04090073 (2) CITY OF CUPERTINOu>rnna,ye � dPs,
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ,, . . . _
eU1LDINGADD[i MARTINEZ ROOFING INC 1111NOD4090073
OWNER'S NAME: PERMIT ISSUE DATE
DNE:
SANITARY O. N OL NO.
ARCHITEC(ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
400 LICENSED CONTRACTOR'S DECLARATION
F❑ 1 hembYY,�aafli� Net I am limed under provisions of Chapxr 9(commencing Job Description
iW with Smdmn]0dry'of Division3ofthe Do4nevyll Pmfrssiom Codc.endmYlicenu is
Zc. h r.0 retro some ys'a / l REROOF W/ COMP .
Lice C Lic.M
It
^o Dem Comrx
�; ARCHITECTS DEC ION
m Tun,moth my phns shallWuxdaspu crtcnNIt /^
G
3 C H
Licensed Pmtcssionel /
g OW NERr exempt
ER DECLARATION (�
3�M I hereby alErm I I em exempt from We Contractors License Law for rW
p O fallowingso
man.(Seeman 703 .5,Business and Professions Cade:Any city or county V
K m which requires a,smut m construct,altar.improve,demolish.or repair any strucum
6490
,nm mils Lcsuenm.alw mquime thetapplicrat forsueh pe.iuo fileasigned summons
Nat he is licensed,....at to the provisions of Ne Commoners Limme law(Chapter 9 Sq.Ft. Floor Area Valuation
mH" (commencing with Section 7")of Division J of the Business and Professions Cook)or
Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by Say applicant for a permit subjects tha applicant to a civil penalty of 35CPN6`1M*Qr00 Occupancy Type
not mom Nan firs hundred tonin($500).
C3 I,as owner of the property,or my employees with wages as Nair sole compensation, -
will do dta work end the aumcwte is not intended or offered fatale(Sec.]U64,Business
and Professions Cote:The Contractors Licenu Law it=not apply in So owner of Required Inspections
property who builds or impmws Nemon,and whodoessuch wart himself ormuough his
Own employees,provided that such imprommenu art not intended oraRered for ale If.
however,the building or impmvemens is Sold who.m¢year of completion.be ownm.
builder will ban the W.den of proving Nat W did not Wild or improve for purpose of
okJ.
Q 1,as Owner of to property,am exclusively contracting with licensed contactors to
consumer du praiser(Sec.74364,Business and protections Code:)The Comracwr's Li
come law does not apply as So owner of propany who Wilds or improves themmn,and
who contracts for such projects with a conmcter(s)licensed pursuant to the Convenors
License Law.
I am exempt under Sec. B&P C for Nis reason
OwnerDau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of Ne following dxlarations:
7�cl
I hasand will mainuin aCeniOmm of Consent m self-insum far Wmkers Comperelian,re provided for by Section 3700 of Ne Inbar Cade,for Na perfam race of the
for which Nis perm it iS issued.
ave and will me.norm Workar s Compcnumon hummu s.as mquimd by Section
of Ne LaWr Code.far the pcfamormof Ne work for which Nis permit is issued.
Workers Cov,cnemion m mac amu rad Policy num ame u Pahccyy��o:A -ERS 2/
CERT( CATS OF EKEMPTIQMFI40M WORKERS'
COMPENSATION NSURANCE
(this section need nothecomplc¢ ftW Permit is for one hundred dollars(SIIX)
at kit)
I certify Nat in Ne performance of On,wart for which this Permit is issued,I shell not
employ any Person in any mother an as in become subject to the Workers Compensation
Laws.(Calif mla.Dam
Als,Bcam
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Com pcnsmimn provisions of the labor Codc.you must
Z foMwith comply with such provisions or Nis Permit shall be deemed moment.
Z O CONSTRUCTION LENDING AGENCY
H� I hereby aRrm Out there is a commandant lending agency Or the perfombrom of
C4the work fur which Nu permit is issued(Sec.3097.Civ.C.)
CQ Lenders Namc
z lender's Address
U 0 1 certify Nat I have mad this application and sure Nat the above infoonatiun is
P coned 1 agree to comply with all city and mUrLy ordinances and sure laws relating to
0U building construction.and hereby authanae mpmumutives of Nis city in enter upon NC
above-mentioned initially for intimation purposes
(We)agree to save,indemnify and hep harmless the City of Cupcnino against
.F.V1 liabilidea,judgments,costs and mapcnses which may in any way acme against said City
in cissOccuters.of On ai Of
s pormit.
U? APPLIICCAN-OsUNDENSTANDS AtND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signazurc of AppliwDau
HAZARDOUS
US MATE RIALS DISCLOSURE Type of Roof
Will Nc applicant or future building mcupem start or handle haaardaus material
u tafimd by are Cupertino Mumvi al Code,Chatter 9.12,and the Health and Safety
gi�rdur
de.secyO25532(tr, No All roofs shall be inspected prior to any roofing material being installed.
pplicant or fuwm building Occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
conummarms as dcGned by dm Bay Area Air Quality Management all new materials for inspection.
District, If
❑Yes /f N.
I have mad the bar ndn/us materials raquimmcnu under Chapter 6.95 of the Califor.
.is Health&Safety Code,Sectors 25505.25533 and 25534.1 urmersrand Nat if the With,
dna not currently have a mnan at it is my msponsihility to num 1,mat occupant of Ne
mq.imA,htswn J pnmrmias. aamncenrea or cap y.
S ature•ofApptcan Date
n onxedagatnt G � �oam7y—" / All roof coveringS_t e Class "B"or better
a1 Community Development
( N 10300 Torre Avenue
Lr' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB AD SS: PERMIT #
21831 /7.e�r4 OYO C00 73
OWNER'S N Rlle-E- —1!5e14,c C . PHONU
GENERAL CONTRACTOR FAX
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
® Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing JeMit�TisVzZ ..✓G
Septic Tank
Sheet Metal
Sheet Rock
Tile
i
v /Con c or Signature Date
Community Development Department
Building Division
��t fr ':' City of Cupertino
10300 Torre Avenue
OzCITY OF Telephone: (408)777-3228
UPEkTINO Fax: (408)777-3333
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 wild comply with the above stated policy on re-roofing.
Homeowner's Name:' //,�2 Cr`
Job Site Address: ���i
Roofing Company Nam 1-16e-% eJ V L AA9:—
A plicant's SignaturesAIA- Date: 3 Cis f
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF O bCITY OF
�
CUPERTINO PERMIT APPLICATION FORM !
APN# Date:
a 9
Building Address: /
Owner's Name: Phone#:
Contractor: Phone#: License#
Contact: Phone#: Cupertino Business License #:
t06. G 7 - i?ar-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X 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: / L �/�
AMo Oj1� �JIr/S C r2 / P4 I jl Ye C
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with PI e t. if
there are ans rictions:
Costf Pr,t jt Type of Co t Occup y gr
Qty. if
A 1' e I Fee 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
J