03060102 (2) C (408) 298-9399
CITY OF CUPERTINOtx'=<
BUILDING DIVISION PERMIT CONTRACTOR INEORMATION: . -
BUILDmcAoOaFss: LOS� GATOS ROOFING PEItMITNo03O6O1O2
OWNER'S NAME: 1771 SMITH AVE . PERMrr Ls��` 13/2003
OW CHARLES ATJn RP.TTY
)NE: SANITARY NO. CONTROL NO.
ARCHITEC ASNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
i ENO CONTRACTOR'S DECLARATION
"§ thI hominy affirm On, under
,o �p.r 9(commencing Job Descripdon
ction7")of
Division 3 of the Business and Profcemum Code.and my license is
m< full fo a cBett R8 ftJ
-O� in
;0 ueenmcl, G3' g ko47o7 REROOF
nipp, oa¢ ��t s t too GCS Atp1 L'u zu
ARCHITE
ATION
d 114deand my plana shall the used as public recnNs
5aL AUG 8 2003
a G os1
Liceed Pmfasm...
OWNER-BUILDER DECLARATION
f I hereby affirm that 1 am exempt from the Contractor's License law for the g��'�®I�
COO following round.(Section 703 1.5.Business and Pmfccuom UU Code:Any city or county
5$ which requires a Permit to construct.alms,Improve,demolish.Or repair any structure t7
prior to its i......also,require Osemplicant for such permit m file.signed sutemom
i `o
that Mislicensed pursuantto the provisions oflieContrecter'sUense Law(Chapmr9 Sq. Ft.Floor Area $22�ty®tion
a� (commencing with Section 7000)of Division 3 of the Business and Professions Cotle)or
y $ Nat he fi exempt therefrom and the basis for the alleged cxampuon.Any violation of
Section 7031.5 by.try applicant for a Permit subjects the applicant to a civil penalty of 3��I�T718P1 O O
not mB
room dom .a hundred dollars(SSBo3. Occupancy Type
❑I,as owner of the Property,or my employees with wages u their sok compensation,
will do the woh.and the awetum is not intended or oRarW fonale(Sec.7w,Business
and Profusions Code:The Conu sane.Liana Law does not apply to an owner of 3 0 7 - I NSULAT Re���d Inspections
Property who buildsor improves thereon,and whodma such workhimself orthmugh his
own employes,provided that such improvements are not intended crofrered forsale if, 601 — ROOF TEAR OFF
howeay.Ne building or imPmvement u sold within me yrar of rompleuon.the owmr-
wildm will have the burden of proving that M did not mild or improve for purpose of 602 — ROOF PLYWOOD NAIL
01. 603 - ROOF BATTENS
❑1,as owner of the property,.Business sins and Professions with licensed CPoma ton's to
came La theprnjoapplyadanOwneofprprly who Wildons a
orUThe
es Contractor's Li 604 — ROOF IN—PROGRESS
ttnu law doe not apply b an owner of property who milds or improves thereon.and
who contracts for such projects with acrntnebr(s)licensed pmswnt to tiro ContnctoYs
License
El .
1 ern uemps under Sec. ,B d:P C for this recon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following deelarmoe:
I have and will maintain a Certificate of CotaenOo wil-True fa Wor sCompen-
Ic"
mn,u provided for by Section 37M of the IJbor Code.for the pedmma ce of thc
rk for which this permit is issued.
I have and will maintain Worker's Compensation Insmanee,u required by Section -
0mf the later Code,for the performance of thc wort,for.lakh the permit is issued.
Wmims',Compensation Insurer curie andPolicynumber'er. �� al+ ,b -�YNo.: ZZ7i-ZOO 3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
or less.) ec
(This stiom need not he completed if the permit u for ono hundred&am(5IM)
1 certify Nat in the perfom anec of the work for which this Permit is issued.I shall not
employ any person in any manner so as to became subject o the workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after mating this Certificate of Eaemption,you should
berome subject to the Wmiem's Compensation provisions of Ne Labra Code,you most
=O funhwith comply with such provisions or this permit shall W doomed mvolmd.
zh CONSTRUCTION LENDING AGENCY
1 herby affirm that thcrt is.ronnrucuon lending agency for the performanceof
Y.7 the work res which this permit u issued(Sec.3097.Civ.C.)
4Q Lcmdcf3 Name
3.
3. z Lender's Add.
;J Q I certify that 1 have mad this application and sum that the above information is
y E corms.1 agree to comply with.II city and cuddly uNthances and sum laws mledng to
0U building connection,and hereby authorim mpresenalives of this city to tate open the
ltl .mea-menudgm Pmpcny for inspection Puryosea
.. fi (We)agree to save,indemnify and keep harmless da City of Cupertino against
UZ inconsequence
of Occrstsang of this expenses which may inany way.ccmc almost said City
nsegnence of No granting of this Permit.
"a APPLICANT UNDERSTA �p WI OMPLY WITH ALL N N-P INT Issued by: Date
SOURCERE 0
i3 03 Re-roofs
ort of Applican✓Con sur Data
HAZARDOUS MATERIALS DISCLOSUR Type of Roof
Will the applicant or future wilding occupant atom or handle hazardous material
as defined by the Cupertino Municipal Coda.Chapter 9.11,and the Health and Safety
ode.Section 25532(a)? XNr All roofs shall be inspected prior to any roofing material being installed.
Will Cho applicant or future building Occupant sac equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
strict? y/
❑Yes Ig No
I have tial the hxrardous materials mquimmems under Ch,w,6.95of he Califon.
ria on,curentlyYCode,Secmm ffi,! .2my and de 1 tImnmiyfto cup building t / �[ 1 " 4 /3103
dues not &Saftyhobo,anent Nat' 55rc d25Sitytoromandu ifthetofthe \ hl� l �T2 )
mqulrtmemts which met p' r Las c Ora Ccruficam of Occu an 1 nature Of Appllcan Date
� i3/3
a edthor M. All roof coverings to be Class"B"or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEI�TiNO
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 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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: Q C I E {I s o LJ
Address: JO69 Q�a Cn
Reroofing Company Name: Los 4 +US , \06 f' G
Applicants Signature: Date: S 6-3
Joe Antonucci�_
(Chief Building Official)
6/25/01
CITY OF CUPERTINO 6 �
REROOF d� 6
CUPEkTINO PERMIT APPLICATION FORM
APN#
Date:
Building Address: O
M 6
Owner's Name: Phone :A
J/
Contractor: 1 IL) bg
Rio 0 -Pin License#:
Contact: � � Phone#:
� a o� 29g 53 99
Applicant/Contractor, Fax#:
Building Permit into:
Bldg Elect Plumb Mech
Job Description:
Residential: Re roo Commercial:
Sq.Ft. Floor Area: /61 $/Sq.Ft.:
Architect/Engineer: Valuation:
ZZ 000.
Type of Construction: Occupancy Group;
Qty. if
A lic Fee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILIDNG
BENERGY Energy BUILIDNG
BSEISMICRE Seismic Fee Res BUILIDNG
BSEISMICOM Seismic Commercial BUILIDNG
BPLANCHK Plan Check Fee BUILIDNG
BUSLIC Business License BUILIDNG
24. z°