03080103 (2) CI'T'Y OF CUPERTINO CO .. d
RMAN ",
BUILDING DIVISION PIRMIT V, NT
BUILDING ADDRESS: SIGNATURE ROOFING""INC PERMIT"03080103 '
a OWNER'S NAME: 555 O 'NEILL AVE, #16 PERMTf ISSUEDATE
IF"E' (800) 644-7410 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECfI
+00 LICENSED CONTRACTOR'S DECLARATION
IC 1 hereby affirm that 1 am licensed under pmvisiom or Chapter 9(commencing lob Description
b with Section 9IXNp of Division o th sinemmil Professions Code,md my licemcis
mudimeane Bee _G � #C , 3 REROOF PINALEO
�'nn License lass Lm.p
~Z Date Co tauter V LA —
ARCHITECT'S DEC RA
fze I understand my plarsahall he used ea public VIA SCfrrpp
2 2003
7yU
:G� Licensed Professional
ta t OWNER-BUILDER DECLARATION
j<f I hereby alum that I am exempt from the Contractor's License law for the BUILDING❑O following mason.(Section 7031.5,Business and Professions Cock:Any city or county
S$� which requires a permit to construct.alter,improve.demolish,or repair any strucwm
-iy prior tat its issuance.alsu requires he applicant(orsuch permit to file a signed statement
o
that he is licensed pursuant to be provisions of the Contractor's License Law(chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 711(10)of Division J or the Business and Profmsinns CON)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of 36908031 . 00
Section 7031.5 by any applicant fur a Permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars(1500).
0 I,as owner of the pmprrt,or my employees with wages M their sole compensation,
will do Ne work.and the swans is not intended oroRered for sale(See7W,Business 3 Ub — F KAM ERequired Inspections
and Professions Code:The CoeV9elnfns g License Law donot apply m Reg
an owner of 3 07 — INSULATION
progeny whobuildmrimproves Hereon,end who does MCM1 work himseBor thmugh his
Own employees,provided that such improvemenuue notimmndedmoRcred for Mle.IL 601 — ROOF TEAR OFF
however,the building or improvement is told within one year of completion,the owner
builder will have the burden of pmving the he did not build or improve for purpose of 602 — ROOF PLYWOOD NAIL
sale')' 603 — ROOF BATTENS
01.as awns of the progeny,amcaclusivcly contracting with licensed contractors to 604 — ROOF IN—PROGRESS
construct the project(Sec.7044,Business and Professors Cade:)The Conaacmri Li
canis Taw does not apply to an owner of property who builds or improves thereon,and
who camracu for such projects with a contractors)licensed pursuant to the Contnnor"
License Law.
0 l am exempt under Sec. B h P C for Nis rcsson
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penal"of perjury one of the following declarations:
I have and will maintain a Ccnificam of Consent selbinsum for Workcfs Cumpcm -
satiun,M provided for by Season 37W of the Labor Code,for Nc performance of Nc
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Insurance.u required by Section
3700 of the labor Cade,for Ne performance of Na work for which Nis permit is issued.
My Wnrkcr'x(� ratrion Imumncc carrier and Policy nu bcr art: t�7 b
carticr. Ja ( 2 Policy Nod /
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
This section need not M completed if the permit s for one hundred dollars I$NB
less.)
I unify that in the perrommacc of the work for which this Permit is issued,I shall nut
employ any person in any manner so as to la come subject o the Warkeri Compensation
Laws of California.Duro
Applicant
NOTICE TO APPLICANT:It after making this Cenif¢a¢of Exemption,you should
become subject to the Workers Compensation pmvisiom of the Labor CAN,you mug
.J O forthwith comply with such provisions or Ibis permit ghall be deemed invoked.
Z " CONSTRUCTION LENDING AGENCY
Iherehyalrfm Nm Vert i....maruainn lendinggency far Ox perfufmanuda
a raw the work fur which Nis permit is issued(Sec.3097.Civ.C.)
(gl Q Lender's Name
= ,z Lcadcr's Address
U 1 ttnify Nu 1 have read Nis applicnion and sole Nu J¢above information is
I7, F coven.I agree m comply with all city and county ordinances and sure laws mladng to
C U building construction,and hereby Antonire arnmilenstivea Of this city to enter upon the
111 ahovomentioned property for inspection purposes.
I�.r.C (Wc)agree loan,indemnify and keep harmless the City or Cuphoon,against
i.. h limilitics.judgrecnu,costs and experos which may in my way accrue against MidCity
Uz In consequence of the granting of this permit.
^' APPLICA UN RSTAN S NO WILL COMPLY WIT ALL N -POINT Issued by: Date
SOUR GU IONS.
2 v O Re-roofs
Sign or PplicanUComncmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
III the applicant of future building Occupant store nr handle hmomu us material
as defined by the Cupertino Municipal Code,Chapter 9.11.and the Health and Safety
Cade,Section 15532(a)+ All roofs shall be inspected prior to an roofing material being Installed.
❑Yrs nNa P P Y g g
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 hanrdnus air contaminants u defined by the Bay Arta Air Quality Management all new materials for inspection.
istrm
0 Yca
I have mad the hagardnunx,ZWals re 33 and nu under Chapter 6.95.f the Califnr fs�/
nu HcslN&Safety Codc,Sttduns 2550 25577 and 25534.1 undersand sif huilding 6 V d
Nes not cumen0y Aose a t nano t s my fespomihility m nntily 1 occu ant of Ne
roquin which mu incl tiutanceara Cmcficr. supan (gnat of Applicant Date
Winer r tat aceagent O p All roof coverings to be Class "B" or better
Community Development Department
Building Division
aM
ity of Cupertino
10300 Torre Avenue
CITY OFTelephone: (408)777-3228
U^E k11 I N O 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: `✓ �`'1/"a�
Job Site Address: /o/ 7U G h
Roofing Company Name:
A plicanYs Signature: e Date:A
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO D 3 v / °3
REROOF
' CUPERTINO PERMIT APPLICATION FORM
APN# Date:
- o � 3 - Z
Building Address: ,
Z0 7 ic4woad Or cw ,efrjwv
Owner's Name: Phone#:
Me cuere o?- 2S3- 27LI2
Contractor: Phone#: -SLicense#: . O/6.N19-THRERyoA1w 6 p
Cogct: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles ;5<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: T # 3 J
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
C DU
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
010 BENERGY En;rgy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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