04080004 (2) CI"I'Y OF COVERTINO
BUILDING DIVISIONPERMITCCTONTRA (IR INFORMATION
OUILUING ADDRESS: PERMIT NO.
LOS GATOS ROOFING 04080004
52 RI;BIR RD
OwNER'S NAME: PERMITLSSUEDATE
E:
SANITARY OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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amZ LICENSED CONTRACTOR'S DECLARATION
FI hereby affirm Nal I am licensed under proo time of Chapter 9(commencing Job Description
�uuwith Section 70(10)of Division J Of Or Businevyaap Professions Code,and my license is
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in fall forces err ✓XI O REROOF W� COMP . SHINGLES �A/_
D Z Licenm - Lic.M a
t p Da t Con a C.�
Y1-w ARCHITECT RATION
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is rad plans my shall hi accords W b
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< OWNER-BUILDER DECLARATION 'V
aachy affirm that I I exempt from Ne Conaaaoo License Law for the /moi
pO following Peron n]Im.dct,altos and Pmfdemoli Code:Any eity.s county
sae m which)its is a permit re construct,alma improve,h Parmit t nr repair any structure
't"^ prior its issmnce,also requires the applicant for such permiuLican.Law(Catemcin 92
Inat he is licensed pursuant to the previsions oflhe Conv«mr's accost law(Coepmr9 Sq.Ft.Floor Area ValUfltlOn
(commencing wi III IID)
Section]( nf Division]of the Business and Professions Code)or
.RE
Nat he Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 9031.5 by any applicant for a permit subjecu the applicant to a civil penalty of 3 Mjll�p�er0 0 Occupancy Type
not more than five hundred dollars($500). m ,
0 1,its owner of the property,or my cmployces with wages as their sale compensation,
will do the work and mcalrucwa is not intended or offered for sale(Su.]O44.Business Required Inspections
and Professions Code:The Contractors Licalse Law it=not apply to an e er Of q p
property who builds or improves thereon.and who does such work himself or through his
awn employees,provided that such improvements are not intended oroOered for sale.If,
however.the building or improvement is sold within one year ofcompletion.the owner,
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
I,as owner of Inc proii am exclusively contracting with licensed contractors to ,
consuua toe pojea(Sec.7164,Business and Professions Code:)The Contras it's Li-
u taw docs not apply to an owner of property who Wilds or improrex themon.and.
who contracts or such projects with aconlraaor(s) 'can pursuant to the Contractor's
License Law
I. ac ter Sec. _ ' .B&P C for this..a. -'ty
Ow Daredid — vJ
RKER'S C n ON LARATION
In by affirm under penalty of perjury one of line but
declarations:
I have and will maintain a Cuddicam of Consein to self-insurefur Workers Compcn-
cation,as provided for by Section 37M of the labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Sachin
3700.17 am LaWr Code,for theperrmmanc orda work fmwhich this permit is issued.
My Work is r ramp urOm nEa...to and Paicyykf11 Mr
T.
Cartier:" IF Policy NO M
S RTIFIC MPP SATION1ON FROM RVJLSj%
COMPENSATION INSURANCE
(This section need not be completed if the permit is or one hundred dollars($10th
or Iesa.)
1 cam fy that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate or Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Car,you must
.J O forthwith cram ply with such provisions or this permit shall be deemed invoked.
z CON S`rRUCTI ON LENDING AGENCY
Ihereby affirm Nat there is a construction lending agency I or the perrurmance of
(1v ? the work for which this permit is issued(See.3097.Civ C.)
{Ld Q Lenders Nainc
Lender's Address
az
V O 1 certify that 1 have read this application and sum that the above information is
Iy F" correct.I agree to comply with all city and county oNinameo,and sale laws relating to
D V building conswction.and hereby suthorine representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
a. (Wc)ago o save,indemnify and keep harm "s he City of Cupenino against
rFy rA liabilities.ju en costs andaaoi ccs which no ywayaeemcagmnat said CiIy
U z in c q c f c graining of Nis permit.r
^ AP L CAI ERSTANDS AND WI PLY WITH NON-POINT sued by: Date
50 E � ATIONS. �✓�!j
Re-roofs
Sig o Ap maaVCo tmxt r arc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
1 the applicant or future building«eupant store or handle remotion material
as defihad by the Cupertino Municjpal Code Chapter 9.12.and the Health and Safety
Code,soy n zsvxpea)+ rY�NO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Or future bu' n «aa ahl are e t or de.i«a whim If a roof is installed without first obtaining an inspection,I agree to remove
rap g p yuipmcn
mit hxaardous air contaminants as fined by the Bay Arca An,
Quality Management all new m er Is i Spectlon.
Dist ict?
❑Y.
Ihavc real avarduus mamrialsm3uire#fica'�Iux
hapmr 695 of the Califs-
—
nixHO.Kh&Safety ,Sec .25X15.255J3ancm.dthu Fast building Ulm
doers nal a rat ha a¢ i.that it is my ms our,the,occupant of the
requirem uwh sl ap' rtuissuanceofOccup cy. aIU o ppl' ant Dale
amtri, cep
Date All roof coverings to be Class "B"or better
Community Development Department
Building Division
') 1 City of Cupertino
10300 Torre Avenue
Cly,OF' Telephone: (408)777-3228
C 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: (N)/C)h 1-,q /J
n /`/ Lq e —.
Job-Site Address:
Roofing Company Name: ,Jt
A plicant'sSignature:y/ � jCNL::Y, iZ Date:
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF O�y.
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN #
Building Address:
1052 &,cLL k4 .
Owner's Name: Phone#:
C � 1�iee- `/Ok S2 '7- 59170
Contractor: Phone#: License#:
dos 6a_Ios �/os' qm - X00707
Contact: Phone#: Cupertino Business License#:
X3,/8/
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
X Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
C3 Other(Specify) 'Ef Other(Specify) 7 / „OS8 4,,-Ce.'6 5e12c7�/
f
Number of existing coverings ❑ Provide I.C.B.O. eport#
To be Removed .`fW Provide Mfgr. Installation Specs.
I Have Read, Understand and WilI Comply With Cu ertino's Tear Off Policy:
ob Description:
e s Com rod 7ns- nll and D Vear Com S o las _
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Pro'ect: Type of Construction: Occu ncy group: [' /
Z_ o T/ /P
Qt
A li b 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