03060130 (2) CITY OF CUPERTINO zamrs« a' #'t: 'r•= '"s "�'"" _ '
BUILDING DIVISION PERMIT a=COt�1T CTQR II k't RMA.TION,,...
3UILDINGADDRESS: CASTO ROOFING PERMIT N0.03060130
OWNER'S NAME: 1938 OLD MIDDLEFIELD .WAY PSB,urET9A/ i8/2003
NE` (650) 961-8922 SANITARY NO. CONTROL NO.
ARCHITECTIEN01MM: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
eas new 1. 0 0 0
.09 LICENSED CONTRACTOR'S DECLARATION PJ
1hereby afBan them 1 am IleemuW under pavisimu or Cltapur 9(cemmcneingC
with Satire 7IXD)af".1m 7of the BusinessW Rofeadons abmjlkensala
An mrauranxmae n� 3C�7a�CO REEO
l UcenmC Lk.p� `
_ Dam TION
1 unMraunJ my rims ahellARCIIl M TS LIRA - _ LA
5� Licensed Prtd,sl...I OWNER-BUILDER DECLARATION
g
i g f 1 hereby nllim that I am exempt from the Consumah License Lew for the
v O following mum.(Section 7031.5,Business and Professions Code:Any city or county
5$ which mquima a permit m comtstmai alcor,morrow,demolish.re repair my amuclum
-Zso prior to its issuance,Jac mquima the applicants formch permit m rile a signed wumcnl
< Net he is licensed purmem ea the pmvWow of the ContrecuKa License Law(Chapter 9 Sq. Ft.Floor Area $1Migglon
G (cammeneing with Section 7M)of Division)of the Business Me Profession.Cale)or
$
that he is exempt draermm anti the bash for mha alleged exemption.Any violation of
Secdon 7071.5 by airy appituet roe a permit subjects the applumt m a civil Penally of 3 ELPld NU&kr 0 0 Occupancy Type
not mom titan five buMmd dollars($500).
❑I,ss owmr of dm properly w my employm with wles u their mlemmpcmdm,
will do the work and mourners.bnotiro m&d orane.d ItrWe(Sec.7044,Beat. Re B
and Professions Code:The Committees License Law does set apply m an..or 307 - I NSULAT M Inspections
Property who builds sir w
impraa durcon,end who time such work himsel f or thmugh his
own employees,provided bmsuch improvemems are set Intended orolfered forum.If. 601 — ROOF TEAR OFF
how ,mebuildingorimpmwmwlamldwlthmomyouarcmnpledm.theownes,
Isomer will have the burden of proving that he,did not build«lmpmwfog purpose of 602 — ROOF PLYWOOD NAIL
"m')' 603 — ROOF BATTENS
❑1,as owner of dm propeny.am exclusively contracting with Imaroud con snout to 604 - ROOF IN-PROGRESS
n
contract du project(Sec.7044.Business and Professions Code:)The Cmtrm.r's U-
cae law does not apply.an anther of properly who buil&or improws thereon.and
who mnrecu for each project;with aemummrts)licensed pursuant in the consumes
License Law,
❑lamexemptundm See. ,Bh PCfmthmreamn
Owner Dau
WORKERS COMPENSATION DECLARATION
I hereby.Rims under partially or pu ary ane of the folkwing declarulmmu
I have and will maintain.Catilh maf Consent to selM1lnsum for WarkelaComPcn-
IMy
nn,u provi&d fm by Section 7700 of me Labor Code,far me performance of the
rk fm which this permit is issued.
1 hew"d will maintain Workefs Corepenutian bergamot.u.quired by Section
of me labor Code,for me performance,of me work for which this permit i.iuucd.
WotAces Computation Insurance carrier and Policy numberam:
rrl,.';Tl FiiLr CA PolicyNo.:CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
cram maim need ml bac completed if the permit Is fm one hundred dollan(SIM)
ser k")
1 ce&fy that in the performance of the work for which this permit is issued,l shell not
employ any person in my miner an as to become subject to the Workeri Comp,nution
Law of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject In the Worker's Compensation provisions of dm Lamar Co&,you mel
.,O forthwith comply with such provision or this permit hall an deemed invoked.
z` CONSTRUCTION LENDING AGENCY
1 hereby M.that Wert ba construction kMing alercy far dm performance of
Zdte work fm which this permit is issued(See.7097,Civ,C.)
Q Lender'a Name
Laser's Address
J Q 1 certify thus I haw mad this applicant n god stam thus dm show information is
i^ cmmn.I spm m comply with all cry meanness county aNxxs utd aur lowMissinMissingm
ng
Q SV' building contraction.and thereby mmori..pesnuuwa of this city m enur upon the
ahow-menuoned property for Inspection purposes
4 y (We)arm to new.indemnify and keep moonless the City of Cupertino almost
rq liabilities,judgments.emu and expense which may in my way seem,against end City
In consequence of the porting of this permit.
ri APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:qjtQ� Dat
SOURqE REGONS.a i4s 1,
9-Q3— Re-roofs
Sig marc o Appcam/Conrac.rDau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicmt an fumm building occupantslo.orltandle huaNaus material
as&fined by du Cupenko Municipal Code.Chapter 9.12.and the Health and Safety
We.Section 25572()7 All roofs shall be inspected prior to any roofing material being installed.
❑uta o
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building Occupant use equlrmenl or devices which _
It heyardnus air conwninsnts u defined by the Bay Am Air Quality Manalemem all new materials for inspection.
imi07
00 Yes ARNO
Ihawmet theIntendant.5505. requirements and 5334.1 nduramr6.95 of the Califon
nla HenithBsaicty Cade.Seedons25505,25577 and 75534.1 unmmnund Nutt dm building
d n t currently haw a mnanx that it u my respmombility m notify th,nceupant 01 the —
atswhicbmuRhemetpdarmi"aance,or aCertiresmar span Si nature of Applicant Date
0 ncrormthorimdopen, ^ panto All roof coverings to be Class"B" or better
Community Development Department
Y Building Division
OCOF
City of Cupertino
10300 Torre Avenue
Telephone (408)777--3228 Fax: (408)777-3333
qUPEkTINO
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 mspectim
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: VYl �t CJ I d<A V) I L
job Site Address: �� �0 C� U-1
asto Roofing Inc.
Roofing Company Name: 1938 Old Middlefield WaV
Mountain View, CA 94043-2503 (� I
A hccant's SignDate:�1 SZ C)3
't 6419
Building Official
Revised 1/30/03
CITY OF CUPERTINO
REROOF
• CUPEKTINO PERMIT APPLICATION FORM
APN# 3 4E70 D 1 D I o D
Building Address: 02 0�)- 19(� CN l Ut
Owner's Name:I ( L Phone#-;
{ 1l
Contractor. 1938 Old Middlefielcr"#. license# as
Mountain View CA 4043-250S *3 C1 I
Contact: Phone#: Cupertino Business license#.
SiALU (650) 961-8922
Type of Roof Covering:
Earisting: Proposed:
o Built-Up Roof a Built-Up roof
o Asphalt Shingles o Asphalt Shingles
&g -Wood Shales O--vood shales
O Wood Shingles O Wood Shingles
a Odw r(specify) o Odor(Spey)
Number of existing coverings o Provide LC-B.O.Report tt
tY To be Removed O Provide Mfg.boallation Specs.
I Have Read,Understand and Will Comply With Cu o's Tear Off Poli
Job Description: CtJ v - pd
S /( GCa
Residential ❑
Fire Zone: Yes ❑ No ❑ Co wi laming Dept.
�—� are an restri 'ons.
Cost of Proj Type of
Qty i
A ca 1,4
Fee ID Fee Description Fee Group
BPERMFEE Bldg Perm[Fees BURRING
BENERGY Eaergy BUILDING
BSEISAHCRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING