03040129 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT '`� R+� ORT„N ' MA" XU.N
BltfglalABDaPADO VISTA DR MENDEZ GEORGE G AND ANNIE PERMIT NO.
G 417 2 GEORGE G AND ANNIE PERM1TlS�t}A,-9/2003
NE: SANITARY NO. CONTROL
CONTROL NO.
ARCHTIECrfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
056 LICENSED CONTRACTOR'S DECLARATION Job Description
Y1+� 1 hereby affirm that I em limned under provisions of Chapter 9(commencing
^� with Section 700DWDivision 3 of the Business and Pmfceslom Code,and my license
_ Infell CCIwdeRecL REROOF FINALEO
Z_ Lionse Clete Lie.N
Dam Comraclor
3 ARCHITECTS DECLARATION p q 9
1 understand my plana shall M used u public records OCT O 9 2003
3 Licensed PrefcWonal
OW NER.BUILDER DECLARATION 1 n
1 Wmhy affirm that I em exempt form tis Contractors License law for the BUILDING
oo Tollmving mann.(Sectlun Professions5,Business end Professions Code:Any City or county
$Ici which requires a permit in construct,ether.Improve.demolish,or repair any structure
FSS^ poor to its issuance,also ox,dres lWapplicant forsuch Permit to file a signed comment
gg < thatW islicensed punuen i to the previsions of the Conuacmrs License Law(Chaper9 Sq.Ft. Floor Area $6V8l8Tdlon
(commnming with Section 70E0)or Division 3 of the Business and Profusions Code)or
dm he is exempt thencfmm and the basis far the alleged exemption.Any violation of y�7�r l.w
Scnbn 7031.5 by any applicant for a permit xubkc0 the applicant to•civil penally of 3 42114 8ID3I 0 0 Occupancy Type
not mom than five hundred dollen(5300).
❑I,u Owmrofthepmpeny,mmyemployeoswithwgesuthelrmle o Peussdon,
will do Ne work and theauuctum Is not intended or offered hotel.(Sec.7044,Business 305 _
and Professious Code:The Counsellor's Liasee Law does not apply to an mvner of Required Inspections
prepeny who builds orimproves dmmm,and whoduessmh weak him¢Iforduough his 307 - INSULATION
ownemploycea,provided thatsuch Improvements are not Intended or Offerad for sale.If. 601 — ROOF TEAR OFF
however.the building or Improvement is sold within one year of eompl uth n,the owncn 1
builder will ban the burden of proving that M did rot Wild Or improve for purpose of 602 - ROOF PLYWOOD NAIL
tale')' 603 - ROOF BATTENS
❑1,Isw
cancer of the pmpcmy,am exclusively cmuuning with licensed ronnsemn in
construct the pmjevt(Sec.70W,Business and predications Code:)The ConuumraL. 604 — ROOF IN—PROGRESS
cease law doss not apply m m net of prepay who builds or imprews them.,and,
who contracts for such prejems with aeonuactor(O licensed pursuant in ft Contractors
License law.
lam exam ,under Sec. .B& c
P C for this reon
0 r D ^1�
RKER'S COMPENSATI DBCLARAT
v
1 hereby affirm under penalty of perjury am of me following destWlon e
1 ban end will meloaln a Certificate of Consent On,sel4insum for Woher's Compere
action,as provided for by SeNon 3700 of the Labor Code,for dm pirformance of the
work for which this Permit is Issued.
❑I hen and will maintain Workees CompnsNon Insurance,Is required by Section
3700 of Ne Labor Code.for dm performance of tiro work for which this permit us Issued.
My Workers Compensa0on Insuance artier and Policy number am:
Carlen: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This auction nod ret W completed lithe pnnll Is forone hundred dollam($100)
or ksa)
I«nify mut in Its,prformame of the work for whish this Permit is issued,I shall net
employ anynon nanym nnennumbecome sybjecl to lhC WOrkem'COmpnsadon
Lawaofcali` ¢L�—'v
AppII,an,
NOTI E AP ma r ca Exemption,you should
baro Jett I the hers Compuoution prevld the Labor Code,you must
^J O forthwith comply with such provisions or this permit[hall W doemod revoked.
z CONSTRUCTION LENDING AGENCY
Imo^ I hembyaRum mer mart is a construction lendingagemy,for the performance of
Pvi> the work for which this Permit Is issued(Sec.3097,Civ.C.)
W Q Lender's Name
w`3 z lander's Address
V Q I certify that I have need this application and scam that she a Wn Information is
Iy COMM 1 agree to comply with all city and county ordinances and state Is”mixing to
Q building construction,and hereby authoNm representatives of this city to entre upon the
Lf] sbuve-mentioned property for Inspection purposes
LL (We)agree In un,indemnify and keep harmless me City of Cupertino against
r/) liabilities,judgments,costs and expenses which may in any way accrue against old City
Cnos)z Inconsequence of the granting of this mit
per .
., APPLICANT UNDERSTANDS ANP WILL COMPLY WITH ALL NON.POINT Issued by:9 Date
SOu�CEREGULA ON . .,
j�d sr �"�4 2J Re-roofs
STw`art Ap°r` miCnf
HAZARDOUS ATERIAIS DISCLOSURE Data
Type of Roof
V� Will the,applicant or future building Occupant store Or handle huudam materiel
a do ned by fee Cupenino Municipal Code.Chapter 9,12.and the Health and Safety
ode,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu o
WIII me applicant m future building occupant use equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove
Diurict7 it haurdaus air rontsminants Is kfincd by the Bay Amo Air Quality Management all new materials for inspection.
❑Yes o6Nu
1 have need!the ImuNousmaterials requirements underChap or 6.95 of me Calif..
nice Health A,Safety Cade,Sections 255115,25533 and 25534.1 under" dmM ft building
doss not currently ham a tenant,than it u my mapusibility he unify tett ut of da
myim ntswhichmu LemelpdormiuuanceofaCcnifsamof cu SignatureofApplicant Date
r ora norn .ant
Data 0 All roof coverings to be Class"B"or better
Community Development Department
�' Building Division
W
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C i 'P E��]N 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 X14" 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: 4;2E O M (;E (,- ,
Job Site Address: /d//6 /0R A D U. )11,57-A
Roofing Company Name:
A pli --e /2 .u-r
cant's Signature: zde- A � Date:
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO b 3 U 2,
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN#
i
Building Address:
/rJ a T p C4g7/ 5-o
Owner's Name: Phone #:
a DE V&?_
Contractor: j� •� one#: License#:
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �W, Asphalt Shingles
'K 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 Cl Provide Mf&. Installation Specs.
I Have Read, Understand and Will Cornplv With Cu ertino's Tear Off Policy:
Job Description-
ResidentiaM Comm ci I ❑ ,��y� / /t
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De
there are an res ns:
Cost of Pr ' t: �� `e-`r7 Type of Const n Occupancy gro
t K ,
Qty. if
A lic Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit FeesBUILDING
BENERGY Ener BUI ENG
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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