03090081 (2) CITY OI"CUPERTINOrc k `+-a
BUILDING DIVISION p1 RMIT CQNTRAC�TnRINFORMATION ''
r� BUILDING ADDRESS: T D ROOFING PERMIT No 03090081
INA T
OWNER'S NAME: 3540 MARGATE AVE . PERMrrISSUEDATE
NE: SANITARY NO. CONTROL NO.
(408) 892-8872 C
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
=1 o 0 0
100 LICENSED CONTRACTOR'S DECLARATION
U el hcrcby affirm that I am licensed under provisions or Chapter 9(commencing jo
< with See
dom 71X(PU Division Sof the Bmincaand Pome,shms Cnde,and my license is
s in full force and rc
REROOF
ulenaaclaaa Lk.N C,Ea
Data
Gantnnor SEP 2 4 2003
4 AR ITELTS DECLARATIONI
f u'� 1 undcmanJ my plans shall W used as puM1lic records
2e0 Licensed Professional BUILDING OWNER-BUILDER DECLARATION BV ` 1Y
2<f 1 hereby affirm that I am exempt(rum the Contractor's License Law for the
O O following recon.(Section](131.5.Beside.and Profusions Code:Any city ca,mmly t
5 m which termites a pearrit in e^nsuuet,alter,improve,demolish,or repair any structure
_Z j, ptiorm its iguana.also requires the applicant for such permit to File a signed sntemem
csp that he is licensed pursuant rothe provisions it(the ConmecturiLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
e,- (commencing with Section 7")of Division 3 or the B usinem and PmfcssinneCmloar
that he is exempt therefrom and the basis for the alleged exemption.Any as Cl Ion of 3423 0009 . 00
Section 7031.5 by a ay app0ant ter.pmmh objects the applicant to a civil penalty of ..ATN Number _ _ Occupancy-Type-
0
ceu ane T e_.
not more than five hundred dollar.(SSW). - - — ---� - P y- yp ---
❑1,as owner of the property,army employees with wages u their sole compensation,
will do Ne wreak,and Ne swcsurt isnot intended or offered far uk(Sec.)094,Busisss yy
and Pmf.ml...Code:The Conmemh License Law does nal apply n an owner of 3 0 7 - INSULATl ON d Inspections
progeny who builds or improver thereon,and who does such work himsel(or through his
own employees.provided that such lmpinvements are not intended or offered 0r sale,If. 601 — ROOF TEAR OFF
however,Ne building or improvement Is sold within one year of completion,the owner
builder will have the burden of proving Nn M did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
wale')' 603 - ROOF BATTENS
❑I.as owner of the property,am exclusively contracting with licensed contractors to --
conswctthepmjcct(Sec.70,kLBusinessandProfessionsCode:)noConmcmr'sLi. 604 — ROOF IN-PROGRESS
muse law does not apply to an owner of property who Wilda or on prows thereon,and
who contracts for such pmjects with a conmenrts)licensed pursuant to the Contractor's
License Law.
O l am exempt under Sm. ,B k P C for this action
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby from under penalty of perjury one.(,he following declarations:
I haw and will maintain a Ccnifcmm of Conserv m self-insure for Worker's Compere
137VIIW
on,a provided for by Sermon 3700 of the Labor Code,for the pafoamance of the
work for which Unix permit is issued.
r have and will moment Workeri Compensation Insurance,u occurred by Section
of the labor Code,for the perfmmance of the work for which this permit is added.
Workels Cnmpevation lm�nce cmier and Policy number art:rver. CVSPolicy No.: I Q-
CERTIFICA OF EX MPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thi,sectionneed not cond,wali(the perm,is(orome,hundred dollars(SIM)
as.)
1 cenify Nut in,he performance of the work for which this permit is issued,I shall not -
employ any person in any manner m u to Weomc subject to the Workcrs Com,prom lon
Laws of California,Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate or Exemption,you should
bttome object so the Worker's Compensation provisions of to Lubar CWe.you must
Oforthwith comply with such provisions or this permit shalt W deemed revoked.
h CONSTRUCTION LENDING AGENCY
mv I hereby afllrm that here its conswction lending agency for the,performance of
]$? the work for which this permit is issued(Sec.3097,Co.C.)
YC) Lender's Name /
z Underi Address
J 1 cenify the 1 have read this application and sort that the above infortne,iun is
.� t: correct 1 agree to comply with all city and county ordinances and stale laws relating to
�U building cmnsmnion,and hereby authorise representatives of this city to cater roan the
W shove-mcoduned pmpcny for inspection purposes.
y (We)agree to ave,indemnify and keep harmlcd the City of Cupertino gains,
h Iiabilitiu,judgments.coats and espensu which may in any way see=against did City �/
J ,Z in consequence or me granting of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
HAZARDOUS
SSignatureof AppliceData
HAZARDOUS MATERIALSDISCLOgURE Type of Roof
Will the Culom or(omeMuni building k,Chapter
store 9.1 or batik Health adSafrmaterial
az,I,Z mthe Cupertino Municipal Code,Chaplet 9.13,vad tW Health end Safety
otic.Section 35533(x)? 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
it he.nmus air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
0 Yes tsgia? \Q
Ihavemad char tnsm 5k5ia5smyvircmcntsunJcr Chapnrg.95e(Nc CalifoC q/
.in HcalthX Safmy r ctiva 255f15,35533od35534.1 undersnndthnirthc Wildin
does not cmmcntly nit's rcspomUtilitym notify theos�open,of the
rtquiremcntsw ' vet anaonCcnlncmcr�CcupgncOy. � Signature of Applicant Date
II I{
Owner m othmired agent Data 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
�UPERTINO 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.
1 understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: F�e
Job Site Address: d �-)l AA ed 11 ck �I
Roofing Company Name: T
A p'icanYs Signature: Date: 911, 10-2
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO0
REROOF 3
CUPERTINO PERMIT APPLICATION FORM
APN# 3 4 g
So 00 9 Date:
Building Address: (
"2 ,1 -iI Med:),c\ Loi
Owner's Name: n Phone#:
NI" 4 lo..cPn .tog S33 I1o9
Contractor: Phone#: License#:
T n Qoo �� U4$ 3N9 tnya 6166 .102
Contac: ' Phone#: Cupertino Business License#:
dyti��� i"Ivc,1� yo$ 646 8 3S O
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )d 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:
re m of e W ocLA S t1 u (p
QSL V e a C.¢. W � ¢o. ��J Cori
Residential []' Commercial ❑
Fire Zone: Yes ❑ No [1 Confirmed with Planning Dept. if
there are an re fictions: ❑❑
Cost of Project:oo Type of Coonsstt,�tcti6h: Occupancy gr up:
h
1 A t
Qty. if
Applica I Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
ENERGY En;rgy BUILDING
SEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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