03060126 (2) CITY OF CUPERTINO +t'•p " v,.a .ag, ra - "'�b�`' �t-r' `" ='
I BUILDING DIVISION PERMIT CONTRAC,,TOR=INFORMATION -t
BUILDINGADDRFSS: CUTHBERTSON THOMAS W AND J WT"03060126
I
OWNER'S NAME: PERMrf'CStfBpAJF� 8/,2003
NE: SANITARY NO. 1 CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 o
IOp LICENSED CONTRACTOR'S Diono.a chap .
d 1 hereby affirm thm I am Ii ft Ba unties and
Potom of chapter 9(rommense is Job Description
iW with Secns,ande)ecDividon3af she Businw end Rofcasiom Code.and my license is
s L eraseull lass effect REROOF
j g? Data Clan Lie.M
F,O Data Cuntrsemr
WARCHITECTS DECLARATION IC���B =®
1 understand my plans sball he used as public records r `p
s LL t; Licensed Rnfwional
$G5 OWNER-BUILDER DECLARATION Nov 17 2003
i<f 1 hereby affirm that I am exempt from the Contractees License Law for the
00 following mason.(Section 7031.5,Business and Rofessions Code:Any city or county ,
5 m which requires a permit to consuun,elft,improve,dem iml,or input,any strumum
MR IBM 0%
prior to its issuance.alsuraft irea theapplicant farsUlt permitte,flee aignadmument
ESD Nat he islicc=dpursuant taNcprovisions oftheCantnnor'sLiccreeLaw(Chapter 9 Sq.Ft.Floor Area tygion
yl- (Commencing with Section 7")of Division 3 of theButilaw and Rofwlans Code)or
Q $ that be is easmpt therefrom and the bssis for the alleged exemption.My violafon of
Section 7031.5 by any,applicant for a permit subjects the applicant to a civil penalty of 3�.9HI�dlBP.I 0 0 Occupancy not more than five hundred dollars(M). Type
I,ssowner of Ne PropenY,ormY cmploytm wird wagesss their sole compensadan,
will do the work,and Neswcwrt u not intended or offered fonale(Sec.7014,Business Rey(�'r�
and Pmrwimu Code:The Con ramoes License taw does net apply m an towner of 307 — I NS ULAT 1'V N d Inspections
property who Wilds or improves thesean.and venoaeessuchworkhimself orthrough his
awn employees,provided matsuch imptavements are not imandMuroRred forsala If, 601 — ROOF TEAR OFF
however,the building Or improvement is sold within arc year of oomplNon,dee owner-
WRder ,will have the bnmmt of proving that he did am mild or improve far pure re of 602 - ROOF PLYWOOD NAIL
atom.). 603 - ROOF BATTENS
❑1,as owner of the property,.a.Business siv ad eontruting with hitchedonntncmn m
comwct doesmct(sec.]B.owneandn,who but Code:)The
oves ft...Li- 604 - ROOF IN-PROGRESS'
cense law does not apply m an owner of propemy who builds or improves to thereon,arta
who mnuacu for such Projects wird a contractor(s)licesued pursuant b the Conrrwtars
License Law.
lam pe h�i tine, .Bh PCfar this recon
Ow r ate 40(.ey '3
ORKER'S COMPENSATION DEC ATION
1 hereby�m under penalty of perjury one of the following dselantions:
ve
1 haand will maintain a Certificate of Consent to uhf-iuurt for Wor m'sCompen-
aation,m provided for by Section 37M of the labor Code,for the performam'e of the
work for which this Permit is issued.
❑1 haw and will maintain Workers Compensation Insurance,m acquired by Section
3700 of Lie labor Code.for Ne performance of the work for which this permit is issued.
My Workers Comperuadon Insurance easier and Policy number are:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CI7lu section teed not be completed Iftht Permit is for one hundred aollm(S Ind)
nr less.)
1 artily that in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner so as m become subject a the Workers Comircm0on
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Cerifcate of Exemption,you should
become subject to the Worker's Compensation provisions of the tatter Cads you most
=O forthwith comply with such ParoWom or this permit shall he dcemcd mroked.
Z�y CONSTRUCTION LENDING AGENCY
I botchy aRrm that there is a construction lending agency]or tW Performance of
Y the work for which this permit is issued(Sec.3037,Civ,C.)
1 3 Lender's Name
3 Z Lenders Address
J Q 1 certify thxt I have rad this application aM rote chat tht above information u
S. F cored 1 agree to comply with m1 city and county ordinances and sate laws relating to
7 V building construction,and hereby authorixe mpresentatives of this city to enter upon the
W limbic-ms.judgcd propc costs
for
ande inspection pugwses
,y 0. (We)agree to rive.indcmmfy and hep harrnlw the City of Cupertino against
h lialmeac,judgments,coming expenses which may in any Ley accrue against said City
:J? A PL19*encc of tht granting of this permit.
SOPLI "ATIONS NOS AND WILL COMPLY WITH L NO Issued by: Date
s' u p¢anJConuacmr Oe Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or futum Wilding Occupant mom or handle hazardous mlaroad
as&flood by the Cupenim Municipal Cade.ChaP er 9.12,and the Health and Safety
,dilikado.them 255320?
Yin �NO All roofs shall he inspected prior to any roofing material being installed.
Will me applicant lir future building Occupant use equipment lir&vitm which If a roof is installed without first obtaining an inspection,I agree to remove
If hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
isuia?
❑Yes Nu
I have read the hxUbJ x ateriab requirtmentaunder
c4 ponfYmCnhoapteys6.95ofuthpaenCalifm-
nuSoftly Code.Seom25505.25573 anal 2553a.l undcsuM Lou gdte building
des.., t Or th,
reyuimm
wichm fine etP rss e rMate��u /� Signature of Applicant Date
ow— aOmOrv4aasenf �D, All roof coverings to be Class "B"or better
Building Division
10300 Tom Avenue
4 Cupertino,CA 95014-3255
Telephone: (408)777-3228
Pak: (408)777-3333
CUPERTiNO
Building Department
Subject: Reroofing policy for the City of Cupertino..
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. New roof coverings shall not be applied without first obtaining all inspection
'and written approval from the building inspector.A finalinspection and
approval shall be obtained from the building inspector when the reroofing 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) Preinspection 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 that the
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 of inspection.
We understand the above policy on reroofin and
dI will comply with this policy.
Homeowners Name: 1'D
AddresJ3/
1;�eroofmg Company)N ( vv\
Applicants Signature(nDate:\
Joe Antonucci
(Chief.Building Official)
6/25/01
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjurythhat the above is true and correct. I have read and understand the
Owner-Builder Information verse s e).
Property Owner's Signatu Da ® Q1
Job Addres • � SIO Iw�t fill Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
D CITY OF CUPERTINO
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# 3 S G — I q — o t V 0 Date:
eb
Building Address: _
O J G t� C O 1
Owner's Name: I hon
Contractor: Phone#: License#:
O LA_2�� r
Contact: Phone#: Ce.t t Cupertino Business License#:
1 t o so 4otl 5 --79t(o q ,3 8'1
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) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed Cl Provide Mfgr.Installation Specs.
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: / � Vb r 12C
'
Residential Corhmercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed an g Det. if
there r ion : LJ
Cost of Pr ' ctA Type of Constru Oc pancy p:
r 060 - m00
Qty. i �(� I C)
Ap c ((( Fee ID Fee Description Fee Group
BPERMFEE BldgPermit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
22
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