03080135 (2) CITY OF CUPERTINO �. n - "�'
BUILDING DIVISION - PERMIT CONTRACTOR+INFORMATION .
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BUILgINCADDRess: C .T CONSTRUCTION & ROOFING PERMIT NO
I-)RCT RID
OWNER'S NAME: 326 CHRISTOPHER AVE PERMIT ISSUE DAIS
NE: SANITARY N0. CONTROL N0.
(408) 378-0797
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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±00 LICENSED CONTRACTOR'S DECLARATION lob Description
I hcrchy mf ion that 1 am licensed under provisions of Chapter 9(commencing cp
? A111cCon
r of Division 3 oftw Du nesamd Professions GuJa,..J mylnearscis �■_��C®
s 0 ffcc 6 s-I ` IU
44 igyp u� REROOF
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3k^� — o ARCHL.'�K,.C,acrtmlcbr s.r SEP
ZC< Iunders,anJ my plans ell .M.puhl'c ucmJ SEP 3 2003
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o
ff Licensed Professional
e _
a 3 OWNER BUILDER DECLARATION BUI DING
ve'i 1 hereby affirm that I am exempt from the Contractors License Law for the Lam./
❑O fallowing reason.(SCcdna]831.5.Business and Professions Code:Any city or county
5$ which mquires a Permit 0,construct,tlter.impmw,demolish,or repair any structure
-i6
prior to its issuance,also requires the applicant for such Permit u rile a signed statement
mm that he is licensed pursuant to the previsions of the Contmcwr*sLicenseLaw(Chapter 9 Sq..Ft. Floor Area Valuation
Gt-O (commencing with Section 7")of Division 3 oflhc B namess and Professions Code)or
Nat he is exempt Ncmfmm and the buts for the alleged exemption.Any violation of 36624035 . 00
Section?W 1.5 by any applicant for a Permit ubjects the applicant to a civil penally of APN.Number Occupancy Type
not more Nan five hundred della.($500).
❑I,u owner of the property,or my employees with wages as their sole eompenmo on,
will do the work.and the structure is not intended or offered for sale(Sir.]044,Business 3 U5 _ g
Contractor'sd Professions Code:The Contractor'sLicense Law does am apply to an owner of 3 0 7 - INSULAT 1 ON d Inspections
property who builds or improves theorem.and who doessuch work himself or through his
own employees,provided Nu such improvements see not inundcd orofferad for sale.If, 601 — ROOF TEAR OFF
however.
one building ar improvement is old within he yam of completion.On owner-
builder will have On burden of proving that he did not Wild or improve fur purpose of 602 — ROOF PLYWOOD NAIL
"k')' 603 - ROOF BATTENS
❑L u owner of ct property.,Business and contracting with licensed eonwamss to
cens✓La does jenpplytooanOwneofproprty who
sds Code:)TheContractors Li 604 — ROOF IN—PROGRESS
cense Law does not apply loan owner of proper(who Wilds or Improves(hereon,and
wheLa for such projects wit ocnntracwrp)licenx . m
licensed to the Contnclor's
License
Law.
❑1 am exempt under See. ,B 8 P C(onhis season '
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury mm of the following declarations:
13011W
haw and will maintain a Cenirieme of Consent to self-insure for Worker's Compere
n,u provided for by Section J?M of the labor Code.for the performance of she
for which Nis permit is issued.
haw and will maintain Workers Compensation Insurance,u mi,fired by Section
of Ne Labor Code,far the pertarmmce al Ne wart for which Nis permit is issued.
Wmom'sCompensation lnsu.nucarricrand Policy numhcram:erre STATE�Gh/l� pot No.:X16
CERTIFICATE FROM WORKERS'
COMPF1i5ATItltltlAAfl INSURANCE
This section recd not Wemade¢J if On Permit is fronts hundred dollars(SIM)
or less.)
I card It,that in the performance of the work for which this permit is iuved,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of califomia.Doc
Applicant
NOTICE TO APPLICANT:If,after making this Ccoificam of Exemption,you should
become subject in the Workers Compensation previsions of the laWr Cade.you must
.JO fonm
hwi th comply with such provisions ar this permit shall W deeed revoked.
z CONSTRUCTION LENDING AGENCY
`
[—� I Wmby alarm Nal thane is conslructina lending agency l'm the performance of
a 7 one work for which this permit is issued(Sec.3M.Co.C.)
Lt1 Q Landers Name
LendersIS, Address
V Q 1 eerily Nal l haw read this application and sum that the above information is
Ll,
correct.
ng1agree to comply with III city and county nNimnces and state tia ter upin the Q building construction,and farcbysecorauthorize reprexmativcs of this city to enter upon the
�-' ehovcmcmiuned property fm inspection purposes.
(We)agree to new.indemnify and keep humless the City of Cupertino apinst
F' N Iimbililiea,judgmenu.costs and examines which may in my way mcrue against said City a x{
U in consequence of the granting of this permit, v\J\
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH NPOINT Issued by: Date
OUR GULATI NS. /
Re-roofs
Signalure of AodicwOC.m.Wr bme ^
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Of future Wilding occupant mare or handle houudous material .K
az dcrined by the Cupcono Mun'ipal Code.Chapter 9.12.and the Healds and Safety
CWc,Section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
C]Y.,
Nu
Witt the applicant or future building=upon(use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
h hmardous sic..mwonanu defined by Nc Bay Arca Air Quality Management all new materials for inspection.
istricl?
❑Yes Nu
1 have mad the hanallous materiels mquiremems under Chapter 6.95 of the Calif.,
nia HcalN&SrfclyCWc,Sections 25505.25533 and 25534.1 umkroand door Nc Wilding �• ��s/f/htl'� a'I p7
Jus net currently have a missal,that it is my responsibility to not il a dsuPar t of Or
requircmenIS hichmusIbcmetpdanniuuanceofaCerdf¢amofOc eyes Signature pplicant Date
Cv v B o
r arm honvad agent oam All roof coverings to b ass"B"or better
Community Development Department
� Building Division
' Ifi City of Cupertino
G��++" 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
U P E T 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 comply with the above stated policy on re-roofing.
Homeowner's Name: ' en-6 Loot 1w" .
Job Site Address: J s8s PrOG0e_j "kL
Roofing Company Name: C-,_T t6hs,{rwz,h nom.,, Q" "�hsz
A plicant's Signature: V ey' Date: 0 3
e \�1IQ61ALXX1 Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# J Date: I ,a�O 3
Building Address:
��SS PRosrE.af �-
Owner's Name: Phone #:
_4ERe) WIPFLEP, qa6- 13141.
Contractor: s "'• ° 114Phone#: /kdB�S�$ -1351 License#: Cs( (- 47
PP- -T (117 l
Contact: Phone#: Cupertino Business License#:
23M71
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nymber of existing coverings ❑ Provide I.C.B.O.Report#
P3 To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: lepLp 7/I4 05b,, M,5- @6, ({ we; f
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Qty. i
A li ab Fee 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