03070163 (2) CITY OF CUPERTINO < '� � ' k"c
BUILDING DIVISION PERMIT CONTRACTOR INFO,MATION
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BUILDING ADDRESS: YORKSHIRE ROOFING PERMIT"°03070163
OW NER'S NAME: 7275 NATIONAL DRIVE PERMIT ISSUE DATE
(925) 484-1900 SANITARY NO. CONTROL NO.
ARCHITE MNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSEDCONTRACTORACI'4 DECLARATION
w❑ 1 rchy alarm that 1 em Iittone0 under p ons Of Chapmr 9 knmmcnse is Job Description
6W withS n7M)) f Division 3 ofthc Busineeeli lssiom Codc.and my license is
in fun hhh me aWcff I. 3/39 REROOF
Ourj E2= License Cl a Lic.a qw�,
AR HITECTSD ThON ■ ��C���®
? s 1 mbcrwnJ my plans ahall he cold as P I Js
LL Licensed Pmfeasi...I SEP 2 Z 2003
vers OWNER-BUILDER DECLARATION
<Y 1 hereby arrived that I em exempt from lie Contractor's Llecnc Law for the
o o following reason.(Section 703 1.5,Business and Professions Code:Any city or county
K„fixe, which requires st permit m emnstmcL a1mn,improve,demolish,or mpair any suucmle
.F=N Prior o its issuance,also requites the applicant for such permit to file a signed statement FU 1111) nnn
poo that he isliccmedfursmnlmlinepmvisimmofNcCnnuactor'sLimnmlaw(Charter9 Sq. Ft. Floor Area Valuation
pH (commencing with Section?010))of Division 3 Of the Business and Professions Code)or
i $
that he is exempt thcrefrtml and the baso for tbe alleged exemption.Any violation of 34248034 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not more than five hundred dollars($500). P Y YP
D 1,s owner of the Preperty.or my employees with wages s their sole compenallon.
will do Rework and the suuctule is not intended or offered for sale(Sec.7BU,Business
and Professions C de:The Contractor's License Law dont not apply to an owner of RCgguired Inspections
property who boilers or improves theme,end who deauuch work himselforthroegh his 307 — INSULATION
own employees,provided that such improvements arc not intended or offered formic.If, 601 — ROOF TEAR OFF
however due building or improve eel is to within one year ofemopicticur the ownery
builder will have the burden of proving that he did not Wed or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.).
D I.as owner of the progeny,am eaelesivdy convening with ueemee contractors to 603 — ROOF BATTENS
consumer did project(sec.7061.Business and Professions Code:)The Contrition's Li. 604 — ROOF IN-PROGRESS
ceme low docs not apply to an owner of progeny who Wilds or improves unclean.and
who contracts for such prejeeB with a emntranor(s)licensed pursuant o the Cmmnemr'a
License Law.
D l am exempt undo Sec. ,B&P C ler this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affinm under penally of perjury One of the following declarations:
1 have and will maintain a Certificate of Consent o self-insure for Wortrr'sCompcn-
lion,as provided for by Section 3700 of the Labor Code.for Re performance of Re
work for which this Permit is issued.
D 1 have and will maintain Worker's Compemation Insurance,res solicited by Section
37 CRehWlCWe.for Re Performance of Re won for which Nis permit is issued.
orkc�ompcnctinn Inxuraag;.=a dl PoIMY �
,a;er: /EX fumy .
CERTIFIC OMPE SATION MSUON RANCEOM ERS'
COMPENSATION
(Thisseeaon need not becomplemiflhe Permit is foronc hundreddnll.rs(5I(10) .
nr lean.)
1 eenify that in the pefonnande Of the work Cot which this Permit is issued.I shall not
employ any person in any manner so as to become subject 0 the Wmrkef'Compcnsauion
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
Income subject to the Worker's Compcmction provisions of the Liam Code,you mus,
.J O forthwith comply with such provisions Or this permit shall be deemed avnked. -
Z h CONSTRUCTION LENDING AGENCY
"eve I hereby affirm that there it.lomuuction lending agency for the performance of
Y� the work for which this permit is issued(Sec.3W7,Civ.Cj
i —
fender's Name
Z) 2 Lender's Address
U p i ttliey Nall have with
Risty and coup and atm that Inc aWve information is
C) CorreE^ Woking 1 egret rl comply with ell city and county ntativ s of and sum laws r upon t e
C) V Wever cmtioned ro and heron vuthonnp representatives or thiuitymcnler upon the
r LO ahnw-mentioned property for impaction purposes.
(We)agree la cons,indemnify and keep harmless the City of Cupertino.g.in,[
LO in
or tire
grantiosts ng of stothis permies t, may in any way acerae against cid City
U z in conscqucncc of Re gmming of this permit, '
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL N-POINT Issued by: Date
SOURCE REGULATIONS. �K2a�
S �'�-0 Re-roofs
JCWC.
mreo APPlicanUCmntaclmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sore or handle havardous material
ned by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Section 25532(1)?DYesNn All roofs shall be inspected prior to any roofing material being installed.
will the applicant or future btruding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mardous air contaminants m defined by the Bay Area An Quality Management all new materials for inspection.
a?
❑Yes IGf No /^
Ihave&Sgct the WnrdtmM25Y)materials requimmemm4,1,under Chopmr6.95 or.ilthec C.-to
L / O/
iliac not,&ently Cwa SccdumhatitI -1lexnd25531.1 undctsmntl that if the Wilding / �y ��n /1 J.
dues not currently haw a tenant that it u my rcxponsiniliry nndfy Inc rccuPnnl of Rc ` �! (/ �(/
eequincWtswnichoumbernL loi�w^ flicemnu racupenoy Signature of Applicant V Date
E 'O c�Z� -21-OS
non Or authorized.,not D„e All roof coverings to be Class "B”or better
07/21/09 09:05 $4087779333 CITY CUPERTINO 1?1003/003
Community Development Department
Building Division
City of Cupertino
P� 10300 Torre Avenue
CIN OF Telephone: (408) 777-3228
Fax: (408)777-3333
C U PE I` ,O u
Building Department
Subject: Re -roofing policy for the City of Cupertino
1. Prior to ermit issuance,you must agree to comply with 1997 UBC Standards
and ma afacturers specifications on re-roofing.
2. New ro coverings shall not be applied without first obtaining all inspection
and wri i en approval from the building inspector. A final inspection and
approv; shall be obtained from the building inspector when the re-roofing
is comp ited.
3. All roof shall be inspected prior to any roofing installation.
4. To recei e a final sign off from the City,the following steps are
requires
1) Pre-i spection and/or tear off approval.
2) In-pi -gress inspection approval.
• 3) Fina nspection approval.
a) S) crk arrester installation.
S. If plyw, ad is installed, a plywood nail inspection is required.
6. Any roi i ing which is applied without first obtaining an inspection,
will req .ire the removal of all new material down to the sheathing,
so a prc Per City inspection can be performed.
IMPORTANT
1. Flat roc s must have a minimum of 1/4 " per foot slope and demonstrate
that the >is no ponding.
2. An I.C. .O. report is required to be on the jab site at the time on inspection.
I understand a A will comply with. /the above stated policy on re-roofing.
Homeowner's lame: I �/ 6—
Job Site Addre s:
RoofingComF any ame:
A plicant's Sii nature. Date: ()3
W lJi1GC)�
Greg eei
Building Offic 1
Revised 1/30/03
Printed on,9mytled Paper
1 �
07/21/03 08:04 $4087773993 CITY CUPERTINO 0 001/003
CITY OF CUPERTINO
REROOF
= CUPEkTINO P RMIT APPLICATION FORM
APN# Date:
2
uilding A dress:
Ow er's Name: Phone#�� c�
C actor: cy / fhone#:� 6o �' -� License#
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingle . Z3Asphalt Shingles
tf Wood Shakes O Wood Shakes
❑ Wood Shingles ❑ Wood Shingles )
O Other(Specify) 0- Other(Specify) Ae-j G�
Number of existing overings ❑ Provide I.C•B.O.Report N
❑ To be Removra - O Provide Mfgr.Installation Specs.
I Have Read, Under, and and Will Comply With Cu o's Tear Off Policy: ❑
J b Description: _
Residents Commercial ❑
Fite Zone: Yes [ No ❑ Confirmed wi 1 if
there are restri
Cost of Proje� Type Qf Construction: Occup an grou r
Qty. if
Fee ID Fee Description Fee Gro
Bl -IZWEE Bldg Permit Fees BUII —IN
B] .14ERGY Energy BUILDING
B: KSMICRE Seismic Fee Res BUILDING
B! I:ISMICOM Seismic Commercial BUILDING
B: LANCHK Plan Check Fee BUILDING
B' iSLIC Business License T BUILDING
2
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