03090192 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT Y�CO,NTRACTnR IINFORMATION KF;.
q BUILDING ADDRESS: T D ROOFING PERMITNOC 3090192
OWNER'S NAME: .3540 MARGATE AVE. PEST LauE DATE
SHIRIN & WA 2003
NE: (408) 892-8872 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
iO0 LICENSED CONTRACTORS DECLARATION
I hereby affirm thus 1 am llicenseddunderunJcr and
Professions
or Chapter 9(commencing Job Description
wiNS ti )n(kq of Division]of NC❑u an and Prufcssi.ns Code,and myliccnu is
infmseOut, f f 3q � AAREROOF-REMOVE SHAKE REPLACE
ikons .' Lk.N /'
�p Da¢ a oro ITH PRESIDENTIAL 50YR COMP
]W ARCHITECTS D RATIO
f < W!J and my plans shall be a public records
soU Licensed Professional
OWNER-BUILDER DECLARATION
�0 0 I hereby maso 0(Sec on I am exempt from Nc Contractor's e:Any
Law for the
ve O follwhich re mason.arrot it]W str Business and ver de aw Calc:Any oily or is my
�:in which its requires a permit to construct,applicant
improve,h Permit
or repair any umerant
4Z prions itsiensed .also..an,,.the the previsions
evisionso for sucContre Lor'sicea Law(ed atocmcnt
e2 (cohe menccgwithSmumu")ofDivinusnoftheBusiness
tranor'sniccnuhw(Chapmr9 Sq.Ft. Floor Area ValL tiq@1000
,1-0 that he is(commencing oreftmn and the
basis n 3for the
the aged exsond Professions Code)of
Net he is exempt Nertfrom and Ne buts for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects to applicant to a civil penalty Of 3 4%11N3Q�er0 0 - Occupancy Type _
not more man Five hundred dollars(5500): - - ... P Y YP -
❑ 1,as owner or Ne propenY•or my employees wit wages as their ele compensation,
will do the work.and the swctum is not intended or offered for sale(See.7044,Business
and Professions Code:The Conuactora License Law docs not apply N an owner of 305 - FRAME Required Inspections
property who builds or improves tenon,and who does such work himself or trough his
awn employees,provided that such improvements are not intended or offered forsale.If. 307 — INSULATION
however,Ne building or improvement Is sold within one year nr completion,Ne nwnco-
builder will have the burden of proving that he did.not Wild or improve for purpose of 601 - ROOF TEAR OFF
sale')' 602 - ROOF PLYWOOD NAIL _ -
O h as owner of Ne property,am exclusively contracting with licensed continental to 603 ROOF BATTENS
construct the project(Sec.70,14,Business and Profusions Code:)The Contractor's Li
core,Law does not apply in an..or of property who Wilds or improves thenen,and 604 - ROOF IN-PROGRESS
who contracts for such projects with a contnetor(s)licensed Poniard 10 to ConerectoM1
License L.
❑1 am exempt under Sec. B J,P C for this reason
Own Dam
WORKER'S COMPENSATION DECLARATION . .
Ihereby arfmn under penalty of perjury mm of the following declarations: _
I have and will muton n a CcniOcam or ComeM to set Name for Worker's Compere
76321CW�"'
on,as provided for by Section 3700 of the Labor Code,for the performance of the
k for which this permit is issued.
I have and will maintin Workc' Comp, don Iruurance,u required by Section
of the Labor Code,for the poAormanee o ,work for whteh oris peon it is issued.
W rkeh Cgpmpeninionn It non OfPolicy number art:a, S Yfs kC s ss G1 policy No.: I al � f y b
CERTI..CA E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This uetuan need not be completed If the permit is formic hundred dillies(giro)
or less.)
I certify that in the perrormance of Ne work for which this permit is issued.I shell not
employ any person in any mannerate as m Wcome subject o the Workers Compensallo t
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this C.nifuate of Exemption,you should
become subject to the Worker's Conformation previsions of did Labor Code,you mut
� z forthwith comply with such provisions or this permiuhall be deemed sensed.
ZO CONSTRUCTION LENDING AGENCY
1 hereby aWhich
cErm No Here its construction 30 loom,agency fnnW Performance of �.
x rte-, Lender's e work fur which this permit is issued(Sec.](797,Civ.C.)
Y Q ein' Name
D z Lender's Address
J O 1 cenify that I have read this application and stow that the above information is
J. F correct.I agree to comply with all city and county oNinances and state laws relatingm
�U building construction,and hereby summers mpreumatises of this city to enter upon the
a ahovo-mcmioned pmpcny for impaction purposes.
r (Wee)agree to save,indemnify and keep Harmless the City of Cupertino against
In Iiobil ittes,judgment.costs and expenses which may in any way acerae against said City
;J7 in consequence of the granting of this permit.
t� APPLICA{VT N ERSTANDS AND WILL COMPLY WITH ALL N-POINT Issued by: Date
S RCE RE AT�D1J5
��(, cl req u3 Re-roofs
ignition of Applica YContracmr Det.
HAZARDOUS hr ERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant slow or handle hazardous material
u dcEned by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
wale.section 25532(a)? All roofs shall be inspected prior to an roofin material being Installed.
❑Yesm P P Y g g
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 havardous air contaminants as defined by the Bay Amu Air Quality Management all new materials for inspection.
IYlrlfl?
❑Yes ZNn J
I have read the havarNws materials requimment under Chapter 6.95 Of the Cali for
nia Hits Safmy Codc.Sado.25505,25533 and 25534.I undetsued that if the Wilding C) /—Igl O 3
docs not c n Y.4aw a um.m.But it is my responsibility m nndfy the.1 an,of or
LL LL r�l�
require he C must W met prior te,issuance of Ccrvoc of Ocrupanf. Igna[ure of Applicant Date
9 2J b All roof c ve 'ngs to be Class "B"or better
0 rser authorind agent Dam
Building Division '
10300 Torre Avenue
4 Cupmtino,CA 95014-3255
Telephone: (408)777-3228
cooFax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection and/or tear off approval.
2) In progress inspection approval.
3) Final inspection approval. .
a) Spark arrester installation.
S. 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of:"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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: in i v'i ([t cv Oc tt n C
Address: ct
Reroofing Company Name: _-_ •1 f) err
Applicants Signature: Date: z'4 L
Joe Antonucci
(Chief Building Official)
6/25/01
CITY OF CUPERTINO D3�%�/9�
REROOF
CUPE o PE T APPLICATION FORM
APN 3 4 -1- 1 S O S G Date: 9 /.2q l b 3
Building dress:
Owner's Name: Phone#:
S k , r �vl km C,Q k_�_ a v- `t'D 3
Contractor: Phone#: License#:
i D foo �)AC yoS 34C1 'ioI7 CT
Contact*-f� Phone#: Cupertino Business License#:
yo& 64-6 S 350 az_31s
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
J( 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: I _Pv epi � y
h2nlo.le vvooci S1Acdce (ie, CzCi- it)*1 v , c . a SO I' ( ho
Residential IV Commercial ❑
Fire Zone: Yes ❑ No ❑' Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
�} I(3 co-u— AC ra 0
Qty, if
ApplicabFee 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
2.3 7