03090037 (2) CITY OF COPEWHNO
BUILDING DlvlsloN PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITNO.
WILLIAMS ROOFING 03090037
3R'S NA T1 PERMIT ISSUE DATE
4921 CABRILLOPOINT
PHONE (408) 252-5120
: SANITARY 0, C NTROL NO.
ARCHITECI'IENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMP MECH
0 0 0 0
±oat LICENSED CONTRACT'OR'S DECLARATION
Eas C I hereby ifnnm that 1 am licensed under pbrepanna of Cimino,9(,mrium cing Job Description
<b with Section"Illtkp ADivision 3 of Ne Business andRofessionx Cade,and in license is
y In Tull fnrcc`nd CIf• ✓�f
Iqz License Cl ud.x y RE—ROOF/TEAR OFF EXISTING
+t9
Late C Contractor INSTALL 50 YR ELK C Taff
`'funder ndmyplansshallThhchoudgs nARAcords • ��Q��D
E U u (
e l Licensed Professional
-sit0� OWNER-BUILDER DECLARATION FEB 1 12004
"2k<Y 1 hereby afrrm that 1 am exempt from Ne Contractor's License Law fur the
Eno o following match,(Section 7031.5,Bailouts and Prefushm,Code:Any city or county
W
hich requires a pcnnit to construct.alter,improve.Jemulish,or repair any spnOwn, —
Prim to its ismenee,also requires tbe applicant far such permit ua file a signed statement 1I
-Ea that he is licensed phourat,,dtepnavlsinneofam Contractor's l,icensc Law(Chapter) Sq. 1't. Floor Area t Y ValuatiAF1000
2 tZ-Q (mmmcnci ng wish Section 700(1)of Division 3 of the But i noes and Pro rush CaJc)nr 'i 7
ORE that he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section]031.5 by any applicant for a permit subjects the applicant to a civil Penally ofCType
not more man rive hundred dollars(B5f10). 3 tl`L PI Tt.r O O Occupancy Y -
❑L az owner of the property,or my employees with wages az their sole rompensatlnn.
will do the work,and me structure is not intended or offered for sale(Sec.704,Business Required CCd In$ CCtIOn$
and Professions Code:The Conuacmr's License Law does not apply to an owner of q p
property who builds or improves Hereon,and who does such work himselfor through his 305 — FRAME
howemployees,provided that such improvements are not intended or offered for sale.If,
ever,the building or improvement is sold within one Wu of completion,the owner- 307 — INSULATION
builder will have the burden of proving that he did not build or improve for pnryom of 601 — ROOF TEAR OFF
sale.).
El 1,as owner of She pmpeny,am exclusively convecting with licensed contracrons to 602 — ROOF PLYWOOD NAIL
conswel the project(Sec.7(),4,Business and Prntessions Code:)The Contractor's U. 603 — ROOF BATTENS
event Law does no,apply eanowner at noma,Who buimsorlmprovesmereon,and 604 — ROOF IN—PROGRESS
who contracts for such projects with a conlracmrfs)licensed pursuant a the Contractor's
License Law.
❑I am exempt under Sec, .B&P C for this reason
Date
WORKER'S COMPENSATION DECLARATION
1 hereby afrmr under penalty of pe jury one of the following declarations:
1 have and will maintain a CCnifcxe of Consent to self-insure for Wmker'a Compcn-
salion,as provided(or by Section 3700 of Ne Labor Code,for the Isco mmona of the
work for which this permit is issued.
❑I have antl will maintain Workcr's Compensation hemounce,as repaired by Section
37M of the labor Code,for me performance of the work for which this peonil is issued
My Wnrkcr's, tap nsadde 1m, ,cc cart and Policy manner ane.
.Calder: Polil;No.:
CER FICA E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This scoion need not be complued tame permit is for one hundred dollars($100)
n less.)
I cenify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner sit az e Become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenilicand of Exemption,you should
become unnuct to the Worker's Compensation provisions of the Labor Came,you must
D O forthwith comply with such provisions or this permit shall be deemed revoked.
r N CONSTRUCTION LENDING AGENCY
1 hereby affirm that mere is a convection lending agency for the performance of
x > ds work for which this pcnnit is issued(Sec.3(141,Civ,C.)
dj A Lender's Name
z Looter's Address
1 certify that 1 have mad this application and state that the above information is
HCarmel.1 agree to comply with all city and county ordinances and state laws relating In
U building convection,and hereby authorim representatives ufthis City build,
wild,upon he
W above-mentioned property for inspersion purposes.
(We,)agree to save,indemnify and keep harmless the City of Cupertino against
raj liabilities,judgments.costs and expcnsns which may in any way accmc against said City
J Z in conscqucncc of the Starting u(Nis permit.
r. APP (�7
IJCA UNDERSTANDS AND WILL C W ALL NON DINT Issued by: Date
. 4(
URC F:G CATIONS.
Re-roofs
Signal c nsicem/conoacer ❑ c
// HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant tar future building Occupant send or handle harandous national
dcfncd by mC Coleman Municipal Code,Chapter 9.11.and the Health and Safety
e.Sp`roCn 25532AU All roofs shall be inspected prior to any roof�material being installed.
W the applicant or mune building occupant use equipment ardevicas which If a roof is installed without first obtainin an/'nspection, I agree to remove
omit bawrtlnus aircontaminants az dcfncd by he Bay Arca Air Quality Management all new materials for inspection.
District,
ms
[]Yes �`11
Ihave mad the hasholous materials requirements under Chapter 6.95 ofthe Cnlifor- , {
ria Health&Safety Cada Sections 2550525533a 5J4.lundetssampsifthc building C/ /(
does nod cu ly have a, thin' my s s�tbili( noddy the cecupanl n(mc
real uircome w hantuat I ts ora c cute of Oce c% V, ature OfApphCanl I
or anmarizee agcnl Dat All roof coverings to be Class "B"or better
SENT BY: WILLIAMS ROOFING; 408 286 5165; SEP-4-03 12:32; PAGE 2
Community Development Department
Building Division
f
City of Cupertino
10300 Torre Avenue
CITY F Telephone: (408)777-3228
CUPEl�TINO 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 manufadurers 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 fust 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 Yi"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: a s M lFH E Z,E5
Job Site Address: s'D 3 Ft NyS Biu s y CdL,4 {- t?uEAW f ar_
Roofing Company Nam n�l tl I Mxs 2a�.�tvf
A plicanl s Signature: +��- Date: 9 4 03
Greg eel
Building Official
Revised 1/30/00
bW IeN nn Far�-Ja.�Oenv
CITY OF CUPERTINO
'm 1 of 1 PERMIT RECEIPT OPERATOR: seem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36229025.00
DATE ISSUED. . . . . . . : 09/04/2003
RECEIPT #. . . . . . . . . : 23026
REFERENCE ID # . . . : 03090037
SITE ADDRESS . . . . . : 7503 KINGSBURY CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MENEZES EUSEBIO AND EUNICE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5043
RECEIVED FROM . . . . : THOMAS WILLIAMS
CONTRACTOR . . . . . . . : WILLIAMS, THOMAS LIC # 6341
COMPANY . . . . . . . . . . : WILLIAMS ROOFING
ADDRESS . . . . . . . . . . : 4921 CABRILLOPOINT
CITY/STATE/ZIP . . . : DISCOVERY BAY, CA 95014
TELEPHONE . . . . . . . . : (408) 252-5120
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- ----------
BPERMFEE VALUATION 5, 000.00 107.00 0.00 107.00 0.00
BSEISMICRE VALUATION 5, 000.00 0.50 0.00 0.50 0.00
TOTAL PERMIT 107.50 0.00 107.50 0.00
METHOD OF PAYMENT AMOUNT NUMBER
____----____
CASH 107.50
TOTAL RECEIPT 107.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
SENT 8V: WILLIAMS HOOFING; 408 286 5165; SEP-4-03 12:32; PAGE 1
CITY OF CUPERTINO
REROOF
CUPEit INO PERMIT APPLICATION FORD
APN#
Date:
Building Address: ¢ t7
'7s°3 le, �un Gcniw+
Owner's Name:
t o 44XAI c'z ltS Phone#:
Contractor: `ygF 14 7 2
IV I u I V4W VPhone#: License#:
t Z6-2- - S/7-0 47 099
Contact: Phone#:
TO ttn ZZ (- 1-72 o Cupertino Business ' ense#:
Type of Roof Covering:
Existing: Proposed:
Ll Built-Up Roof
Asphalt Shingles ❑ built-up roof i
p Wood Shakes )- Asphalt Shingles
O Wood Shingles ❑ Wood Shakes
❑ Other(Specify) 13Wood Shingles,`
be
ClOther(Specify)i
To
Number a existingg Removed coverings ❑ Provide I.C.B.O.Report# a
❑ Provide Mfgr.histallation Specs.bJ-K�'r/B
I Have Read,Understand and Will C
Job Description: ,Comply With Cu ertines Tear Off Policy El
7 x o ca Axl S,tr ' 61).V R-1 feu sd y a�s< sew f,
Residential commercial ❑
Fire Zone: es ❑ No Confirmed with Plan ' g t. if
Cost of P est: _ there are an restr' io
J 5-1 p0 Type nst tion: Occupancy gro
RE-Rw
Qty:t.,)
A c le Fee ID Fee Description Fee Grou
BPERMFEE Bld Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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