03010018 (2) CITY OF CUPEW11NO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
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BUILDING ADDRESS: ADVANCED ROOFING TECHNIQUE PERMIT NO.
1148 DERBYSHIRE DR 03010018
OWNER'S NAME: 1179 MYRTLE DR APPLICATION SUB DATE
BECK RUSSELL E 01/06/2003
ONE: (408) 249-4937 _ SANITARY NO. CONTROL NO.
ARCHITECnENGINF.ER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Woo LICENSED CONTRACTOR'S DECLARATION
keu F 1 hereby affirm that 1 am littnud under pmvisions of Chapter 9lccmmucing Job Description
y,C, with Section W(q of Division 3of the Businessand Pfnfessimns Code.and my license is
m@B( nd L .n REROOF
Liccnsc(ilMs Lie I
Z
Dale / Court DEVEr•7 T/0 EXISTING COMP. , INSTALL 30 YR. COMP .
As shift mo Dfi�1RAION
� lander Nd my plans shallbeuud as public rccnrJs
X�.0
id 0 Licensed Professional
OWNER-BUILDER DECLARATION
<q 1 heuhy affirm that 1 am exempt from the Cmmfactors Liecnu Law for the
i O o following reason,(Section 7031.5,Business and Professions Code:Any city in county
x$ which requires a Permit to construct,alter,improve,demolish,or repair any structure
prior it)its issuance,also requires the applicant for such Permian file a signed statement
that he is licensed pursuant In the pmvisionsof the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
zH$ (commencing with Section AMk)of Division 3 of the Find ocas and Professions Code)ur 6500
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicanlf^r a permitsubjeca the applicant br a civil penally of APN Number Occupancy Type
nm more than five hundred dollars($500). 3622 1024 . 00
0 1,as owner of the property,or my employees with wages as their ante compensation,
will do the work,and the structure is not intended or offered hostile(Sec.7w,Business
and Pmfesstrns Code:The Cmin actor's License Law does not apply to an owner of 305 - FRAME Required Inspections
Property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are No l mended or offered for sale.If, 307 — INSULATION
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did net Wild or improve((it purpose of 601 - ROOF TEAR OFF
sale') 602 - ROOF PLYWOOD NAIL
0 I,as owner of the property,am exclusively contracting with licensed contractors 10 603 - ROOF BATTENS
consbYct the project(See.7044,Business and Professions Code:)no Convector's Li.
cense Law does not apply toanowner of property who Wilds or improves thereon,and, 604 — ROOF IN-PROGRESS
who contracts for such projects with a contratrof(s)licensed pursuant o the Contractor's
License Law.
0 I am exempt under Site B&P C fee this umon
Owner Date FINALED
WORKER'S COMPENSATION DECLARATION
I hereby alRrre under penalty of perjury one of the following declarations IAN 1 0 2003
I have and will mortal n a Cacti Etude of Consent self-insure for Workers Cumprm JAN 1 L
I cation,az proviJCJ for by Section J]011 of IaMr Code,for the pcRnrmance of the
f/ work for whichthi,Permitisissued. BUILDING
0 I haus and will maintain Worker's Compensation Insurance,as required by Section
3]IXI of he lahmr Crile,for Ne performance of the work for which this permit is issued,
My WmIne nmpercen n uvna ca 'r and number,
Camel'/� Policy No.: Y G Y'�3—
CERTIFICATE OF EX EM PnON FROM WORKERS'
COMPENSATION INSURANCE
massection nerdnot secomplued iflhC Permit isformic hundred dollars lSlIXp
or less.)
1 certify that in the Performance of the work for which this permit is issued,I shall not
employ any person in any manner sm ono become subject o the Workers'Compensation
laws of California,Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exem plinn,you should
become subject to the Worlecr's Compensation provisions of the Labor Code,you must
OO forthwith comply withsuch prmtaions to this PermiLshull be decreed reviled,
z CONSTRUCTION(.ENDING AGENCY
[—t 4 1 Worthy Ncon
y affOat fere is a traction lending agency lot the perlirmance mf
ai > the work for which this permit is issued(Sm.3097,Civ.C.)
aQ Lemb,'s Name
7 z Lender's Address
(� 1 unify that I have read this application and state that the shove information is
correct.I agree to comply with all city and county ordinances and state laws(elating m
0 U building construction,and hereby amhnrim represenmtivas of this city to enter upon the
W above-mocrimned psopcny for inspection purposes.
IY (We)ague to save,ande expenses
and keep harmless the City of against
against
Te, liebilitics,judgmeII, uandet his pewhichmayinanywayname against sail City
f,Jz inc0nuyucncc n(the 6rani nl this permit.
'—' APPLICA U ERS DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE EGU TI
/I ,C�� Re-roofs
Si Lure nfAPP s HAZARDOUS MATERIALS DISCLOSURE ar Type of Roof
Will the applicant or future building occupant store or handle hi'ma ous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
COJe.SectYcs ion 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building occupant use equipment or devices which If a roof is installed withou rst obtaining an inspection, I agree to remove
m
oor hazardous air contaminants as defined by the Bay Arca Air Quality Management all new ria for ins C on.
fr74.n�,
ad the hma nus materiaLertyuimmemv under Chapte,fi95ofthe Califor-
ctyQdc urns 25AIS,255A and255J4.1 undersand fmi(Ihe building
Iy hese ..I.fat it is my rtsrymsihiiny m nody IM rccupmtof theichm melpnnrnritsuanttofeCenificuteuf rose ancy. Ig t - ofApplicant Date'
nted agent Oate All roof coverings to be Class "B" or better
Building Division '
CIO
, 10300 Torre Avenue
Cupertino,CA 95014-3255
4 Telephone: (408)777-3228
Pax: (408)777-3333
CUPEDTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address:
Reroofing Company N
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01