03060180 (2) 1 CITY OF CUPERT[NO •'v_
BUILDING DIVISION PERMIT ACONTRAC�f tINFORMATIQIV.
BU]LDING ADDRESS: R J BEAN ROOFING PERMIT N003060180
41 T;c)TT.TNrr.R Rn
OWNER'S NAME: 6355 COTTLE RD PERMIT ISSUE DATE
ONE: (408) 358-4028 SANITARY NO. CONTROL NO.
1,iin
CHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATIONIOb DeSCrIpIl00
1 hereby affirm that I am licensed under provisions of Chapter 9(commencingh Section 7010)of Dividon 7 of the BusinessaM Proassiuns Code.and my]loan.u' ullfo.eandcffe a " REROOF FUNA .F0
jm,3 Llarmsagam La.N
9 Onu Contractor 2CICh/
A C 1 CTS DECLA A ION
Iundcmm�d my plum shallbeu.du Puhlic.cnNs
5�UJUL 0 2 2003
r
t J Liccttsed Professional
..77 OWNER-BUILDER DECLARATION
Coni ION BUILDING
I00 I hereby a(Ertn ohms 1 em exempt from the ConOecmh License Law for the IYSr
eo following mama.(Section 7101.5,Business and ve de ions Calc:Any city os county
I: which requires a Permit m cnnnrucL al¢c improve,demolish,nr repair any structureeno
pdorto its iuuunce,elso requires the applicant forsuch permiuu file axigued statement
ss< (hat he is licensed pursuant the previsions,,(the Cmmumr's License Law 9 Sq.Ft.Floor Area Valuation
tt
IF$ (commencing with Section 7")of Division 3 of the B minor and Professions Code)or
y Nal he is exempt memfmm and the.buB fm the alleged exemption.Any violation of 35924012 . 00
Section 7031.5 by any applicant for a permit subjects me applicant to a civil Penalty of APN Number - Occupancy Type
net.ae man five hundred dollars($300).
❑I,uowner*(the property,or my employees with wages u their sole compensation,
will do me work,and meswctum is not intended orof(emd for sale(Sea 7014,Business — RR r dIns ections
and Pmfemions Code:The Com on's License Law does not apply to an owner of 307 - INSULATnV P
property who builds or Improves thereau
on,and who deshwork himself ermmugh his
Own employees,pmvided that such improvemcnu are not Intended or offered for aB.IL 601 — ROOF TEAR OFF
however,the building or improvement is Said within one you Of completion,me owwr-
builder will have Bte burden of proving that he did not build an improve for purpose of 602 - ROOF PLYWOOD NAIL
ale')' 603 - ROOF BATTENS
❑I,at owner Of the propcny,am exclusively contouring with licensed crummusto 604 - ROOF IN-PROGRESS
construct the pmject(Sec.7044,Business and Professions Code:)The Conlnetor's Li-
ccme Lew does not apply to an owner of property who builds or improves menton,and
who contracts for such pmjecB with acontrator(s)licensed pursuant to Be ConOsetor's
License Law.
❑I am exempt under Sec. .B h P C for this muen
Owner Dau
A961111, WORKER'S COMPENSATION DECLARATION
1 hemby afff under Penalty of'do,one of me following detlunium:
I how: will mainuln a Cenifimte 01 Consent to self-Insum for Warmer's COmpcn-
mtom,u provided for by Section 3700 of the labor Code,(or Lou performaue of the
work(or which this permit is issued.
1 have and will maintain Workers Compensation Imuranm,as acquired by Section
3700 of the Tabor Code.for me performanec of the work for which this Permit is issued.
My Wormer Corona nsafirm Imumra camier and Polity n Sark,am:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITB.ction wed not b reompmad[film permit is(mane hundreddollara(SIM)
or lou)
I certify that in me performance of On,work for which this Permit is issued.I shall not
employ any peon In any mennerso u Of become subject in the Workers'Compensation
Laws of C_aI RICO Ktil .. .. y
NOTICE T —APPLI NT:If,offer making this Ccnincam of Exemption,you should
become subject to the Workefs Compensation provisions of me labor Code,you must
veil z forthwith comply with such Provuinm of this Front Shall he deemed.mked.
.zi y CONSTRUCTION LENDING AGENCY
t—r I hereby effmm that them is construction lending agency for the Per(mmawe of
(Yi the work for which this permit B issued(Saxe 3(197,Civ.C.)
W�Q Under's Name
z Leader's Addoes
U 0 1 coldly mu I haw read this application and sum that the above information is
coma.I agree to comply with all city and county ordinwas and state laws misting to
0 U building comuuction,and hereby aumome reprcu nurives of this city to enter upon be,
ul abeve-mentioned Property for impaction purposes.
plr (We)ag.e th ave,indemnify and torp harmless me City of Cupertino against
r p/J liabilities,judgments.costs and expenses which may In any way sum against Said City
U in consequence of the granting of mis Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RFL NS.
._J i 6-2-6-Ob Re-roofs
ignuurt of PlicanUConRDO Date ,type _
HAZARDOUS MATERIALS DISCLOSURE Of ROOF
Will me applicant or future building Occupant stem Or handle hamdous material
S darned by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
our,Section 2553HU? / All roofs shall be inspected prior to any roofing material being installed.
1-71 Yr. 0.N✓
Will the applicant or future building occupant use equipment or device;which If a roof is installed without first obtaining an inspection,I agree to remove
It humainw air contaminants u find by the Bay Arm Air Quality Management all new materials for inspection.
nuict?
❑Ym
Ihave rcadthe hamrdne 25505,25533
3and25534.
5under Chapur6brofhe vdldinr- / ,v �t
nix noth6Ently ho aSCctiumhatit My UCSPUMINI4rel undc.und thmifdu beilJing X �
Jae not currently heat a anent.that it B my respomlhility to noul'y IM wcupant of me _ VV sra_y V
aim hie verb.mmpdeTtolssaanaeraCertifmauofOccupancy. Signatnreo pplicant Date
wast nr a OmeJ a en, (,ate All roof coverings to be Class"B"or better
Community Development Department
Building Division
sm i City.of Cupertino
10300 Torre Avenue
4 CITY OF Telephone: (408)777-3228
U 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 �p� 10'X
_74Job Site Address:
Roofing Company Name:
A phcanYs Signature: �� Date: b�
tCM6W0��Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 3 Q Z Date:
Building Address:
O I
Owner's I�{tte: � _` Phone�s _ 3 D�
X11
Contractor: Phone#: License#:
7 qbo_ �3 3o2--
Contact: Phone#• Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
O Asphalt Shingles a"Asphalt Shingles
El-- Wood Shakes ❑ Wood Shakes
O'Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Cl Provide I.C.B.O.Report#
9e-To be Removed L—_ ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: E "-
Job Description- rr kP(" 07ry t
Jl-
�2H✓ e-CTWr] tQrS�flaF flPP� I z 3 ' fc7 r- I It
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Pro t: e f Construction: Occupancy group:
Qty. if
Applicable 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