03050022 (2) CITY OF CUPERTINO '' '"N''""' � F° " ' ' t`� `•"
BUILDING DIVISION PERMIT „CUNTRACTOR�TIVFORMATION ''
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BUILDING ADDRESS: ROOFMASTER OF SANTA CLARA PERMIT"903050022
7610 HOL ANME.�RY PT
OWNER'S NAME: PO BOX 2711 PeRMlrhsffn6/2003
CH ERNEST W AND PATRICIA J
ONE: (408) 741-4900 SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p 0 0 0 0
yo Z' LICENSED CONTRACTOR'S DECLARATIONIdi Job Description
1 Mrcby arrum that I un IialuW under pmvislom a chapter 9(wmmewing p
with Section? (Division Jofdm ButlmasSed limfcaslmu Cocke.endmylicemeia
nn intuit fortes ✓ _ ��� A l��q
zJ LDi�Nnse aCie.ce, C g Coalrs REROOF At D
CHITECfS DECF.A A IONI
F.Iamu id my plans shell be used u public records MAY 1 5 2003
. O Licensed Prefesmanal
OWNER-BUILDER DECLARATION BUILDING
.� I hcrehy aBirm Nm I am exempt from the Contractors License Law far the
0 o following reuon.(Section 703 1.5,Business and Prefevtiom Cade:Any city or county B
g which requires a Permit to camlmet alter hnpmve,demolish,or repair any structure
Fly prior In its issuance.and requires the applicant for such permit in Ne a signed suamem
m<
that he is licensed parallel.to the provbiom of the Comrecmr's ULTme UW(Chapter 9 Sq.Ft. Floor Area $6N6iIJgtion
e�th (commencing with Section 7")of Division 3 at ft Butemuend Professions Code)Of
$
that he Ie eaempl therefrom and the bub fm the lifted exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 @2144fiftBPerO 0 Occupancy Type
not more then row hundred dollar[4500).
0 I,a owner of W property,or in,employes with wages u drab Sul.Compensation,
will do the work end Ne swcure is at intended w offered for sale(Sec.TOM,Business — YRAmhITS
ggp�p�tr
and Profusion Code:The Contraction's License Law deal not apply u an owner of 307 - INSULAT1VPTed Inspectio
property who builds or impravee thereon,and who dwuwh work Mmselrmr through Ma
awn employee,pmvided that such improvements are not intended aroRertd for sold.If. 601 — ROOF TEAR OFF
however,the building or impmwmenl Is mid within one year of completion,the owner-
builder will haw the burden of proving that W did not Wild or imprew for purpose of 602 - ROOF PLYWOOD NAIL .
sale 1.
603 - ROOF BATTENS
0 I,as Owner of the prnpmrty,am exclusively contracting with licensed wntncu s In 604 — ROOF IN-PROGRESS
comuuct the projest(Sec.7044.Business and professions;Code:)The Communicates Li-
ceam law does not apply in an owner of property who Wilds or improves themon,and,
who contacts for surL projects with a conuactons)Itsemed pursuant to the Contractors
License law.
0 I un exempt under Sec. .B&P C far this mason
owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby rm under penalty of perjury ane of the following declantiom:
r� I haw and will maintain•Cenificmlo ofCensenun scIf-nsumforWorker'sCompen-
7` utlam u provided for by Section 3700 of the IaWr Codc.for the performance of the
work for which this permit is island.
0 1 hew and will maintain Workers Compensation Insurance,as required by Section
3700 of the Taber Code,fu the performance of see work for which tris permit is issued.
My Workers rep soden Inss�r race Cortise and nu ra
Grde L' Pali O
CERTIFI \ - F COMPENSATION
INSURANCE
Cris
WORKERS'
COMPENSATION INSURANCE
(Thb section wed mine completed lithe Permit is(crone hundred dollars($IM)
Car.)
I certify Net In the performance of the work for which this permit Or issued.l shall not
employ any Palmer in any manner an as u become subject to the Workers Compematlan
Laws of Califomia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
became subject an due Worker's Compensation previsions of the LAW Cade,you mut
,J O forthwith comply with Such provisions mit sh
or this permit be deemed remked. .
y y CONSTRUCTION LENDING AGENCY
(.. 1 herby affirm that then its emnSee.30 lending agency for the performance of
CE2 the work for which Nu permit iss banned Co (Sec.ion le Civ.C.)
ILl ELendcrs Name
0.. z Lenders Address
U O 1 card y that I have read Nis application and sou that the move information Is
D. ;"! correct I agree to comply with ell city and county ordinances and sou laws retain,to
C) Wilding const%tion,and hereby autharin representatives of Oil city he color upon the
ahave-own ioned property for inspection purposes.
aA
(We)agree to save.indemnify and keep harmless the City of Cupetina against 6
rIlebllllles,Judgmon cosec and expense whi slay in any wy acme egeimt slid Clly
C.1 z In consequence o c gnndng of Nis pe
APPLICANT ERSTANDS A ILL COMPLY WITH ALL NO -PoINT Issued by:9 Date
SOURCE LA NS. s,
Re-roofs
sign a Appli C r atm
H A US MA DISCLOSURE Type of Roof
Will the appli t ( cart build rccupanuun or handle huudou material
u dcOmd by the Cu no uniri Code.CWprer 9.12,sad the Health sed Safety
Cade,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
0Yes No
Will Ina spPlic or rte bole occtp.nt tan egaipmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
rob Malcom air Mimi 0 will by the Bay Area Air Quality Management all new materials for inspection.
Dauicn
❑Yes
. Ihave mad are Our smauriahmmqquimmcnlsunderChapur695ofdleCilifor-
nialloaW&Safmycele, cru MM5, 653Jand2SS34.Iundcmw thaiftho Wilding
docs not me ewe mm Nati my respomlldliry u notify sec t of Ne
requirem, h tbe pnauism. rencertinaatear % Signature of Applicant Date
d Y� All roof coverings to be Class "B"or better
Owner�rired agent _ Dau
Community Development Department
Building Division
City of Cupertino
nom' 10300 Torre Avenue
C
CITY OF Telephone: (408)777-3228
C U P S kT 1 N 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 comp ith t ove state o 'c on rk-roofin ..
Homeowner's Name: I ' I
Job Site Address: b ( (,� _ �—
Roofing Company Name: t,,W\ _
A plicant's Signature: Date: Q
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO a a
yr REROOF�
C PEkTINO PERMIT APPLICATION FORM
PN# / J O C — OC2 S� Date: S
wilding Address: \
�.._.-.. .-) L 1 d n u_D,
Owner's Name: / Phone#:
Contractor• Phone#: License
1 #: (011 JJ
Contac Phone#: Cupertino Business License #:
I R 119 3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles A Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Cl Other(Specify) '
Number of existing coverings ❑ Provide I.C.B.O.Report It
t� To be Removed ❑ Provide Mfgr. Installation I
ecs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 2Tz. o� Z rZoc � tr S�'A L 3 O y rt. I^L I
A
Residential Comme cial
Fir orre Yes,R No , Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost Project: J Type of n ructio Occupancy group:
Qty. t
A licabl 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