03040025 (2) CITY OF CUPERTINO `� ►�C .1UR�IN' O 'f,jQj, .
13UnAINC DIVISION PERMIT
PERMITN0.
BUILDIN03Dg 766 BROOKWELL DR R E
l U PERMIT D
""MEROWNER'SNlrMgvER CHARLES A 15230 CLYDE
SANITARY NO. C 0.
P
(408) 925-9995
BUILDING PHRMR INFO
A /ENGINEER: BLDG ELECT PLUMB WHICH
6 LICENSED CONTRACTOR'S DECLARATION Job Description
1 he AM that 1 am licensed under provisions of Chapter P(Commencing
withsecdon 70W)of Divldo 3,r Buduuand PrORsslnmC m,md myBeenmis
In full fart and effecL C ti �x� C;
z LkenwC] REROOF
D0 ARCHITECT tanmr D REMOVE 2 LAYERS OF R90K, INSTALL 1/2 "CDX PLYW00
1°edermnd my ptsn""i0 h`u"d°i publl`rerw 30# ASTM FELT & 30YR. COMP.
Licensed Pmfeaalonat
OWNER-BUILDER BUMPER DHC C'mostN
1 herby°(Ilan that 1 1 exempt from Ne Con ons Co License Law far He
o following reawn. CmrR t 7031.3.Business and fit.de oli Cade:Any city m runty
I� which requires•Permit to emnmcL a@r,hnprow.&mmleh,fir repatr any urucmre
Pdormlu iuueme.aim requires dm aPPlicantfar ouch permit to 0leaalgned augment S Ft.Floor Area
dwholsiirved pumuntm tie provislonsaf Oe Cantmemr's LlCottw law(Chaptu9 q•
$ (commencing with Section 7000)of DiAslcm 3 of the Buainess and Profusions Call)or
Net he b asumpt rm(rom and the bola fm re alleged exemption.Any violation Of APN Number EJ
Sidon 7031.5 by any aPPllunt for a permit subjects the aPPlksnt w a civil penally of O
ccupancy
nm roma 0un five handled dollars(S500L
❑j,M owner of the Property,or mat employees with"Sun rets sale Compensation, squired Inspections
wifido rework.and thesueim,u notimended oronered lorsale(Sec,7ooe,Bwirwa 36921037 . 00
and Pmfndom Cade:The COndlrcmM1 Lion s law deals rot apply man owns of F O rRv B A II E
pmpenywhobuil&orimpmv dr n,andwbodaessuchwarkhimselfmtluou{hhts If`� awl! I�el�n
ownemployw,provided ratsuch improvemenu are not Inmnded moRcmd forsale.IC
hosamr,the buddingor impmvementismld withinere3aar ofrmpledr.the owner- 305 — FRAME MAYA 6 2003
builder will have the burden of proving that he did not or build impmw Ins Pulp=of 307 — INSULATION
sale.).
❑1,u ewaer of the Property am nalmively canbwting with licensed Contnctm to 601 - ROOF TEAR OFF
Comirucd the project(Sr-7024,Bouin and Pmf.Wo-Code:)The COmwatces LL BUILDING Np�G/�
True law does not apply to an owner of pmpeny who half&orimplmm,thereon.and
602 — ROOF PLYWOOD NAIL ®V�L6P�ItlV1
whorntr°cts for such projects with a conuman(s)licensed Pursuant to the Crmmnta 603 — ROOF BATTENS
lau
Law.
[3 lam Law. under Sec .Bapcfa.0&mason 604 - ROOF IN-PROGRESS
❑
Owear Dau
N
WORKERS COMPENSATION DECLARATIO
I hemby affirm under penalty of perjury am of the following declmtionr.
w and will mainWn a CeelfiLwtsef CmuCN to'If""fm Wmker'st"mpen-
As inmvided for by Secdm 3700 of to labor Code,for the P°nannamx of the
W for which this permit is lathed.
I have and will maintun Workers CompensNon buurmce,u required by Schon
of due Labor Gds.for the performanr°f 0e work fm which this permit is Word.
My Waftes Iwrarue ard.and Policy n r All:
e� .
C°m`u D I C UlMCA7E 7 EXEMPTION FROM WORKERS'
COMPENSATION INSURANCR
iThAseetlon need Out becurpleediftae permit Is for ane hundr ddollm(5100)
or lues.)
1 certify that in the perfomanee of the walk for which cels permit is iuued,I.hail am
employ any pawn in my manner an as in become subject to the Warkarl Campenution
LAWS of California,Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cemneam of Eacmpdom,you should
become subject m the Walkel a Compensation Pwvtstrr of the labor Code,you muu
'Z forthwith Comply with such provisions ar this permit shall the&cmed revoked.
C) CONSTRUCTION LENDING AGENCY
r Iherehy Affirm that Nett is•Cemmction lendinga;emy for the perfarmaom or
Y> d.work fm which this permit Is Issued(Sm.3097,Civ.C.)
4 QLendces Name
2. z lander.Address
:.7 1«NfY that I Tuve read Oda city
and
on and rote thud the oboes I"K 1.0un u
L4 F riming I agrt re comply with all Nth anti county aNtnancef and Cute Ins,up K1.0.1 e
p U building Co)agree to an rode suth limand m P huh advemf rob City re cnilm 1m the
lTd al mc.mentioned property for inspecdoa Purposes.
n,
(We)agreemow,Indemnifyandhep may in An re City Of Cupeniwagainst
Vy ince sequence enu,Comand of this rs which may in any wry amma{dnatuid City L,
2 A PLICA T airs RSTAImalingof this pefmit. Date J
F7 APPLICANT REGULATIONS-
AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
2�01 .a
Re-roofs
Signature ofArepOcanuComrwter arta 'Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the appilnm or future building mcupantatore or handle hazardous material
as defined by tie Cupertino MunIN ode.Chapter 9.12,and the Health and Safety
Cade,section 35532(an All roofs shall be inspected prior to any roofing material being installed.
Oyu No
If a roof is installed without first obtaining an inspection,I agree to remove
Wilt the applicant or future building Occupant uw egalPmanl or devices which 11 new materials for inspection.
It hanrdom air rommuunu u tarred by the Bay Am Air QualityManagement
atfieR
C]yet
Jn'af%
oC.
Ihrveread We hvallommamdeR553'3 cnuumMundcouu duldif Gldint
nieH d•.Saicty Ca&.Smdons 25503,23533 end 35534.1 unMrwnd thuif tho ilding
ora mole ndy hew a enan4 tut It b my reaponslMlity u mdfy th accuPand aFdvv Date
regmreme m rum ales CeNncee orocc � Igna[Ur of-Applicant
i All roof coverings to be Class"B"or better
.deed agent / Dem
r
Community Development Department
Vt j�A Building Division
F(.11C�•jl �`�' City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
CU PEkTiNO
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 r/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: �/iRirl�t JL5 L_Au L.
Job Site Address:
Roofing Compan Name: I tv `� cc /� IA STI &W I I C
A plicant's ignature, Date:
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
o,3 o I;/-
' REROOF
UPE kTINO PERMIT APPLICATION FORM
APN# � G - Z I - Date: 4I 310 j
Building Address: l
M 6 � RooK 6U!✓�Ll. �•12. p.
Owner's Name: Phone#:
Contractor• ( Phone#: q2s License#:
'� �obYirl s (JC.
Contact: �p Phone # Cupertino Business Lic nse#:
bD l e 1 RUCTrsYL V-q wh-meq ct�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shinglessphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
ood Shingles ❑ Wood Shingles
Other(Specify) () ❑ Other(Specify)
u ber of existing coverings Z ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
ob Description:-g ]M6A 2 LM b1F 001E (NSTA l.L tJ 1 Z �t C,D f LyWOaD
ZU -z A-S i M Z-(J - P N-M-f am-p
Residential Commercial ❑
Fire Zone: Yes ❑ No ._ Confirmed with Platmig7DeDt. if
there are any r ctions: LJ
Cost of Projec . UU Type of Cons ti . ,� / Occupancy oup:
Ra 0 y
Qty
A tc 1 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
# 137• �