03050080 (2) CITY OF CUPERTINO �`�""^ * °""""��''` '
BUILDING DIVISION PERMIT -O RUT RANEPMa�WON:
BUILDING AGGRESS: TEO a S ROOFING PERMIT 50.03050080
OWNER'S NAME: 691 W SAN CARLOS -p�"J$19/2003
EN SAKIMA
NE: (408) 279-8797 SANITARY NO. CONTROL NO.
ARCHITECf/ENGINEER: BUILDINO PERMIT INFO
BLDO ELECT L� O PLUMB MECH
D 0
o ij LICENSED CONTRACTOR'S DECLARATION
ly 1 thereby aRtrm met I am literucd under Provisions of Chapter 9(commencing Job Description
with Section )of Division 3 close Bu'n and Profeamona Code,and my license It FIN a LCD
mmnmleean e y_ io5 REROOF ,1 G
S Inallf rte 3 LtYx
° D
Co.
`X MAY 2 2
ARCHITECTS )ia. RA °N 2003
I understand mY pans shall he usrd u public meards
jo Licensed Profcuional
OWNER-BUILDER DECLARATION BUILDING
1 homily.form that 1 em exempt from the Camomile's License law for the
0 o following moon,(Sudan 703 1.5,Business and Prorcuinn Code:Any city at county
$ which requires a Permit to construct,aher.Improve,demolish,or repair any stmclum
FSS^ pduNita issuena.atsu requirta the appiinnl foranch permit 7o fie a signed ststemenl
< that he la licensed pursuant In the provision of the ComracmeWano Law(Chapter 9 Sq.Ft,Floor Area $-y2l"ion
$ (commencing with Section 7M)or Division 3 of the Buincsaml Profestlnna Code)or
.. Nal he is exempt therefrom and de but,for ds,alleged exemption.Any violation of
Section 7031.5 by."applicant fora Permit aubjecu the applicant to a civil penalty of 3A&M Mi0er00 Occupancy Type
not more than five handled doll.(5300).
❑I,ssowoerof the property,or my employcta with wguulhir axle cvmpeametion.
and Promotion,
r thewo*ana thetwduleltnmmteicense aw does Out apply,nono owner
--FRAME Re aired Inspections
and property
who
Code:The vesmeConaraton.res and
who law don let apply lf rt owner of 307 - INSULATION p
property who bu I Ids or int proves Nelem,and who does ouch work hi mself or through his
awn employees,provided thauuch Improvements am not intended motioned for sale.If. 601 — ROOF TEAR OFF
however.the building or improvement Is=to within am you of compledon,the owner.
builder will have the burden of proving that he did met build at improve for purpose of 602 - ROOF PLYWOOD NAIL
`°1e')' 603 - ROOF BATTENS
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.70ed,Business and Profusion Code:)The OMMICmr's U- 604 — ROOF IN—PROGRESS
ane law does not apply in an owner of property who bull&or Imprews mleon,and
who contracts for such projects with a conlracmrt0 licensed pursuant to the Contncules
Liana law.
O l am exempt under Sec ,B&P C for this reason
137100
ner Dam
WORKER'S COMPENSATION DECLARATION
I hereby aRlrm under penally of Perjury ate of the following deelamtm ov
I bow and will maintain.Collimate ofConannt m self-inure for Worksb Comfort-
.must,
ompete
io°,u provided fu by Section 37W of the Labor Code,for me performance of the
rk for which this permit Is Issued.
I haw and will maintain Worker's Compensation Insurance.u required by Section
of the Labor Cade,fm lie performance of the wah for which this permit is Issued,
Wallace,Compensation Insurance ypier and Policy number art:
ntic`�Tftil�. FwLn.Q, Palrt .:7 - G�i033
CERTIFICATE OF EKEMPn MWORKERS'
COMPENSATION INSURANCE
(This secllmrcrA not be completed ifflat Permit isforone hummuldollaran](a))
of Ieaa)
I certify that In the performance of the wark for which this permit Is issued,I shall not
employ any penin In any matter an u to become subject to the WorkeW Cornmas.tlon
Laws of C.lif..I..Dam
Applicant
NOTICE TO APPLICANT:IL after making this Ceeifaeam of U,mption,you should
become mhjecl at the Woher's Compensation prevision of the labor Code,you most
.JZ foMwith comply with such provisions or this permil&hall be decreed revoked.
OCONSTRUCTION LENDING AGENCY
L.t IM1emhy allirm that Neo its eaautmctlnn lendingagency,far the Performance of
6i r7 the work for which Nis permit is Issued(Sm.3097,Civ.C.)
WMr-�Q Lender's Name
✓ y Lendaea AddressC)FQr . I unify that 1 have mad this application and sum that the above information is
IF cortetl.I agree to comply with all city and county on inaruzs and tum laws mining m
Q building convection,and hereby authomm mincmnutives of this city to cater upon the
` W about-mentioned Property for InflaIndemnify
and keep ha /
(r^y IA (We)agree to saw.
Ind expen and kith may
In m me CITY o C lsoloino againold
City IA liabilities.judgments,ethegrowing
ro in ofthisseswhtCM1maylnanywayaaNeagalntUOidClly f 3
V 7 A PLIC NT or me grantingof this Permit.
F7 APPLIC NT UNDE TANGS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC EGUL NS.
Re-roofs
SiIIcu of Appl antremlor Dam
RDOUS MATERIALS DISCLOSUR Type of Roof
Will the app amt Or future building occupant mom or handle hasudou material
as danced by the Cuperlim Municipal Code.Chapter 9,12,and the Heald and Safety
IDisnict?
ce.Section 2553:(.)7 I, All roofs shall be inspected prior to any roofing material being installed.
DYta LyNo
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haurdous air commarmanta u krincd by the Bay Area Air Quality Management all new materials for inspection.
No
0 Yea %
I have mad the hasaknu,7ss mamrialtmquimmenu undcrCM1amr6.95of Ne Ca ifaa
Hedm&S IyCo00,5ection 25305,25533 and 25534.1 understand thaH(thc building `ta amt cu sly by tenant,mu Itis my rtsponiMlity m notify t aecupant of me man 0 hich bcmetpdortnPssuanaofsCeNfita of )' % a S lure ofApplican —' Date
L -�
r unm mf ted*01 Dem All roof coverings to be Class"B"or better
n
Community Development Department
Building Division
(f� City of Cupertino
�! 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U^���I�O 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 will comply with the above stated policy on re-roofing.
Homeowner's Name: Lc—�AV" �C', G�
Job Site Address: -7 ro b'S h40 I ICA N dy v'r V
Roofing Company Name: TD�eti Uro n J!UF)c
A plicant's Signature: JCcl "O_k-Ce. Date:
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
t
CITY OF CUPERTINO
REROOF .S^
o o �
CUPEkTINO PERMIT APPLICATION FORM
APN# '��/ . O Date:
Build i_- Address:
r�603 �l
Owner's Name: Phone#:
/f: S <, M CL
Contractor: Phone#: License#: /
�C�0S tK. �y08 �V$�OS� 6 8100
Contact: Phone#: Cupertino Business License#:
S
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles �n(�
L3Other(Specify) C3Other(Specify) I �'St��M?t k/ 714
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: /
I've. kc TaIl 3oLt, lreQ -P'esrrbet[?lc{ 17
Residential �_ Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: ype of Construct Occupancy group:
111,2,
JO.ot7c- roo{• /
Qty. if
AppliFee 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
X137• � °