03030139 (2) CITY OF CUPERTINO "°''T a•*s : ' ` " `�' o,''• 7N `-q�s.Jr 'y"
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BUILDING DIVISION PERMIT � .� R7 �M ' �b-N
PERMIT NO.
BUILDING ADDRESS: ROOF GUARD ROOFING CO
I Q1 60 PARK 121R PERMIT LssuE 9SF0 3 013 9
OWNER'S NAME: 740 W SAN CARLOS
SANITARY N0.0 3 2 5 .2o"q,NO.
(408) 293-9519
BUILDING PERMIT INFO
ARCHITTIC7VENGINEEM BLDG ' ELECTPLUMB MECH
Q t�
00 LICENSED CONTRACTOR'S DECLARATION .lob Descrl titin
uDz, 1 n:h affirm that 1 em I]ronud under previsions of Chapter 9(commencing MAL
pis.
< with Sutlo Dofpivldon 3orthc Bu[inu)ndPr�Won.Cnde,end mylkense4 7me fid!
Z mfullfn s edema We�fl[J tl REROOF
Ifoq Uccu I e y5��gg�� -
i�qq Down run mundmypl n.ah.11W.sa p,blcc AxmdNs . APR 0 2 2003 -
o�7W
:off
Licensed Professional BUILDING
OWNER-BUILDER DECLARATION
} I 1 hereby affirm that I am exempt from Ne Contractors
3 DCemLaw for IM
OIS.eoiOcas end Pvfcadons Cow:Any cry ar county
$J following mason. Sector.
which requires a Permit to<onnrOc4 alter.impmw,demolish.or repair ray atmctum
�n priorloiu iuusnco lase rtquima the applicant forsuch permit to rile a signdnatement Sq.FL Floor Area Valuation
E-Es�s"< that W it licensed
punuanl M the provision of the Comnnor'sUcenu Law(Charmer 9
zF� (commencing with Section 7000)or Division 3 of the Bigmannend Professions Cork)-1 $3400•y�
9 E I Net he Is exempt therefmm and Ne basis for the alleged exemption.Any vinlgfon of �I.�j]}..1,syt,�t' •J P
Section 7031.5 by my epplicnt far a permit subjects the applicant to a civil penalty of �kI7IJ_ISlilmbet'. 0 O Occupancye
not mom than nw hundred dollen($500). j 2(j j 2 OI`�
❑I,as owner of the pmpony,of my employees with wage.u odi wile compensation,
will do the work,and the inocmre is not intended or offered foOdc(Sec.701a,Badnas Re uired Inspections -
and religion.Cede:The Carmelites Lianas Law deal not apply to n owner of 305 — FRAME q P
pomenywho bulldsmimprows tiierean,end who doessuch work hlmulfor throug ldl 307 - INSULATION
own employees.provided hot such improwmnuam not Intended oroQemd for set&if,
however,the building or improvement is sold within oro year ofeompledol.we owner• 601 — ROOF TEAR-OFF
builder will haw the burden of proving Net be did Out build or Improve for purpose of
602 — ROOF PLYWOOD NAIL -
isle.).
p 1,a.owner of Ne property,am eeelopwly containing with licensed contractors to 603 - ROOF BATTENS - - -
common wepmjca(Sec.7W,Business and Professions Code:)The Contnaters Ll' 604 — ROOF IN-PROGRESS
cease law deal net apply to a mwntt ofpmpwywho Wilds or Improwa Human,and.
who contracts for such projects with acniramoRs)licensed puruunl to the Comnetora .
Lkeem Law. .
❑I gra exempt under See .B A P C for this waxen .
Owner Dole -
WORKER'S COMPENSATION DECLARATION - -
I hereby affirm under penalty of perjury Oro of do following declgolions:
ave and will maintain is Conlficate of Consent to ulydisum for Workers Conran- - -
1MMYWorkg`sCmpKc
,as provided for by Section 37M of the Labor Code,for the pedmmance of the .
far which Nps permit is issued. -
aw and will maintain Workers Compensation Insurance.as recruited by Section
of the Labor Code,for we pcdaimance of Ne work for which Nie permit is Issued. -adminisunna rdcrand Policy nytnItoiI
CURTIFlCATE OF EKEMFROM WORKER
COMPENSAT INSURANCE
(Thu section reed not necomplewd]fine permit is foroac hundred dollars(SIM)
or pas.) -
1 certify Net In Tho performance or the work(ter which this Permit is Issued.I shall not
employ any permit in any counter as w become mnject in the Workers'Compemadon
Law.of Cal trouble.Dew -
Applicant
NOTICE TO APPLICANT:If.after making this Cmificem of Exemption.you should -
become subject to the WorkeM1 Compensation previsions of the Loam Code,you most
forthwith comply with such provision or this permits hall be deemed revoked.
r CONSTRUCTION LENDING AGENCY
I hereby alarm that there Ise connuctian Icnding egeney for the performance of
a 7 the work for which this permit is issued(Sec.3077.Civ.C.) -
W Q Lender's Name -
G Isnwrs Addicts '
rJ z I cenify out, m
1 haw rod this application and sow that the above Inre nlun is -
W F 10= 1 as=to comply with all city and .only ordinances and su:laws relating to
0 C.7 buildingrwi)agree n,and I.Somhembyewhadrzwpresenmiwsa(Cit city Capone.
agao Carol No inst W show-mentioned prowny for inspeNon purpmet _
G (WaYageemsew,indexpenfy ndkeep nay Inasbless,theyrucof against
Wt /7
y Incl ilumocm of the
Stnntl expenses a which may in any my eceme agalnsl said City
U 7� A PLICANce NDER TANDSng of lhiND Z Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURy REGULATIONS.
Re-roofs -
lie oTppOa Dau
HAZARDOUS MATERIALS DISCLOSURE
E Type of Roof
WIII the applicant mfuture MillJin6 uccupanumm or henJlchnaNum mawdal
as dellned by the Cupertino Municipal CadeChapter 9.12,and the Health and Safety - .
.Code,section 25532(.)7 All roofs shall be inspected prior to any roofing material being insta led. .-
❑Yea
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 contaminann ruined by the Bay Arta Air Quality Management all new materials for inspection.
stric0
❑Yes Nu �
IheverzaE Nehgerdo.25505.2553 irtmcnuun Chepwr .5.95ofthc Glifor / / �� /-•/��
nus not B:ently caw,Sodom 255 it 4 m responsibility
rsHy Nollcup nt Kthe s
Jon not currently Nth a wank Net it w my mtpomlhility w n tlfy iecupni M Jte
mquirtmcnuw hmuolwmet pale 'ssuuRc aria Ccrtifeew f yvpnry. �'ignatur Ap Icant Date
All roof coverings to be Class "B"or better
Ow ser these' a ant Dam
.,, Community Development Department
Building Division
✓ j+ City of Cupertino
. w 10300 Torre Avenue
' Telephone: (408)777-3228
CITY OF
Fax: (408)777-3333
C i 'P E 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 corn with the above sta d policy on re-roofing.
Homeowner's Name: 112
Job Site Address: �OIG�y—� r ✓ (C e t f Gt f'
Roofing Company Name: 1LcJO { GVAr
A plicanYs(S�ig�nature: Date:
\i1J�61htiD�X1
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper