03060044 (2) CITY OF CUPERTINO �1110+s aa�,;� a � �^ .r�' '"""
r BUILDING DIVISION
PERMIT BUILDING - 1NF
BUILDING ADDRESS: PERMIT NO.
WOODS ROOFING 03060044
M FERMITISSUE DATE
2179 STONE AVENUE S= 22 06/05/2003
SANITARY NO. CONTROL NO.
(831) 637-5576
ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby sfrinn that I am limmead under provisions of Chapter 9(commencing P
i with Socohm7")ofDivivanSoftheBox.AndProfcWOmCode.andmylimuseis ��eO� ® �.r�
^mor is full(ars and L B— 99 VV``m!r''�
Zgit DannClu ` 3 Cont 31 REROOF
°ate TSDECf Ti I JUS! 3 0 2003
ARshot Is use DECLARA ON
e+� I understand my piens shall W used As public narN
5 U
)0 Licensed professionalO
Oat I am exempt
fa DECLARATION BUILDING
.0 i 1 hereby.affirm(Sm that 1 1. exempt faro the Conon,Co License Lew for the
O O follwhich
meson.retail
t 8mistra5.B.arm. and Pmfessiom Code:Any city a county
L$ which mqulma•permit ra aonraL alter,ie for such
demait,n,m e.signed
nnctuu
_ thit he it,issuance.
c..dnatioalso Ito the Previsions far Cchpermit to6lcaagncdmumem
pp_ that he is lianud pursuant to the of Division
of Ne he Business
bh and
Porti law(Chapter 9 Sq.Ft.Floor Area $11 'ajl,6tion
p $ fust tax exemptomion nate and of basis for
deux,eged exe andon.Any
Cninof
Q�.. Nat tax exempt therefrom and este ba4 far tix,alleged exemption.Any vlole�an of �r
Section 703115 by any applicant for a permit subject,Ne applicant to a civil penally of ��pt�t t�7�w Occupancy • P
nut mare dun five hundred d0llssu(M), 3t/7U'_YV'Y'%R0 ecu ane e
❑I,As manor of the property,or my employees with wages as their sole Compeallon,
will do the war- adthe svueun isnot rounded or offered for age(Sec.7044,Budoas 305 - FRAME Required Inspections
And Pmfesdous Code:The Carmine,Liam&Taw docs not apply a e ns an owner of q P
property who builds or impormtamon,and who doessuch work himulfor through his 307 - INSULATION
own employees,provided that such Improvement,are not intended oroffered future.If. 6O1 — ROOF TEAR OFF
however,Ne building or improvement is sold within rote year of completion.Ne owner.
Wada will have the harden of proving WP he did not bund or improve far purpose of 602 — ROOF PLYWOOD NAIL
ode.).
❑1,as owner of the property.am exclusively convecting with licensed anvacrou l0 6 03 — ROOF BATTENS
ctnmroct the projM(Sec.7D44.Business and Proteuioa Cade:)The Contractors Li. 604 — ROOF IN-PROGRESS
cense law docs not apply 0 an owner orporany who builds or improve themon,and
who contracts for such project,WIN a convactor(O Iimnud punam to We Con moor's
License Taw.
O l am exempt under See, .B k P C for this tenon
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following dalvalioa:
1 have end will numuin•Cenilicate of Continuo sel6iaum fa Markers Camps.-
anion,
ompereanion,as Provided for by Section 37011 of the Labor Code,for Ne peAOrmana of the
work for which Nis permit Is issued.
I here and will maintain Workers Compensation Insurance,As required by Section
(K of the labor Code,for the performaa of Ne work for which this permit is issued.
y Workers Cn pe zd--FlnsupmKria end Policy�nu�mbGer em:
Carrier. �I /� Policy No.iv..+'�3�f�IIw
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rrhls section need not tecompleted If the parent is foram hundred dollars(SIM)
or less)
I anify that in Ne performance of Inc work for which this permit Is issued.I ales((am
employ any person in my meaner an As in become ubj"L to este Workcn'CanaNnanon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this CenlRcate or Exemption,you should
become subject m the Worker's Corn incarnation previsions or Ne Labor Code,you math
�Z forthwith comply with such provisions or this permit anall be dimmed uvokcd. t
zO CONSTRUCTION LENDING AGENCY f
'p+ 1 hereby affirm that Nen H a construction lending agency rot the performance of
p:,7 the work far which this permit u Wood(Sec.3097,C.v C.)
IL)Q Lentler'1 Name
j z
Len a, Addma
V Q 1 cepm Nn 1 havply rad this and coon mtl nate the red Above information rmning u
0 U building 1 agra w Comply with all any mtl penny nalLIM Of and tiff t ant relating e
V building construction,And hereby emhonurposennutives of this city reenter upon the
!27 sWvo-meNo agree
no ny for inspection keep
(We)&gra Po an,indemnify and kx,e0 humleu the City of Cupertino goat
it h liebilities,judgmentacast,and expenses which may in any any seers against said City
in consequence of the gnNng of this Fermis.
APPLICANT UNDERSTANDS NP
A ILL COMPLY WITH ALL N POINT Issued by: Data::9/51
SOURCE REGULATIONS. Q
I1---K—- 6 5 Re-roofs
Station of Applican/Convacmr Dire—
HAZARDOUS M RIALS DISCLOSURE Type of Roof
Will Im applicant or future Wilding occupant store or handle le ardour material
as defined by the Cupertino Municipal Cade.Chapter 9.12,and the Heslth and Safety
Cade,Section 25532(.)7 All roofs shall be inspected nor to an roofing material being installed.
"Yes P P Y g g
Will enc epplican0 ar future building oaupam us)equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit ben,.,s air conuminanu As dc0ned by Ne Bay Ana Air Quality Management all new materials for inspection.
Disvict7
❑Ya u
I he.read the havam0ua materials requirement,under Chapter 6.95 of the Coder.
n.Health Is Safety Caste,Sce9om 25505.25533 and!25534.1 the flux,building ' y�^—`1 B (-15
dao rot carrenuy na a wnw4 the it u my mpomihiliiy w notify fix,=upm,of the i f��l• /O 3
require m the mel r w issumcc or a Certificate of a py Signature of Applicant Date
ower 01&nthvas ascot ` °ate All roof coverings to be Class"B"or better
Community Development Department
Building Division
ANN
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E TIN 0 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:
Job Site Address: ,L�D
Roofing Company Name: A)0" '� 'S
Ap'can' Dat
sSignature: e: G S 03
• I Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
CITY OF CUPERTINO o 0 6 0 f
j
REROOF
* CUPERTINO PERMIT APPLICATION FORM
APN # 6 6 / Date:
Building Address:
Owner's Name: Phone#:
Contractor: s PhrW� G (1O-D$U3 License
Contact: �o Phone#: c Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �K Asphalt Shingles
A 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, Underst an Will Com Wi Cue inn's Tear Off Policy:
Job Description: TO /G C7 30 �'
O
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: Lf
Cost of
Project: Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
/ BPERMFEE Bid Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
�7e, 216)