03030126 (2) CITY OF CUPERI'INO y
) ; BUILDING DIVISION PERMIT CONTRRiaR &ORINkO0 ,, .TION -
BUILDING ADDRESS: T D ROOFING PERMITNO.
20902 9RERN LEAF BR
• OWNER'S NAME: 3540 MARGATE AVE. PERMIT ISS A
RRITCE
E: SANITARY 19. O OL NO.
(408) 892-8872
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
>05 LICENSED CONTRACTOR'S DECLARATION
'rl u1 hereby affirm that 1 nm licensed.ager provisions oPChapmr 9(commencing Job Description
wish
S tion7")of Division3ofthe Businc ProfeWou Code.andmylicenseu
inmhfo=andeffect., REROOF
'
5'q= ucenm Cess 3Q ue.a 6 b a' .
Dam1 1ARCHITECTS DECLARATIONT REMOVE 2 LAYERS OF WOOD SHAKE, REPLACE W/ LANDM
understand myplains shalto,udupublic memtls 30 YR. COMP. & 716°OSB, 30 #FELT
DpU
G Licensed Professional
g OalNEmBUILDER DECLARATION
d n C I hcmhy.(Torre that 11. exempt from the Consnctoo e:Any c Law for the '
❑O which re reason.(Section 11131.5.Business and improve,
demolish.
Code:Any city as county
le$�i which myulma n ePermit ac comwcl.alnC improsu etcerroh t fi repair any structure
Foy prior mits issuance.also requires@c applicam for such permiuo file aaigneJ mmmcnl
< that he is licensed poomant to the pmvaions of the Contracture License Law(Chapter 9 Sq.Ft.Floor Area Valuation
as
Ft•� (commencing with Section 1000)of Division 3 ofthe Businusand Professions Code)or
..
that he i3eacmpt Ncmfrom and One basis for the alleged exemption.Any violation of
Section 1031.5 by any applicant far a permit subjcm the appiicanu0 a civil penalty of APN Number
not mom than RK hundred dollars($5fu). O lffi"Y Type
❑I.uown.of Nepropcny.or my employcm with waguuJeh sole compenution,
will do Rework,and the urecwm is act intended or offered formle(Sec.100/,Business 3263016700
and Professions Code:The Contractors es w .
License Law donot apply an owner of Required Inspectioncy�
propenywho builds or impmves thereon.andwhodoessuchwmkhimselforttuough his ff��Ri n p p se�,Bq,
own employees,limited that such improvements are not intended oroffemel formic.If,
however,de building.,improvement is sold within ane yxasofcompledon,the own.- 305 — FRAME
bulletin,will have the burden of proving Nat k did not build or improve for purpom of 3 0 7 - INSULATION
ole')' - APR 0 8 2003
❑1,as own..(do progeny,em eselusively eontncting with licensed contractors m 601 - ROOF TEAR OFF
convect the pmject(Sec.RNq Business and Profeulons Code:)The Conha.ori U. 602 - ROOF PLYWOOD NAIL
come Law does not apply w an owner of property who builds or Improves thereon.and BUILDING who contracts far such projects with Is moraemr(s)homed purivan to tee Dnua..rs 603 — ROOF BATTENS BU
ElIaLicenmexe 604 - ROOF IN-PROGRESS
❑lam Law.
undo Sec. ,B&PCfor thu,raven
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under pemlty of Perjury one of she following dmlvatiom: .
have and will maintain a Cenificate of Commentw aclf-imam for Wmker'sCompen-
on,u provided for by Section 3100 of she Labor Cudc,for the Notormanm of the
work for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,u moired by Section
300ofthc UWr Coda,forthep.formanceofd workfmrwhichthiSNMitis Wued.
My Workers Compemation ldnnro cannot and Policy number em:
Carrier. S Paley N..: 14-al I5 (i
CERDFICA OF-FIXiA ION FROM WORKERS'
COMPENSATION INSURANCE
(This mn;m need not ba completed if the lermh lafm.m hundred dollars($100
or lcuJ
1 eeniry that in she performance of the work for which this permit is ounce.I shall not <
employ any person in any mannerm u to become subject to WorkeW Compeuation
Laws of Ca1ifom;a.Date
Applicant -
NOTICE TO APPLICANT:if,ager making this Ccdifcam of Exemption,you should -
become object m the Worker's Compemefion provisions of the Labor Code,you must
.J O rordewith comply with such pmviumor fir this permit shall be deemed revoked.
Z h CONSTRUCTION LENDING AGENCY
F Ihereby affirm that there is a c.nstmction lending agency for the performmm of
a etre work for which this permit Is issme(Sec.3091,Civ.C.)
W A Lenders Name
G
z Lender's Address
�
U Q i certify Nn 1 have read Nsty and our end stave son the above information is
W(•' cored.l oma to on.complyand with all city end county ordinmtts and case lives relating w
Q U ouomoocmoved .nand hereby amhonpurposescnsahvrs of this cirymenwr upon she
ahnvrmenua progeny for inspection purposes.
FOw (We)agree m saw.indemnify and keep harmless the City of Cupertino aga;rot
Z incoflablinex,Judgments,the 'nm'sts and opcnma which may in any way secmc against aid City
t)z, meonscquencc ofthc renting.(thle Permit.
APPLICANT UNpE STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE U GNS.__ ./s / _A��
a'.'/I'irf^/"X�/ 3/a11 1C3 Re-roofs
Ssgnuu¢ofApphmHAZARDOUS MATERIALS DISCLOSUREData
Type of Roof
Will the applicant Lir form building occupant nom or handle huudous normal
Our defined by the Culaminn Municipal Code.Chapter 9.12,and the Health and Safety
coM.Section 25532(.)7 All roofs shall be inspected prior to an ,..fort material beim
❑1'mrio P P Y g g installed.
Will the applicant or future building occu nl me If a roof is installed without first obtaining an inspection,I agree to remove
shav<Nnm air c.ntemimmis u dcfincdh thoaBe Area
g p
ren �m
r r Quality Management all new materials for inspection.
❑Ym
1 have read the hamNommawrials reyuimments under Clexpmr 6.95of the Celirm-
sixHrshh&safelYcode,S«tiom25w5.25533and 25534.1undetstandmat;nhehuiwfng
does not curtenit hnvc a to Not it is my responsibility w nodly the occ imm M the
reyuimmc h must h met 'or w issuance of a CertiOcew of cogen .
j Or �7 03 Signature of Applicant Date
Owner ormatiorired agent am All roof coverings to be Class 'B"or better
Community Development Department
Building Division
I,Miin�
d' City of Cupertino
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: VA6U% gay- fS n u c- \'(WA 9
Job Site Address: —.10 cl 0 1 G v t&\-\ V c� !Q
Roofing Company Name: T p 2
'
A plicant's Signature: Z , Date: slay I O 3
Greg e
el
Building Official
Revised 1/30/03
Printed on Recycled Paper