03020061 (2) F"I7LIENG
TY OF CUPERTINO
BUILDING DIVISION PERMIT i�CONTRACTOR INFORMATION x
..S. mDk:8c8 airx', s;. P
'\ ADDRESS: ROOFCO OF SILICON VALLEY PERMIT NO.
R'S NAME: APPLICATI A
844B EARLE AVE
E: SANITARY OL NO.
(408) 795-3335
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
50z LICENSED CONTRACTOR'S DECLARATION O O O O
C 1 hemhy afro Nall.m licensed undef provisions of Chapter 9(commencing Job Description
b witbsepppyyyllp��tttm777777(AMPof Di,xd,w3of Sam essand Professions Code,and mylicensc is
Z�y in fol rad elle 5' 7t 7
? Line I c. T —I RE-ROOF LIKE FOR LIKE
a FCO /d 9mo Contact r m CO OF S
��-ARCHI D LARATION
y ce V I understand my plans shall be used public records
6
MAR 1 8 2003
is 0 t; Licensed professional
gOWNER-BUILDER DECLARATION v
<0 1 hereby.('firm that 11. exempt from the Contractor's License Law for the BUILDING
Q O following rcuon.(Seaton tf131.5,Business and improve,
dr ions Code:Any city or county -
L$ which it,iscs a permit rec ares th 1,applicant
improsu demolish, I repair any stracrom
priorto its issuance,atm requires the the inion of roe such permit m Glcssigned naremem
FTD IhalbelslcewithSezuamon TIM)ofDivisi n3 theoft Comm�ess ndProfil..w(C cur)or Sq.FL Floor Area 6V��I6ion
z (commene xempt theefrom a d Its DlNis Ter of the egeBusd cc and Pro Any vi l.tirm or
i Nn he is 31.5 b therefrom aP Il and the burs for be alleged applicant
to Any violation of
not
itcan by anyeedldoll furapates(aubjmtstheepplicanlIoacivilpenallyof Occupancy Type
nm mpre th.n fi.e nanama dollars(ssoG7. 3'���51��0 0 P Y YP
❑I.as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the swcmre is not intended or offered for sale(Sec.11144,Business 305 - FRAME
and Pmfemions Code:The Conlractork License Law dors not apply to an owner of Required Inspections
property who builds or improves thereon,and who doessuch work himselforthrough his 307 - INSULATION
Own employees,provided that such improvemenla are not intended or offered forsale.If. 601 - ROOF TEAR OFF
however,the Wilding or improvemant is sold within one year o(completion,the owner-
builder will have the burden of proving Nat he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.).
❑1,as owner of the property,am exclusively contracting with Berated epntnctors to 603 - ROOF BATTENS
construct the protect(Sec.10J4,Business and profusions Codc:)The Contractor's Li 604 - ROOF IN-PROGRESS
cense Law does nes apply to an owner of propcny who Wilds or improves the con.and.
who contracts for such projects with aeontractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. ,B A,P C for this rcuon
Dare
WORKER'S COMPENSATION DECLARATION
1 hemby sand under penally of pstjuey one of the following decturc om:
1r37]1
ave and will maintain a Certificate of Consent m self-insure for Workers Compcn-
,u provided for by Section J100 of the IaWr Code,for IM performance of the
for which this permit is issued.
ave and will maintain Workers Compensation Insurance,as required by Section
f the labor Code,for dm performance of the work for which this Permit is issued.
orker's Compensationtoren.caner and Policy nu ram:
r. S{N't-tf 1'UN� Polity No.: Z
CERTIFICATEOFEXEMPfIONFA WORKERS'
COMPENSATION INSURANCE
(Tris rection need not W completed it the permit Is fm one hundred dollars(SI W)
or less)
1 certify that in the performance Of the work for which this Permit is issued.l shall not
employ any person in any masher se,as at become subject to the Workers Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL lum,making this Certificate of Exemption.you should
become subject to the Workers ComIm notion provisions of the Labor Code,you must
.,O forthwith comply with such provisions Or this Permit shall he deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
(~ .N. I hereby affirm that there is a construction lending agency for the performance of
C' the work for which this permit is issued(Sec.3891,Civ.C.)
Lender's Name
r7 z Under's Address
U Q 1 comfy that I have read this application and state thal the above information is
U, F correct.l.gree m comply with all city and county ordinances and state laws relating to
pU building construction,and hereby authorise onnocntatives of this city to enter upon the / a
F yabove-mentioned property for inspection purposes. 1
(We)agree to save,indemnify and hep harmless the City of Cupenino against
y liabilities,a� lmxpenses which may in any way accmc against said City
X__�
U z m con®quthis permit.
ICA AND WILL COMPLY WITH ALL NO -POINT Issued by: Date
E
nuure of Appm Omrecme 2 arc Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the aPPIiu I.1 home Wilding Occupant am.or handle havaNuus mabnal
defined by Inc Cupertino Municipal Code.Chap¢r,9.12.and the Health and Safety
.Semon 255324)? All roofs shall be inspect"
nspect prior to any roofing material being installed.
Yes No
Will the applicant or future building Occupant use equipment or device,which If a roof' installed wit t first obtaining an inspection,I agree to remove
u bavardous air contaminants as defined by the Bay Area Air Quality Management all new t {al In Ction.
District?
❑Yes �No
I have read the hara dous materials requirements under Chapter G95 of the Calier-
niaHealth afclyC dons25N15.25533 end2551d.1 understand thvifthc Willing �3
does not u tly ro ¢ t,that it is my respunsilohly m nod ly the Occupant of the
rewire en nn t etpdnemissamapracemaa orae ane. igna[ureof pplcant Dale
O mutant mmn agent Dg3 AI roof coverings to be Class "B"or better
Community Development Department
} Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
C U P S IST I N O
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. O"e IA4 �_J gsnp ea
Job Site Address: CD2 Jrwsw. y-LJ4
m 1 /
Roofing Company Naes/ Bb ' E4 V
A plicant's Signa Ddb
- CA/�L'�ldCX1
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
m-, REROOF
CUPEkTINO PERMIT APPLICATION FORM
6 3
APN # 34 5 ZS 09,1/ Date:
Building Address: I
O Ja/�rQv F/✓� . 9So/g
Owner's Name: Phone#:
•✓ 400- G01-2Y13
Contractor.
License#:
t?D�l'D -814 / tBy✓ T'� �3
Contact: Cupertino Business License #:
� - 4
Type of Roof Covering:
Existing: Proposed:
A Built-Up Roof At Built-Up roof
36 Asphalt Shingles A Asphalt Shingles
Cl Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles r
M Other(Specify) JAC4696L6E= 9 Other(Specify) S
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.-
I Have Read, Understand and Will Comjply With Cu ertino's Tear Off Poli
Job Description: . , /�
/x f " Z AC g- z .� ar u/ S C� DFS
Residd� 6® a Commercial ❑
Fire Zone: Yes ❑ No ® Confirmed With Planning Det. if
there are an restrictions: LJ
Cost of Project: T of Construction: Occupancygroup:
sF
Q
NB
Fee ID Fee Descri tion Fee GrouPERMFEE B1d Pemrit Fees BUILDING
ENERGY Ener BUILDING
SEISMICRE Seismic Fee Res BUILDING
SEISMICOM Seismic Commercial BUILDING
PLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING