04060223 (2) CITY OF CUPERTINO a''�
BUILDING DIVISION PERMIT "CONTRACTOR INFORMATION ;
BUILDING ADDRESS: LEGACY ROOFING & WATERPROO ��NO04060223
11475 CANYON VIEW CL
OWNER'S NAME: PERMIT ISSUE DATE
ABE YOUNG 860 FAUL
NE: SANITARY NO. CONTROL NO.
(408) 467-0150
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LOo
LICENSED COhnRACfOR'SDECLARATION Job Description
¢ I hereby affirm Nat I am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 Of Me Business and Professions COM.and my license is PON
a E®
m fun mreeand efrgt. U'L fW7 b REROOF Y`lFi +flga
,j3z Liaamc Cl d-- Lia.a�-�-�� .
c- Dam GanDECL lJCaar'L Ka Y'7f
n1Z-Z� ARCHITECTS DECLARAT SDN JULf. 200
1 understand my plans shall be used u public 2 4ie records (.I `h
ZiU
3 u. Licensed Pmfessienal e�
$03 OWNER-BUILDER DECLARATION �sYYU��®�t��Re/��
d i 1 hereby alnnm Net I am exempt from the Contnctofs License Law for the 1tl
p O following mason.(Section 703 1.5,Business and professions Code:Any city or County
=� which requites is permit m construe,alter,improve,demolish,or repair any suucmrt
Fib Prior m its imo.c.alsu oxuimstMapplicautforsuch permit to Like signcdautcomin
I90NatbeixlicenuU punwammthe Provisioru of Me Contracwr's lJeame Law(Chapter 9 Sq.Ft. Floor Area Valuation
¢F (eommcnciarood Saaturmt0)of Division)nflM Business arM Profussinnx Codc)ur
to 5Net he is exempt thetefrom and the burns far the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of 3_9&N7'ffi'iIber00 Occupancy Type
oat roam than five hundred dollars(SSW).
I,as owner of the property,m my cmployces with wages az their to wmpewtlon.
will do tae work.and the machine is.1 intended or of@rW for ask(Sm.7044.thaixss Required Inspections
and Profession, o a
sions Cade:The Contractor's License law does dpply m an owner of q P
progeny who builds or improves thereon,and whoduessuch work himse for through his
own employers.provided that such improvements are not intended oraRemd forsate.If.
however.to building or improvement is sold within ane year of completion,the owner-
builder will hove the burden of proving that he did not Wild or below for purpose of
axle.).
O h as owner of rhe prupcny,am exclusively contracting with licensed Conaams to
comact the pmject(Sec.7144,Business and Probsumas Code:)The Contractor's Li
cense law does not apply to an owner of property who builds or Impmws theneon,and
who contracts for such projects with a mammonist limited pursuant to de Canameames
License
law.
C]1 am exempt under Sec. .B R P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby a0'mn under penalty of perjury am of the following declarvuona:
1 have and will maintain a Cenineam of Consent to=If insure for Worker's Compen-
737W
ion.as provided far by Seen..37M of the letter Code.for the performance of the
rk far which this pcmrit is issued.
1 have and will maintain Wark.fs Competss,00 Insurance,u required by Section
of Ne Labor Code.for Ne performance of Ne work for which this permit is issued.
y Worker's Compensation Lnmmae carniad Paticy number are:
at�.,�TAre Il a.:Z8� 75y�
V CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE Z-f-OS
(ITIS action aced not becomphoed if the Permit Is for one hundred dollars(SIM)
or less.)
1 certify Net in the performance of the work for which his permit is issued.)shell me
employ any persan in any manrsrm az in become aubjat to the Workers'Compensation
Laws of Califon,.,Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenifcom of Exemption,you should
became subject to to Worker's Compensation provisions of the tater CMC,you must
.,Z faMwitb comply wish such provisions or this permit shall be do med revoked.
z CONSTRUCTION LENDING AGENCY
lhcrevR
by from Nthe
at re isaconxtmninn lending agcacy for the performance of V
Q:? the wink for which this permit is issued(Sec.3097,CO.C.)
j
WA lander',Nam.
6. Icnticr's Add.
U C) I easily tha 1 have rad this application and sae:Nn the above informed.-is
W E' Correa 1 agree to comply with all city and county ordinances and state laws relating to
OU bottom,consuullum,anal hereby authonne mpr...ntxhivu of this city to enter upon Ne 5
T W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of GUPCOm against
F N liabilities.judgments,toss andespenus which may in my way acme against Mid City
U Zin c ee of Ne granting of this Permit.
'-' AP LI ANT UNDERST6,NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
LL
RE ULA'1'tAl7C-
S �?�o�? Re-roofs�Ignalurt of ApPlicanJC A RDO
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fumrt building aapt stow m m
handle hardous material
az defined by,rc Cupertino Municipal Cude.Chapter 9.12,and the Health roti Safety
cade. ❑aYoan25532(a)r �No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment a,device;which If a roof is installed without first obtaining an inspection,I agree to remove
in hoamous air Conm otion"as dcfned by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Ycs Nu
IA ad die hvardnus materials mquimmens under ChaPmr fi.95 of the Califon C
pia Heal R Cty Codo.SCCams25505.25533.,255J4.1 cadcrso.dthmilM bel:Uing !L.!-� /
fops c ,y haw a an4 Nal it is my msponsiM1iliry m nuuly the anupmt of the +
mqv tit met prior u,issuanaaracertiiatearampemy. ignature of Applicant Date
-Wm 6115/w All roof coverings to be Class"B"or better
Own rauthomcd ages Dam
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRjSS: PERMIT # jj D �y
OWNER'S N ,yQtr ov HONE #
GENERAL CONTRACTOR: • e,. FAX # /
I am not using any subcontractors: c2 2-1 l
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing y�
Septic Tank
Sheet Metal
>Sfiee Rock
Til
er Contractor Signature _/ a e
Community Development Department
Building Division
t :• City of Cupertino
r
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
*UPEkTINO
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:
Job Site Address: y7 e4 ti/ya�
Roofing Company Name:
A plicant's Signature: Date: /Zi—
Cil/P6IAOCXI
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
i ai
REROOF G 2—L,3
CUPERTINO PERMIT APPLICATION FORM
APN # 3Sb_/ Date:
2 025/
Z (d/
Building Address:
11 '(-7S- Cep v_I Vlc� Crrc /<
Owner's Name: Phone#s
Adm VO 10 G.—. 3910
Contractor: __ Phonle!#: License#:
Contact:3 5 Phone#: Cupertino Business License#:
�- -7 r3�
Type of Roof Covering:
Exist: Proposed:
Built-Up Roof t�Built-Up roof
❑ Asphalt Shingles ❑ 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:
U avi/C or ,-s rF /.1s7�6Il -54 i
Residential ommercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anv restrictions: LJ
Cost of Project: k Type of Construction: Occupancy group:
Qty
A i e 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
Z� �7 7
167- z78 . 2°