation of 34215074 . 00 Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mom than five hundred dollars($50y. P Y YP I,to owner of the pmpcny,at my employe.,with wages As their sole compensation, will do the work,and Oar,structure is not intended or offered for sale(See7D44,Business 3Ub — gg and Professions Code:The Contractor's License Law does not apply a an owner of 3 0 7 - INSULATQMgd Inspections pmpeny who builds or improves hereon,and who does such work himself or through his own employees.provided that Such improvements ere hal intended ororfemd tarsale.If. 601 — ROOF TEAR OFF however,the building or improvement is sold within oro year of completion,he owner. hudder will rove the,burden of proving that he did nor wild or improve for purpue of 602 — ROOF PLYWOOD NAIL i1e')' 603 - ROOF BATTENS ❑1,as owner of ct property,.B exclusively and concessions with:)Ths,d conuactort to cense uct Law snotAplytoaownsinwandrty wh i bus Co or impreve&theon,Li- 604 — ROOF IN-PROGRESS me Law docs not apply m m owner of property who wilds or improve.hereon,and who contracts for ouch prokcu with a conlranor(s)IiunseO pursuant in the Conceectors License Ls- 0 1 Am aw.❑Tem exempt antler Sea ,BkPC for this mason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty or perjury ane of the fallowing declarations: - 1 have and will maintain a Cerdifcancof Continuo self-imam for WarkcM1 Compen- sation,m provided for by Section 3700 of me Labor Code.for he performance of the work for which this M mil is issued. have and will maintain workers Compensation Imum um,u required by Section 37M of he labor Code.(m the Performance of see work far which his rcmtit is issued. My Worked Co peuatlon Injawrum carrier o,0 Policy number �7 Cartier. 'Z�-a �_Policy No.: x.13,ky CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need not w completed if the swot is forone hundred dollars(SIM) in,loss.) I cenify that in thc perfnm Arcc,of the work for which this Permit is issued.I shall not employ any Nixon in any manner an As m lcmme Subject a Be Warkeri Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compcmalion previsions of this labor Code,you must O fonhwi lh comply with such provision or his Permit shall he deemed mvnkod. Z m CONSTRUCTION LENDING AGENCY ��+ Ihemh affirm that hem iso cmutmctinn lending[-a Y g agercy for he ler(mmarux of C .�-r he work for which his permit Is issued(Sea 709).Civ.C.) W Q Lender's Name Z) z Lender's Address U 0 1 cenify,that 1 have mad this application and mm that the.hove infarmeliun is {l. Fw correct.I agree to comply with all city and county onlinmces and sum laws nalating to DU building construction.end hereby Antonio,uprucnutises of his city to enter upon he IA ewve-(We) nedpmpny limimpectian keep hs. cA (We)agree to cove,indemnify and keep harmless the City of mCupnst against v — aFsr/) Iiobilittesjuen.fth,caN And capcmeswhich may inany way accme.gainn aid City U r77 mconscyucnce of th29%� APPLICANT U COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGU O O Re-roofs Signature ofApplicaDA HAZARDOUS MATE DISCLOSURE Type of Roof _ Will the applicant or future building occupant store or handle hazardous mamdal A,tlofineJ by the Cupnin Epal Coda Chepmr 9.12,end the Heath end Safety Coda, L]y Section zss32(a)+. All roofs shall be inspected prior to any roofing material beinginstalled. w n me app0eant bwilding occupant ati egaipmenr or devices which If a roof is installed without first obtaining an inspection,I agree to remove tit hozardnus air conumin.nu as defined by the BayAta Air Quality Managementall new materials for inspection. ❑Yes I have mad the hazardous materials requirements under Chapmr6.95 bile Califor- O O ilia Health @ Safety Cme,Section.25505,25533 and 25534,1 duce stand thatif the wilding does not currently how a unarm,Nat it is my responsibility to noddy ills,occupant of the requirements which must be met prior d issuance of a Certificate of Occupancy. Signature of Applcanl Date Owner or aulwdmd agent Dam All roof coverings to be Class "B"or better Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY Of Telephone: (408)777-3228 Fax: (408)777-3333 U P E IST I N O 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: H ary R a,e� Job Site Address: c,R efi Roofing Company Name: i D o of 1N Cl I Aplicant's Signature: Date: o / p 3 Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper r CITY OF CUPERTINO o o 7k, 0REROOF CUPERTINO PERMIT APPLICATION FORM APN# 3 4 a I S G Date: (o f 3 0 l b 3 Building Address: / . 2a6(0 3 W0OAV cl9 Owner's Name: i1 Phone'#: HCXV- Vy s,j yo$ gc16 3503 Contractor: /. Phone#: License#: T D (QS c� -Iq Io 4.,9 , G Contact, Phone#: Cupertino Business License#: I�c.v ; c` -1J8 S ocl 14101 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 9 Asphalt Shingles 10 Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# ATo be Removed ❑ Provide Mfgr.Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: S It a fa 1 I � ''S eh CI e 1 Fi Cv 5 o vl N' re»�ove vw�ci re � GGt vJi Residential Commercial ❑ Fire Zone: Yes ❑ No ' D Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Type of Constructio : Occupancy group: Qty AppAcAbje 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 222 L