03060112 (2) �a ?mmas+
CITY OF CUPERTINO R
v BUILDING DIVISION PERNIITPiN
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BUILDING ADDRESS: PERMIT NO.,3 0 6 0112
(1,46:7 Boil_1NCzRR.
t OWNER'S NAME: "ET9'7`.7/2003
NE: SANITARY NO. CONTROL NO.
ARCHITECf7ENIGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
1r,
3CZp LICENSED CONTRACIOR'SDECLARATION
bin 1 horcby allimi mat 1 an licensed under pmvWom of Chapter 9(commeneing Job Description
with Sam ..7�0('10y1.of Divld . oBWn PmfeWom Cade.andmyli..t.
e
in full force a�ect.�
: : Daena // II�� Lk.• REROOF �(�J�ALE®
Dam can see CONTRACTOR: MAINTENANCE UNLIMI EI5
e ARCHITF.CI'S DEC 10
t I understand my pl....hall housed m cats Be records JUN 2 7 2003
5
Licensed Pmfesaionat OWNER-BUILDER DECLARATION
I botchy affirm that I am exempt form the Contractors License Law for me BUILDING L^I e
p O following reason.(Section 703 1.5,Business and ProfeWon Code:Any city or county B L1' NG
3$ which acquires a Permit to customer,eller.improve,dernolim,an repair any stmcturc
prior at its isauence.alwrequirn Inamplment fasuch Permit to file a.ignedmumem
< met he is licensed purstanlm the provision of the Contractor,Lioeme Law(Chopur9 Sq.Ft.Floor Area Valuation
F
}E 9 (cat he
ingwith Section 70W)of linesfrth al Bminnsmpton.Any
Code)or
that Ire 4 exempt Iharefrom and de buts far the alleged exemption.Any vIoIW on of $7500
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollen(5500).
❑I,u owner of the property,Or my employers wide wages as their into compensation. 36936004 . 00
will do the work aM thenmcnm m text intended of oneed for We(Sec.7044,Business Required Inspections
and Pmfesatom Code Tim COnmctarn exes License Law dot apply m an Owner of q P
properly who buildaorimproves mernen,and whadaeamclawakhmumforthough his 305 — FRAME
awnemployera,pmvmed that such improvements am mot handed maamed for tele If. 307 — INSULATION
howem.the building aimpmvement is sold within one you of campmtion,to fivs
wuaer wiU hate the burden of proving Our he did notbuild or improve fee purpose of 601 — ROOF TEAR OFF
mm')' 602 — ROOF PLYWOOD NAIL
❑1.as Owner of the property,am exclusively contracting wish licensed convector,to
aontmct the project(Sec.7044.Businesa and Profession Code:)The Conueemr'a L1. 603 — ROOF BATTENS
cense Law done not apply to an Owner ofpmpery who builds or improve memon.and, 604 — ROOF IN-PROGRESS
who contracts for such pmjecu with a contractor(s)licensed pun r m to the Conunmra
me Law.
I am exempt under Se. ,B k P C for rola reuan
Dam
\ WCRKERTMMPPNSAnON DECLARATION
1 hemby drum under penalty of perjury one of the following declmd axV
1 Mw and will methods a Carel of Consent a self-intim for Workers Cmnpem
sauon,m Provided for by Section 3700 of the Labor Code,for the performanca of the
work far which mit permit is issued.
❑I have and will maintain Wakcr's Compensation Insurance.m required by$ardor
3700 ofthe Labor Code,for the p rformmce of the woh for which this permit le issued.
My Workers CnmPensation lmuremecaM. d no number are:
curer. Pa
CERTIFICATE OF E3(EM OMWORKERS'
COMPFNSA N SURAL
(This ace mat neW net be completed lfine permit B fororc hunNeddolim(SI0(A
or lest)
1 certify that In the performance of dm work for which this permit Is issued.I shall not
employ any person in any men aumjbeco bjertm the Wohcn'Campewdan
Laws 0 iirorvia.D=u
ApPlicar
NQQQQTTTTIQCe'1� ICAN'C ,afar making this Ccnificam of Exemption.you should
badpmf subject m the Worker's Compensation proviemns of me Ichor Coda you must
Oro nth comply with such provision or this Nnniuhall be deemed invoked.
Z= CONSTRUCTION LENDING AGENCY
I hereby aRrm than mere is a construction lending agency rex use Perfurmene of
x the work for which this permit is issued(See.3097,Cl,.C.) -
SQ Lenders Namc
7 z Lenders Add. _
J Q 1 certify nut 1 have reed this appllcadon end sum that the above information is
y corms I gree no comply with At city and county ordinances and sate law relating to
lr.^! building construction,and hereby authorize mpresenutim or this ity Or enter upon me
above-mentioned property,for Inspection purposes
(We)agree to save,indemnify and kerp harmmas the City Or Cuperine against
r f0.A Ilabilidee,judgments,casts and expenses which may In any way seethe against mid City /
J Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS 0COMPLY WITH ALL NON-POINT Issued by: Date
S EREGU
--- 7� Re-roofs
�natn�e I App11 HAZARDOUS MATERIALS DISCLOSURE tee Type of Roof
Will the applicant or future building occupent nae orhandlc hvudous numoul
u de0ned by me Cupertino Municipal Code.Chapter 9.11,and me Health and Safety
ode,Section 13531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ym o
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
It havardnus air conumi...U sa de d by me Bay Arm Air Quality Management all new materials for inspection.
District
13 yes Nu
I haw mad me hvardmumemrlals mquimnunu underchapter d95of du Cstifor.
nu Hcal"SefnyCOd.Satiau4$D 5533 atW135Ja.I udnimed ft lime Wilding b
dao not rmntly h enact 61iyar my respomihility m�otil' me axupent of me
mqn new' a misavameoracanimatc IOQup =r' S atureofApplicant Dale
O oreulb xedagem DatF All roof coverings to be Class "B"or better
Community Development Department
%i Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E kT 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: I- 7
Job Site Address: �� 1L
Roofing Company Name:
A plicanYs Signator Date:�y
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
CITY OF CUPERTINO o
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# / Date: /7
Building.Address:
7 .6oLL1416��
Owner's Name: Phone#:
Contractor: Phone#: License#:lZd
JX
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof O ilt-Up roof
O Asphalt Shingles phalt Shingles k
❑ Wood Shakes ood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nuroer 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:
TiY�l46 ,5�0X 7Z oF7 �'z'.E'Odf
Residential Commercial ❑
Fire Zone: Yes ❑ N Confirmed with PI t. if
there are any r actions.
zp
Cost of P ct: Type of Constructi n Occupancy roup:
Qty. if
A I' able 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
13P