03070074 (2) ' CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFvORMATION f
BUILDING ADDRESS: TNT ROOFING CO PERMIT"03070074a OW NER'SNAME: 210 SAN JOSE AVE PERMIT LSSUE DATE
.INE: SANITARY N0. CONTROL N0.
(408) 277-0800
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+00 LICENSED CONTRACTOR'S DECLARATION (rS
no I hereby affirm that 1 em Ii it under provim no of Chapmr 9(commencing Job Description
wit Scc,m.7 )) fDivbdon3oftc Businmun scions Code,and Any hear.is os-
in full forteat. /�S L
yg? icense Cl ` t+ tic.. REROOF .
Da Cuntracuor
e7e�Q ARCHITECTS DECI1''MM�Tl ON JUL 2 8 2003
glt Iundermandmy planasha11homedaltuWfrecords
BUILh0 Licensed Professional DI{�r^
OWNER-BUILDER mcmprDECLARATION
��VV�7
COO 1 mate affirm that I tum cxcmpt from @ Contractor's e:Any c Law for
the
19� which
nquiresa permit
]f131.5,ct,Businesscand Pr A,demolish.no
Any tiny or county
which requires n permit nth air ewe,dant improve,dem msh,nr e a sig any structure
-Z< prior In its issuance.also requires the applicant for such Permit tilt asigncd statement
£gmm than heislicensedpursuantntthepmvisimdortheComramor'sLicenselaw(Chapter9 Sq. Ft. Floor Area Valuation
YF� (commencing with Section 7f1110)of Division 3 of the B nosiness and Professions Code)it
y Nal he Is exempl nbcmfrum rend the bais for the alleged exemptlon,Any violmlon of 32635026 . 00
Section 7031.5 by any applicant for a Permit subjects to applicant no a civil penalty of APN Number Occupancy Type
not more Nan five handled dollars($300).
El 1,as owner of the property,or my employees with wages a their sole compenssdnn,
will do the work,and to someone is not Intended or offered for sale(Sec.70aa,Business
and Profmaions Code:The Contractor's Lucrew Law dors not apply or an owner of Re aired Inspections
property who builds or improves Leman,and who does such work himselfor trough his 307 - INSULATION
own employees.provided that such improvements are not inmMcd or offered for ale.If. 601 - ROOF TEAR OFF
however,to building or improvement is sold within one year of completion.to owner
builder will have to burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
aalc.). t
El 1.as owner of the propcn,,am exclusively contracting with liccmed enormous m 603 - ROOF BATTENS
construct do,project Ike.70ss,Business and Professions Code:)TDI Contramori Li. 604 - ROOF IN-PROGRESS
can=Law does not apply no an owner of progeny who builds or improves Lemon,and
who contracts for such projects with a contractor(&)licensed pursuant to to Contractor's
License law.
❑1 am ezedon under Sec. .B&P C for this reason
Owner Dau
' WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I has and will maintain a Certificate of Consent o¢lf-insureen-
foeWorks'sComp
avian,u provided for by Section J700 of to ober Code,for to performance of the
work for which this Permit is issued.
❑I have and will maintain Workers Compensation Imunnce,a required by Section
37W of to labor Code.for to performance of the work for which this permit is issued.
Workers m tion In Unna artier and Policy num Tyre:
•RTIFICATE OF E%EMMON'FRB'M WORKERS'
COMPENSATION INSURANCE
(This section need not becomplemd if flak:permit is for one hundred dollars(gid))
I'm.)
1 cenify that in the performance of the work for which this permit is is ded,I shall not -
employ any person in any manner an,as to become subject o the Workers'Com amsation
Laws of California.Da¢
Applicant _
NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should
became subject to the Worker's Compensation provisions of the Labor Code,you must
.JO fonhwi lh comply with such provisions or this permit shall be deemed revoked.
'z " CONSTRUCTION LENDING AGENCY
'p-t I hemhY affirm to there its construction lending agency forsbe performance of
Ci i the work for which this permit is issued(Sec.3097,Civ.C.)
lgd Q Lender's Name
jz Lender's Address
U 0 I certify that I have lead this application and sum that the above information is
11.. F correct.)agree to comply with all city and county ordinances and state laws mining to
�U building construction,and hereby aoborim representatives of Lia city no enter upon the
W ahovamennioned property for inspection purposes-
t�,.r,fy (We)agree to save.indemnify and keep harmless the City or Cupertino against
it tag liabilities,judgments.costs and expenses which may in any way aamc against mid City
U7 in conxqucnce of,hc gaming of this permit. '
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCIONS. � /
2:��
Re-roofs
SrR A of ApplicantlConuacor
r Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant sore at handle harudous material
AA defined by the Cuyeni no Municipal,Code.Chapter 9.12,and the Health and Safety
oda, -IYet 35533(a)] H� All roofs shall be inspected prior to any roofing material being installed.
Yes
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
in tantrums air contsminanu as defined by[be Bay Arca Air Quality Management all new materials for inspection.
7nim
uie"
❑Yes
Ihacmad tehusaefnons 2555,2333 ls requirementsnd5534.1 rCNpur6.95dthat ofte Calding
Hcallh&Safety Cmlc,Sections 255(15,35573 and 35535.1 understand Not if the building Lsss!!!
s non currently have a nonan,tat it is my responsilmin,no nodly the occupant of the
uirem xwhi uvIN,met prior oissuance ofaCcniOcamofOc y. Signature of Applicant Date
-al or `— All roof coverings to be Class "B"or better
Owner tar authnrizcd ogees Dam
Community Development Department
Building Division
alla4l ,
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
UPEI�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 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: /"C-C) /� e/Z- (I I'),�-
� -`
Job Site Address: fUS^tel a d e_ C,
Roofing Company Name: / ZGO /Al
A plicant'sSignature: ✓ _ Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINOcL
' REROOF Q 3 U
7
. CUPERTINO PERMIT APPLICATION FORM
APN # G Date: 7/1
/ / j
Building Address:
a 5 / kciditlul 0k,
Owner's Name: C r� Phone
2
Contractor: / /''r� Phone 7 7 r. License#:
� v �r d L -c v� S-01 rZ-
Contact: G .// J Phone: 7 7 Cupertino BusinessLicense#:
Type of Roof Covering:
Existing: Proposed:
Cl Built-Up Roof ❑ Built-Up roof
O 9sphalt Shingles J]�sphalt 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:
Residential EK Commercial ❑
Fire Zone: s ❑ No Confirmed with Plan ' e, . 'f
I there are anrest'' tions:
Cost of Pr ject:.,Z f- Type of Construct' n Occupancy grou
Qty. if
Appli ab Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Eneriy BUILDING
- BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
Z2 `F
z� 7 ?°