03060074 (2) CITY OF CUPERTINO ^� �
BUILDING DIVISION PER HT �'CUN"L.RACT,URI�NT•, RNI�,'CIQN
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EUILDINGADDRFSS: DAVE 7SMITH ROOFING PERMIT"03060074
OWNER'S NAME: 1052 KELLY DR "B`910/2003
"E` (408) 973-9427 SANITARY NO. CONTROL NO.
ARCHITECD/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
3ozp LICENSED CONTRACTOR'S DECLARATION
r� 1 hobby am that i am Imemsed under pro of Chapter 9(mmmeboing Job Description
z with Sectkn7 ) Ivldon3ofth Busincasat fculam Cade.udmYllcenxla
"^ infuliforcaand 5 t{,3-7 REROOF
j vG1a Lkcnsc Ciw 3� Lm.•
0 Dau — (
—ARCHITECTS DECATIO arats 'I O
5 nd my plana shall be used u 1 public records JUN B 2003
b CLL(((03775 Licensed Prefcssinnel
9 R DECLARATION
1 hereby,mart Na N am exempErmm de, de,Communes License Law for the BUILDING
0 a following rumen(Scedon No 1.5.Business and Professions Cub:Any city or county
$a! which inquires a permit to Construct.Glue impmw.demnlLah.or¢pair any structu ,
to prior to its issuance.also requires ds applicant forsuch permit to 01u a signed musmnt
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that he is licensed pursuant m the provisions of the Conmcturi Lksw law(Chapter9 Sq. Ft. Floor Area $ �l�lOn
(commencing with Seclien700(I)of Division 3 of the Budnwand Professions Code)or
$
that he IsexmPt therefrom and Nh fm e basthe alleged c mmpdon Any violnion of
SeNon 7031.5 by any applicant fm a permit subjects the applicant to a civil Penalty of 3%9142QMer 0 0 Occupancy Type
nut more than Rw hundred dollars(SSW).
❑1.an wbor ofthe property,or my employees with wage a them sole compensation,
will do tis work and themumme isnot Intended ereBemd female(Sec.7014,Businces �pW��f1�j'�
and Profeminru Code:The CoouuuIn x co
mor U.law data rot apply rcr of 307 — INSULA 1 1 VN d Inspections
Property rho buildamimprows thertonM
awhodoeuuch work himsalfor through his
own employee,provided teat such improwmenu art not lmenled monerad forsam If. 60I — ROOF TEAR OFF
buttoner,the building or Impress enern unsold within one year of cmmplemm,the owner.
builder will haw the burden of proving the he did ant build m improv for purpose m 602 -. ROOF PLYWOOD NAIL
sale')' 603 - ROOF BATTENS
❑I.u Owner of du property,am udutiwly commaing with licensed contractors to 604 - ROOF IN-PROGRESS
coutmm Lha project(Sec.]014,Bonin.and Fabrications code:)The Camrumra U-
( eene law does not apply in an owner of property who build,or improws thereon.and
who contracts for made projects with a emusmm(a)liamed personal u tee Counteract
Licew law.
❑larneamniu ader See .BRPClmthhmaxn
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury,mm of ds following decimation:
I
luta and will maintain.Card icamaf Consent to mif-imus fm Worker's Compen.
7376(0
on,u provided fm by Section 3700 of Lha Labor Code,for the pergorma um of the
ft for which this permit is Wood.
1 haw and will maintain Werkols Compemadon Imuamm.u required by Section
of the Leber Code,fm the performance of the work far which this permit is issued.
Worker's Compensation Inarence carrier and Policy number art:
SI=L. Pan y I1 z4 CGS-o?
CE FICATEOF E% PION OM WORKERS'
COMPENSATION INSURANCE
(labs section bond not aeeomplowl ifds permit Is foronc hum and dollw(SIM)
or lou.)
I anify that In Nc performance of tis work for which this permit h Wood.l mall not
employ any person In any mamter an as u bccomesubject to the Workers'Compensation
Lawa of California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this CenNcate of Exemption.You mould
become subkct m the Worker's Compensation provision of ds labor Cade,you mm
.,O forthwith comply with such provision or this permit mall he Method towline.
r y CONSTRUCTION LENDING AGENCY
1 hereby ammt Met Nem I..conmentho lording agency far site performance of
x the work for which the pemtlt Is issued(Sec,3097,Civ,C.)
7.1 Q Lender's Name
7 Z Landers Address
L) 1 coolly that 1 haw read this pplication and sum that the show infotmnloo Is '
U, y-t uormn 1&gra to comply with all city and county ordinances and sum Isw Mating to
C) rV^ building construction.and hereby auNodxmPreenutiws of this city to enter upon Ne
In, ahow-mentioned property for Inspection Purposes.
(Wc)agree m saw,indemnify and keep Motherstie City of Collection against
H
liabilities,judgments.casts and expenses which may in any way we=against said City r
In comequeme of the granting of this permit.
AP NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 .0Date
SOUR .
Re-roofs
i ort of pplicanVConlnemr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building cementation,or handle hmardous material
u dc0md by the Cupertino Municipal Code.Chapter 9.12.and the Haa1N and Safety
I
de, 0Yen:ss31(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs �No
Will site applicant or future wilding recapture use equipment m device which If a roof is installed without first obtaining an inspection,I agree to remove
it hnsrdaus air contaminants u normal by the Bay Arte Air Quality Management all, rials for inspection.
mict7
Oyes Nu
Iharcreal huamnusmturialsrcquiretnentsunderChapterQ95oflhaCalifon /HulNkSafctyCedc.S.Ii.25505,13533am12553/.lundcoundNuifNc WildingJnt co onatY haw a want,Wt It's mY MPoruibillty u ramify du occpant of Ne
ui nu which mm be met prior tu issuance of a Certificate of Occupancy.
Vig-na®ree of Applicant Date
_Ip
to- °-PAll roof coverings to be Class"B"or better
car ar authomnd agent Dau
Community Development Department
lc Building Division
"City of Cupertino
W"M
10300 Torre Avenue
� I CITY OFTelephone: (408)777-3228
C U PE DT]NO 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: S w
Job Site Address:
Roofing Company Name:
A plicariYsSignature: ��v �g� Date:
\�Jt1DW
Greg eel
Building Official
Revised 1/30/03
Pdntod nn Domxlail Dane.
CITY OF CUPERTINO
REROOF
TACUPEkTINO PERMIT APPLICATION FORM
APN# �b Date:
V I
Building Address: elf
Owner's Name:
Contractor'
D a� S� ``• D e1� Phone#: R ,2 - -4 z� License
Contact: 'J T• Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles _ I, 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: -1—egQ 0-" S Lac IG_S �YtS-I �i 1 �z r' o S 2 2tu 1
a� GP
Re ' Commercial ❑
Fire Zone: Yes ❑ No fi Confirmed with Planning De t. if
there are any res ons:
Cost of Project: q b Type f Cons ct' Occupancy gro :
1 �
Qty. if
Applickk 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
7 2 14
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