03060084 (2) CITY OF CUPERTINO ' sT ""' ra ` a•N°• +�'' '_ k
BUILDING DIVISION PERMIT CONTRACTOKINFORMATION
BUILDING ADDRESS: LEGACY ROOFING & WATERPROO "°03060084
• OWNER'SNAME: 860 FAULSTICH CT. P° S"b"On1/2003
)NE: (408) 467-0150 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
�Op LICENSEDC[I mads Ida, DECLARATION Job Description
F 1 hereby affirm that 1 an liattaed untie Orovisions of Chaptar 9(Commencing P I�
nib with Section) )of Divivon3of thea aM Professions Code.arWmylicenxis tt�O N A LIED
_oy in mum de S L a2 SCP REROOF
)Ll z License
1g,
` ARCHI'MCTSD rhRA Ng JUL a 2003
-t I understand my plans shat w used as public records
baU
goy LicensedPmisian.l BUILDING
OWNER-BUILDER DECLARATION Com eta
f I wreby effort SCet that 11. exempt from the Contractors :Any c Law for the
HO o O whnwing mason.Permit
t RD Lq B.aims and w.de tuns Cade:Any city or county
$ which requires a rami re construct.alter,i applicant forsu h Permit t ri e a sig any umment
_Z< th ton its censed c,afuant in to,thcflue visinor for,onousmi's Lice ce,Laved sutomcm
E oNalwisd,wJpurman70DO.fDnioort3of cflusi eattru!Ponelaw(Chpxr9 Sq. F[. Floor Area $10�ty®tion
>:�$ that
exgwith therefrom UW)of Division3 of theeged exempton.An vi Code)or
.. Nn h is 31.5 b therefrom and or amu for the allegro plica don,Any violation of
Seton firms n airydred dont for a permit subjects the applicant w a civil penalty of 3 tA2N0IaihUP_r 0 0 Occupancy
not mom thnevemmnamdamlars(ssW). TYPe
❑I,umwwofthepmpwy,mmycmployceswithwaguuftkmlecompencodon,
will do the work and th structure is notinuMed interfered forsaae(Sec.7044,liminess —
.na Profusion Code:The Conuaeme,Lt..Law dose not apply to an owner of 307 - IN
SULAT P�ffd Inspections
property who burldsor improvmthemon,and who daessuch workhimself ortmough his
awn amplayans,provided wt such improxmanu are not intended moResN remade.If, 601 — ROOF TEAR OFF
however,Ne building or impmvcment issold within one year of completion.the owner.
builder will haw the,tyrant of proving that he aid not wild or improve for pmpox of 602 — ROOF PLYWOOD NAIL
yR')' 603 - ROOF BATTENS
❑I.as owner of the property,am exclusively contracting with licensed Contractors to
consumer the project(Sec.T(ma.Business and Professions Code:)The Conermurr's Li- 604 — ROOF IN—PROGRESS
cc m law doe not apply w an owner of property who builds or imp rum Hexon.and
who Contracts for such pmjeeu with a eontncmr(s)licensed pursuant o time Convector's
License IoW.
O l am amonpt undo See. ,B A P C for Nis mason
13700
ner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of the following declarations:
I how and will maintain a CenlGnta of Consent M self-insure rm WeAst'sCompen-
n.u provided for by Section 37W of Nc laver Code,for the performance of dta
k for which this permit is issued.
1 have alb will maintain Wmkcrs Compensation Imursnce,u required by Section
of the Laver Cde,for the performance ofthe work for which this permit is issued.
Worker's Compensatia w eaoivand P airyn�uum.bsberare'er: Pd o.:G�S2 27 So3
CERTIFlGTE OF FXEMPfI OM WORKERS'
COMPENSATION INSURANCE
Cntusection need not w camplemd if,w permit is foronc hundred dollars(SIM)
or thss)
I unify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as w become subject a the Workout Compensation
Law s of California.Date
Applicant
NOTICE TO APPLICANT:I(,after making this Cenificau of Exemption,you should
become subject an the Workers Compensation provisions of the labor Coat,you most
=z foMwith comply with such provisions or this Permit but)ac deemed mwkd.
Zr CONSTRUCTION LENDING AGENCY
1 hereby affum Nat Vert is a comurroamn lending agency Tar the performance of
Y. the work(ser which this .it is issued(Sec.3097,Cie C)
S]Q Lcndcfs Name
Lcndces Address
�z
:)Q I certify Nat 1 have read this application and sure that the above informadun is
y Correct.1 agree to comply with all city and county otdiaanRs and sum law,totaling b
•� wilding construction,and hereby authodn mproammadws of this city to enW upon the
yawve-mentiuxd property for inspection Intrudes.
(We)egme w cove,indemnifyexpenses and keep harmless the City of me gronal against Gl/
h u.erouti. expenses which may in any wayacemc against mid City
Jz Co. the gnntin of Nis rcrmit.
AP O A S AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat
an✓Comme"n a� Re-roofs -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
licant or future building occupam store a hnam hazardous motorial
upertino Muninp odes Charter 9.12,and the,Health andSafety
ode,Section 25532(.)7
❑Yin Na All roofs shall be inspected prior to any roofing material being installed.
Will tw applicant or future tui ng oce, am use equipment or deticm which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air cousno, u u nncd by tw Bay Am.Air Quality Management all new materials for inspection.
atria?
❑Yea Nu
1 hart teal the hvabausmannials tequimmcros under Chapterti.95 of the Celifor.
nice He a�h.t� n:�,
25505.25533 and 25534.Imutersund Natirthe buildingd t c nthin it is my respomihility to nudly tw upanto(dtam tudorwissuantt oh Cmtifw f u i nature of Applicant ate
ar ar.uth.need.gena ,V All roof coverings to be Class "or better
Community Development Department
Building Division
City of Cupertino
li 10300 Torre Avenue
Telephone: (408)777-3228
CITY Of Fax: (408)777-3333
qUPEkTINO
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.
r
Homeowner's Name: �0-r �
y/�/ 5
Job Site Address: l� l`�
Roofing Company Name:
A plicant's Signature: �I� ` Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
f
CITY OF CUPERTINO O ,
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# � 2 J 0 Date:
Building Address: /
17 y 9 e /<i ,S, v2
Owner's Nam : Phone#:
6 AJ ��! � 08-3 S- 957I 7
Cor)tractor: Phone#: License#:
/
nG ro�iw ( Z,0e) IU/, 0/Sb
Contact: Phone#: Cupertino Business License #:
Lai �'ti+iL �o0 yco - o/S"/
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ -Up roof
❑ �phalt Shingles Asphalt Shingles
p� 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 Descriptiog: / /
1 w+� .361 g /"4- L//0 Vz CJ
Residential - Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are res coons: 15
Cost of Project: /O k Type o C s ct' n: Occu Ay gr
A 1' le 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
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