04110066 (2) CITY OF CUPERTINO _Q" ' 'yam " " x"
BUILDING DlvlsloN PI';RMIT 4CONTRt1.GTO INFORMA' 100 '4,
BUILDING ADDRESS: PERMIT NO.
LOS GATOS ROOFING 04110066
O�It A N PERMIT ISSUE DATE
TONE:
SANITARY OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
0 0 0 0
u00 LICENSED CONTRACTOR'S DECLARATION Job Description
1 thereby affirm that l am licensed under powders of Chapter 9(commencing
nYa wilhSTtin�000)nivision Saline Busdidp�d✓andPufcsstoms Code,and my license is
_cam arms rnmadf D
a er¢e .o -7 REROOF W�SHINGLES
p�? Liccnse'Clvsa n Lima
4 D' Contractor
RCHITLCI'S QF��,Q�L�A k C
I understand my plans shall he ux4as�ERe mods /
DyU pQa�y 77
}0� Licensed Pn fincru mal /
OW NER-BUILDER DECLARATION
<� I naso .(fent that 1 1. exempt from the Contractor's Co License Law for my
p O following reason.permit
t 11131.5,Business and ova.demob Code:Any city ns county a/
ais m(Li which acquires a permit m construct,alter,impmve,demolish,or repair any structure
and Professions Code)w"r+ prions its issuance.also requires the applicant for such permit m rile a signed xmremem
that he is licenxJ pursuanlmthe pmvisiuns of the Contractor's License lsw(ChopterH Sq.Ft.Floor Area
a (commencing with Section RINE of Division 3 of the BusinessValval ❑
�
~
.. that he is exempt themfmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for n permit subjects Ne applicant to a civil penalty of
not more than eve hundred unit...($500). 3 56PA�Jjl*n 0 Occupancy Type
❑ 1,res ownerof the pmperty,or my employees with wages as their sole compensation,
will do Ne work,and tirestructure is not intended or offered for sale(Sec.7844.Business
and Professions Code:The Conuactofs Licenu Law does not apply to an owner of Required Inspections
property who builds elimpmvea thenen,and who does such work himself err through his _
own employees,provided that such improvements are not intended proffered ferule.If,
howevey Ne building or improvement is sold within one year of completion,the owner-
builder will have the burden of paving that he did not build or improve for purpose of
sale.).
❑1,as..at of Ne property,am exclusively contracting with licensed contractors to
Construct the project(Sec,7344,Business and Professions Code:)The ConUvcwr's Li.
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a co erselm(s)licensed pursuant to the Contactors
License Law.
ED I am exempt under Sec. ,B&PCforthismason
Own Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Cimmerian of Consent to self-insure for Worker's Compcn-
sadpn as provided for by Section 31W of the Labor Code.for the perfprmancc of the
work far which this Permit is issued.
1 have and will maintain Worker's Compensation Insursnce,as required by Section
3?W fthe Labor Code.for Ne performance ofthe work for which this permit is issued.
I My rknners�Cnmpensali/pn�ln�sumn\m carrier andP myn milestone
'err.fl�l� / KMI Polity N9.
q CERTIPICAAMO ? EMPI'IONFROMWORK I
COMPENSATION INSURANCE
(This section need not hecomplemd if the permit is portion hundred dollars(SINE
or less.)
1 coni fy that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner sit as to become subject n the Workers'Comforr atien
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenilieare of Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Code,you must
,JO forthwith comply with such provisions or this permit shall M deemed divided.
Z•i ti CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
lYi .7 Ne work for which this permit is issued(Sec.3001,Civ.C.)
QLender's Name
0.0 Lender's Address
V Q 1 certify that 1 have muslin.application and sae Net Ne above information is
{L correct.l agree to comply with all city and county ordinances and stare laws relating to
0U building construction,and hereby authorise representatives of this city to enter upon the
W shove-mentioned pmpeny for inspection purposes.
(We)agree to save,indcni fy and keep harmless the City of Cupertino against )
fa'q m
liabilities, costs and expenses which may in any way accme against=ad City 11
U in consequence of the granting of this permit.
APPLICANT UNDEliSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
URGER GDNS. //
I��d G7J �'��/��V Re-roofs
ewe pl Applicaq omrnc t� Date
kiA2AR US MATERIALS DISCLOSURE Type of Roof
Will the applicanimm(marc building occupant store at handle havvtlous material
az ticfined by the Cupeninn Municipal Cpae.Chapmr 9.12,anJ the Health and Safety
Code.Section 35532(a)?
rr Yea All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
-mit hazardous air conmminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
[3 Yea lfNu
1 have mad the hazardous materials requirements under Chapter 6.95 of Ne Cali fm.
nip Hex"&.Safety Code,Sections 8505.M533 and 35534.1 understand thm if the building i
docs not currently have a tenant,that it is my responsibility to nouly the 'caponI of the
mquireme is whi pat dtirmieseaneeoraccmrc.a Ona, err — Si nature of lican[ 'Date
G ` s
Owp ter authmoa
ived agent o�te All-Lf coverings to be Class 'B or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
CUPEI\TIN® 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.
g
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: 1 l)541 --
q
Job Site Address: J 6
Roofing Company Name: /�� (J—GLs�b 00 - I/1
Applicant's Signature: Y J Date:�Z '6/; +�
Greg teeI
Building Official
Revised 1/30/03
Printed on Recycled Paper
I
CITY OF CUPERTINO
REROOF c�
CUPERTINO PERMIT APPLICATION FORM
APN# 3�
Building Address:
Owner's Name: Phone#:
c
o �2ss- ��9 7
Contractor: n Phone#: License#: �Q�O 7
S 6`
Contact: Phone#: Cupertino Business License#:
// 08 12 8
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
'J9 Wood Shakes ❑ Wood Shakes
30f Wood Shingles ❑ Wood Shingles 1,
❑ Other(Specify) X Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O. epori#
' To be Removed 1�1 Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Job Descri tion: N
d
6�� 50
R idential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type6f Const ction: Occu ancyoup:
n e ill
Qty*f—
A he 61. Fee ID Fee Description
Fee Grou
BPERMFEE B;Jdg Permit Fees BUILDING
BENERGY Ener BUILDING
13M MICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING