03100124 (2) C TY OF CUPER'I'INO
BUILDING DIVISION PERMIT ICON RACTOR INFORMATIO N ;
BUILADDRESS: JNS'J ROOFING INC PERMIT NO.03100124
OWNER'S NAME: 691 W SAN CARLOS ST PERMITLSUEDATE
NE: 4082796171 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lop LICENSED CONTRACTOR'S DECLARATION O O O O
I m F 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
:ZW with Section 70001afDivision 3 ofthe BX;and Professions Code.and my license is
j�= in fail int—``A3-Wlc a. ✓" '?39 /`� .. REROOF
Liccnx CtaSe4 _J._Lic.M /
O Date I Cuu�pIraypr `TINSZ la.•1 Q/
f� ARCHITELT9]fiCLARATION —�-
vU �f„nde my plans shall he used as public records
0.t; License siona)
g OWNER-BUILDER DECLARATION
y ehy affirm that 1 am exempt from die Contractor's License law for the
fon ng mason.(Section 7U31.5.Business and Pmfe.aiens Code:Any city or county
ch mat irea a permit In construct.alter.improve,demolish,or repair any structure
Szi prions its issumare.also requires the applicant(ersueh permit o file a Signed statement
ixap that he is licensed pursuant to(be provisions Ofthe Contractor iLimnxLaw(Chapter 9 Sq. Ft. Floor Area Valuation
2l- (commencing with Section 7000)of Division 3 of the Business and Professions Code)of
$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of 32610055 . 00
Section 7031.5 by any applicant for a permit sunccu the applicant o a civil penalty of ane AIN Number Occupancy Type
not mom than r hundred dollars($500). P Y YP
0 h as owner of the pmpcny,or my employees with wages as their sole compensation,
will do the work,and the suuctum is not intended or offered for sale(Sec.71k4,Business
and Profeasions Cndc:The Contractor's License Law docs nm apply to an owner of Required Inspections
prepeny,who builds or improves thereon,and who does such work himself or through his
Own employcea,provided that such improvements are not intended or offered for sale.If.
however.the building or improvement is sold within one year of completion,the owncr-
builder will have the burden of proving Nal he did not build or improve for purpose of
sale.).
0 1,as owner of the progeny,am exclusively eomnning with licensed contractors m
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
ecnse law dors not apply to an owner of property who builds or improves Nemon,and
who trounce for such project.;with a contractor(s)licensed pursuant o the Comracrod
License law.
0 1 am exempt under Sec. B&P C for this heated
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I haw and will maintain a Certificate of Consent to sel6lnsum for Worker's Compere
ration,m provided for by Section 37M of the labor Code,for the performance of the
work for which this permit is issued.
0 I ban and will maintain Workers Comlxnsalion Insurance,as required by Section
37M of the lahor e.for the perf smtanee of the work for which this permit is issued.
My Worker's Cut noun Insurance up olicy number am:
Ca('e/� a.�A Faaa aIi a., I^a9Y SL6 7�
RTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not becnm leted ifthe
p permit is formic hundred dollars(31(N))
m 4ss.)
I certify that in the Performance of the work for which this Permit Is issued.l shall not
employ any person in any manner sat as to become subject o the Workcts Compensation .
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ceniricate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you most
:I O forthwith comply with such provisions or this permil shall be deemed mooted.
CONSTRUCTION LENDING AGENCY
1 hereby a1Tam that them is a construction lending agency far the Performance of
the work for which this permit is issued(Sec.3097,CO,C.)
y A Lender's Name
Y lender's Address
Z
0 1 certify that 1 have read Ibis application and some that Ne about information is
L P cortwt.1 agree 10 comply with all city and county Ordinances and start,laws relating to
�U building convection.and hereby authorir,expresemmisv of this city to enter upon the
xUa ahove-mentioned property for insri purposes.
G. (We)agree Ip save.indemnify and keep harmless the City of Cifrom o against
f l liabilities,judgmcn¢, oats and experts which may in any way accrue,against mid City
Jz in consequence of ming of this permit.
^ APPLIC/� N TANDS ANO WILL COMPLY W}TH ALL NON-POINT ISSUCd by:CE NS. L Re-roofsSignewrc monscu r pHAZARDOUS MATERIALS DISCLOSURE Type Df Roof
cant or future building acupmlstorearhaNle hssarduusmatcria)
as oby the Cupertin
f d o Municipal Code.Chapter t)A2,and the Health and Safety
.SccRm 25532(a)? J
pros [,p Na All roofs shall be inspected prior to any roofing material being installed.
Will mea besot or ra/la�rr building
Occupant
ea ant axe If a roof is installed without firs[obtaining an inspection,I agree to remove
PP 6 p equipment
or devices which g
it hvardnus air conuminams as defined by the Bay Arca Air Quality Management all new materials for inspection.
D'sit R (
0 Yes f1Nu
I have mad the heramouus maacrsda requirements under Chapter695 ofthe Califor-
ilia Health&SafctyF dc.Sadans 25505.23533 and 25534. Natifthe building / ti
to isolonts.l w a tenant that it is my respomihiliry c madly We omup>nt of the \ V
m immcnHw most he met pilar to iuuancc n(a Ccrtifcare fCccu cy —T'1V0
�'" Signature o pelican[ at
Owme r pI n. gen, Da1e� All roof coverings to be Class "B"or better
r
Community Development Department
Building Division
City of Cupertino
• �t 1 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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: Ctt.�M S Sb�a91i
Job Site Address: Fro ppC�•pp Ql�rj• �/�
Roofing Company Name:
A plicant'ss Signature: Date: t o IZ 03
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 631 o o / Z 7
` REROOF
CUPErRTINO PERMIT APPLICATION FORM
APN # !1 Date: ION,/
I D-
lJ l
Building Address: C+ n
108ao frat�to �Id . rJ
Owner's Name: C )2V �0 S`1^ �1 Phone#:
SCC lar2
Contractor: Phone#: License#:
JN SJ Roo- sc� . dog z1q-611 ► 739780
Contact: Phone #: Cupertino Business License#:
Type of Roof Covering:
Existin�+ Proposed:
T Built-Up Roof �lt-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:
�exrove cP) wo�)z , t1,shU t�o.•..� `fP� t«Me,.a1- stitr�� RUR
Residential ❑ Commercial •[�-
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: f 950 Type of C ru tin: Occup y group:
Qty
Apl4icablFee 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
$ (07, v