03090202 (2) CITY OF CUPEW11NO
BUILDING DIVISION PERMIT CONTRAOT-OR INFORMATION:<
BUILDING ADDRESS: TNT ROOFING CO PERMITNO03090202
0220 10CKWCXjD QR
OWNER'S NAME: 210 SAN JOSE AVE . #19, PERMIT ISSUE DATE(408) 277-0800 .
NE:TZ,F. SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
L� 0
+00 LICENSED CONTRACTOR'S DECLARATION ]ObDeSCTI IIOn
Z 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing p
a=Nwith Sccnion]IXX))of Division�f the BusingaS end PryJCOss ns os,a�myli,maria
= m full roLcep rad effect. J7
Lleensetl6fa tie.« REROOF /
ea p~p DateC.Olmeasso!' "ARCHITECf'SDZP RATION Q /
LW I understand my plemaha11M used.public.error
G In Licensed Professional
�1 3 OWNER-BUILDER DECLARATION
2gV
x 1 hereby affirm that I am exempt from the Contractor's License Law fur the
C20 following remnn.(Secuun 7031.3.Business and Professions Code:Any city of mety
<m ff which requires a Permit to consumer,alter,improve,demolish,or repair any strmmum
!2i prior to its issuance,also requires the applicant for uch Permit o file a signed statement
aso that he is licensed pursuant an the provisinasn(theContractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
a (commencing With Section70XB of Division 3 of the B usinem and Professions Coate)or
tu,0 Nat he is exempt therefrom and the basis far the alleged exemption.Any violation of 34215060 . 00
Section 7831.by my applicant for a permit subjects the applicant to a civil Penalty of AIN Number
Out mare than five hundred dollars SSM). Occupancy Type
---
0 1,m owner of the prapcny,or my employees with wages m their sale companardon,
will do lie work,and the structure is not intended or offered for sat.(So,.7W.Business —
and Professions Code:The Contractor's License Law does nor apply to an owner of L�gd Inspections
property who builds or imprnven thereon.and who does such work himself or through his 307 - INSULA �tJN
own employees,provided that men improvements are not intended or offered for nit.If, 601 — ROOF TEAR OFF
however,Ne building or impmvemem I.sold widen one year of completion,am owner-
builder will have the burden of proving that he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
mle.7. 603 - ROOF BATTENS
co h m owner of the property,am exclusively contracting with licensed convectors i. -
come,LawhoesnotpplyainownerofprndProfessionsCodet)The Reunion. Li 604 ROOF IN-PROGRESS
.rue law does north apply to ts owner of property who Wilds or improves demon,and
who contracts for such projects with a contncmr(a)teamed pursuant to the Contnctoh
License law. '
ED 1 am exempt under Sec. ,B&P C for his moon
Owner Date
WORKER'S COM PENSATION DECLARATION
1 hareby aRrm ends,penalty of perjury arc of the following declarations:
1 have and will maintain a Certificates of Cement noself-loan.for Worker's Compere
.
error as provided for by Section 37]U of de Labor Cade,for the perfmmance of the
rk for which this permit is issued. ..
1 have and will maintain Workels CompemNon Insurance,as inquired by Section
of are labor Code,for de performance of the work for which this Permit is issued.
Wodefs Cn Pe don lmm�nce carrier antl Policyn r'� Policy tjp/ tl /
}'
CERTIFICATE OFEKEMPTION FROM WORKERS'
✓ COMPENSATION INSURANCE
(This motion need nm rocompined If rhe Permit is formre hundred dollars(SIM)
cure)
1 certify that in the performance of the work for which this Permit Is issued,I shall nut
employ any Person in any manner an as to become subject o IM Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccninea.of Exemption,you should
become subject to the Worker's Compensation previsions e(the LoWr Code,you must
Qforthwith comply with such provisions or this Permit shall he deemed reveled.
Z
CONSTRUCTION LENDING AGENCY
I hereby alarm that there is a construction lending agency for the Performance of
Y, Ro work fur which this permit is issued(Sec,3897,Civ,C.)
AUndoes Name
z Lcader's Address _
;)Q I cenify that I have read this application and sone that de above information is
y f correct.I agree to comply with all city and county ordinances and foto laws misting to
J U building construction.and hereby surhonnic inPresematiws of this city to error upon de
6i above-mentioned properly foriuroction purposes.
y (We-)agree to rove,indemnify and keep historic.tM City of Cupertino against
,A
liabilities,judgment,costs and expenses which may In any way accmc against aid City
;)Z in consequence of de granting of this Permit.
"'� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N POINT Issued by: Date
SOURC EG TIONS. /
, Re-roofs
Srgnemrc of ApplicanVComrscmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future building uccupent store or handle havardous maonal
as defined by the Cupertino Municipal Code aper 9.11,and the Hcald and Salary
ewe,Orion 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Ye
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
it hazardous air contaminants tar defined by the Bay Area Air Quality Management all new materials for inspection.
i.trict?
0 Yea
(have real the haze dos mamrielsmyuircmcnu under Chapam 6.95 e(thc Califory
nice Hwldtls SefmyCaM,Scwons 8585.15533 and 15574.1 undcraonJ thmifthc Wilding (/fA
does not currently have a tenant,that it is my responsibility 0 nodl'y de ox:cuPmt of the
requirementswhichmustbemetpoor w'ssuancc.face ncaoof Occupmcy.
�J ignature of Applicant Date
ter ser authorized agcnn par
jt
All 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
U P E T 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: G" lam'�Yf ' // cvj ��'V 4/f'/''
Job Site Address: l () p (.Ye_6jc)cw OA
Roofing Company Name:
A plicanYs Signatul�U�. T- Date:
AI
\rl/�iWOlX1
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO43 /�O zD 2--
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date: z Y U 3
Building Address:
Owner's Name: C/o Phone#:
Contractor Ph6ne#: License#:
77/r 2uo � 6�s z77-090(j
Cont c / / Phone#: Cupertino Business License#:
/v A41V
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �0- 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 ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 1 ,/
Kelwt,k X CL, SP L( Usf� ( Ws6b 3aLS
Residential ommercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plannin De I. if
there are any re ' tons:``
Cost of Project: w Type of Cons F io . Occupancy roup: /pZ
Qty
A is 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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