03070010 (2) " CI'T'Y OF CUPERTINO MI
BUILDING DIVISION PERT C4O. NTRACTOR INFORMATION
avaold4c npDREss: PETERSEN—DEAN INC PERMIT ND.03070010
OWNER'S NAME: 7980 ENTERPRISE DR PERMIT ISSUE DATE
ONE: - (510) 494-9982 SANITARY NO. CONTROL NO.
ARCHITECIPENGINCER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
±Oo LICENSED CONTRACTOR'S DECLARATION
�mp4 1 Mneny arum mat I,m Ganeta under previsions car enamm 9(commencing Job Description
<6 with SO,timu70M)).f Divi,km3.f the Bu sincosand Profcasso sCode,sndmyliremcis
KKK in Bill force and er[pt.
Lk.N 6 RE
ROOF
et— Date cum o [{�
ARCHITECTS 0 �e4
1 undcrmanJ my plain shall be used as public records
y0.ob Licensed Professional JUL 1 7 2003
OWNER-BUILDER DECLARATION
2 i I 1 hereby affirm tom I am exempt from the Contractor's Licene Law for the q
O O following reason.(Section 703 L5,Business and Profcsximn Care:Any city or county �UILD1NG
42 f which requires a permit to construct,site, m
rimprove,dcolieh,or repair any structure
4;0 Prior u)its issuance,also requires the applicant for such Permit t)Glc a signed statement
pm<
that he is lice need pursuant to the provisions of Contractor&[.ken=Law(Chapter 9 Sq. Ft. Floor Area Valuation
(commencing with Section 700D)of Division 3 of the B usinci and Professions Code)or
;? $
Out he is exempt Cemfrom and to basis for the alleged exemption.Any violation of 36221040 . 00
Section 1031.5 by any applicant for a permit subjects Cc applicant to a civil Penalty of APN Number Occupancy Type
not more than five hundred dollars(9500).
❑I.ss Owner of the propcns,or my employees with wages as their aide compensation,
will do the work.and the structure is not intender or offered Russia(Sec.1044,Business — Re UIrCd Inspections
and Prediction.Code:The Ctntpctoes ofs License Law dat apply ino
an w g r of � 307 — I NSULAT 1 ON p
pruriently who builds an improves thereon,and whodoes such work himselfor Crou hhis
own employees,provided Our such improvements are not intended or offeree faradic.If. 6O1 — ROOF TEAR OFF
however,to building or improvement is sold within ane year of completion,the Owner.
builder will have the burden of proving mat M did not Wild or improve for purpose or 602 - ROOF PLYWOOD NAIL
pk.). 603 - ROOF BATTENS
1,a tweet of the properly,am exclusively contesting with ) clicensed cnnu¢mm to
construct shoes not (sec.11x4,wneross and pmwho Professions or improves
Contractor's an 604 - ROOF IN-PROGRESS
come Taw Unca not apply a an owner of protons who builds or improves Corton,and
who contracts for such projects with o ctnuacdorp)IlceneU pursuant to dte Comnctor's
Licence Law.
❑lin exempt under see. ,B&PC for this Teton
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby a"nn under penally of perjury one of the following declarations:
I band
will malnuin a Certificate of Content to self-imum far Worker's Compcn- r
sarion,as provided for by Section TIDE of the Labor Code,for the Performance of the
work for which this permit is issued. '
1 ban and will maintain Wmker's Compensation Insupna,p required by Section
1_1of the labor Code,for Ce performance of the work for which this permit is issued.
My Worker's Cnmpe Cation Insurance rainier and Policy n her e
Curler.7�W W"a/x/<t6eliy Nt.: a ZI c O o
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if tbe permit Is for one hundred dollars 15)01)
or less,)
I cenify Cat in Or performance of the work for which this Permit is issued,I shell not
employ any person in any mannersn as to become subjecno the Workeri Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:IL after making Nis Certificate of Exemption,you should
become suhjmt to the Workeh Compensation provisions of the Labor Code,you must
.J O forthwith comply with such Provisions or this Permit shall be deemed revoked.
Z"" CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the perrarmancc of
d.: Ce work for which this permit is issued(Sec.ANI,Civ.C.1
Wti A Undch Name
.7- z Lender's Address
U Q 1 certify tet 1 have read this application and sate Nat the above information is
(~ coned I agree to comply with all city and county on inanues and More laws relating to
�U building conviction.and hereby authouire rcpresenutivxs or this, ity to order upon the
r G above.mentioned property for inspection purposes.
(We)spm,to save,indemnify and kap harmlms the City or Cupenina against
liubllitia,judgmenucam aneupenses which mayin any way acerw sgaina pier City
Uz in conveyance of th pining of thisrc
^ APPLICANT'U STANp L CO Y WIy/ALL 0p POINT Issued by: Date
SOURCE EG p
Re-roofs
Signature of ApplicantlCommctor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle harudous material
as defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and safety
Code,Scctior255R(a)P
Oyu. d � All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or future building uncertain use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
It hozordous air conmminants as refined by the Bay Arca Air Quality Management all new materials for inspection.
istricfl
❑Yes L]taB
I bac read the hazardous materials requirements under Chapter 6.95 of Ute Califon.
nit Hear"Safety Code.Satios 15505,25533 am 25534.1 understand tin if Us,Wilding 7 O
rtm not cunemly here mnank Nat it u m ponsihilir m noddy tic mcup///-,of Uc
mquimmcnuwhich tbetnmp' t a t�trar cat ;apAnSignatureofApplicant - Date
.All roof coverings to be Class "B" or better
Owner or authorized agent Dam -
Community Development Department
Building Division
City of Cupertino
v :.• 10300 Torre Avenue
CITY�F Telephone: (408)777-3228
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: Co �(D��L�e� (�0-22' 1,
Job Site Address: Fy,
Roofing Company Name:
A plicant's Signature: Date: Wo-3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO e3 a 70 z-T/6?
REROOF
CUPER`INO PERMIT APPLICATION FORM
APN# 2- D Date: 7///D .3
Building Address:
/0 9ilz
Owner's Name: Phone#:
4 vc .e. 25 3 — 7 qL1 Z
Contractor 4 — n � IC,ne#: y 9 (1 - 9 gFz- License 4 (o �/ / 7
Contact: �[C Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X 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:-T , Q�QO SO
Residential Commercial ❑
Fire Zone: /Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: j Type of Construction: Occupancy group:
97��
Qty. if
Applicable Fee ID Fee Description Fee Group
I BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
I BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
22 3 �s