03060140 (2) CITY OF CUPERTINO -
BUILDING DIVISION , - PERMIT CONTRACTOR INFORMATIQN:
Bml.Dl"c noDREss: DAN ELLIOTT ' S ROOFING CO """'0306014003.93 ScFhNic RT-1-TI)
OWNER'S NAME: 2669 COIT DR PERMIT ISSUE DATE
O (408) 559-7327 NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
lop LICENSED CONTRACTOR'S DECLARATION - o lob Description
[�❑ I hereby affirm that 1 em licensed underderp provisions or chapter Y(commencing p
fZW with Section 7000)of Division 3 ofthe Business and ProfessionsCode,and my license is
°'am infull 1 REROOF -e.NI"�LE
Licen Class �,Lic.aY
Dale/—2S—O"� Contractor
!�p ARCHITECTS DEC uc DEC 082003
understand my plans shall M ablic reused pucords
>yU
e O Lirenscd Pmfcssianel
g OWNER BUILDER DECLARATION �ILDING
0 1 hcrchy affirm that 1 1. exempt from the Contractors Cm Liecnu Lew for the
4 2 O fallowing rcama(section 703 construe,
Business and r Professions demolish.or Any city m county
<m� which rcyuircs a permit no cnnsumC alley.improve,h prop 11 repair any structure
ii that he iucensedc,alwrcyoite.he thovisiosor for Contractors
mOense La cJ staumcm
gogn
EYCthommecingWitpSectiotloth)ofDivisionofthenuanessanecnuLaw(Chapter3 Sq.Ft. Floor Area Valuation
�t$ (est he
(Commencing With the
Division]due al Business and Profession Code)of
3 Dat he ie exempt therefrom and Ne bazis for the alleged exemption.Any violation of 35702010 . 00
Section 7031.5 by any app:icmt for a Permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not more Nan five hundred dollars(5500). p y yp
❑1,as mune,of the property,ar my employees with wag.as their sole compensazion,
will do the work.and theswaum iso at intended or offered far I.].(Sec.7Dbl,lusin.a _
and Prowsaions Coda:The Contractor's License law da.not apply to an owner of Required Inspections
pmpeny,who builds or unproven thereon,and who doessuch work himse:forlhrough his 307 - INSULATION .
own employees,prodded mat such improvcmenu arc not intended or offered retrials,If. 601 — ROOF. TEAR OFF
however,the building or improvement Is sold within one year of completion,the owner,
builder will have the burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
azle.). 603 ROOF BATTENS
❑hes owner of ct properly,,B exclusively and contacting Cid licensedCcrno¢mrs to
conswmthe
oes net apply.]Wq Businessandrt, h.buid,or
,.Contractor',Li 604 — ROOF IN-PROGRESS
ceoe Intr do.not apply m an owner of property who builds m improv.thereon,and,
whoLacu for such projects wire e
a can0mmu
r(s)licensed puent to the Comnctors
License
Law. -
❑I am exempt antler S.C. .B&P C for this rtazon .
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury,ane of the following declaratians:
1 have and will maintain a Cenifieam of Conant m el6lnaurt for Wortela Compere
lv/
an.o provided for by Section 3700 of the Labor Code,for me Performance of the
rk far which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,az required by Section _
W of the labor Code.for the performance of the work for which this Permit is issued.
Work/esr's Com natio 1�.�y��./p cart�Ipr and Policynumber am:
:.NWIest l I Y/R>•r l�Policy Nap ' k,7 Z/l7+Y)CERTIFICATE OF EXEM PTION FROMWORK RS'
COMPENSATION INSURANCE -
(Thu section need not he completed if the permit is farrow hundrtdmulars($100)
or teas.)
1 certify mal in the performance of The work for which His Permit is issued.:shall not
employ any person in any manneru as to become subject o the Worlan Compensation
Laws of California.Date
Applicant '
NOTICE TO APPLICANT.If.after making this Ccnirtcaw of Exemption,you should
become subject m the Worker's Compenmtion provisions of the Labor Code,you must
QO fanhwi lh comply with such previsions OF this Permit Shall he J)etned revoked.
Z"' CONSTRUCTION LENDING AGENCY "
ti
(•+ I hcrchy aBtrm Our there isoc (Set.nn leading agency In, perfurmencc of
ai ti He work Ire which this permit is issuedd(Sec.3037,Civ.Cd
W Q
Lamina Name
Q z
Lender's Address
V Q 1 cenify that 1 have read His application and saw that the share intmmauun is
{f. correct.I agree to comply with all city and county ordinances and state laws relaying to
0 building construction,and hereby authmirc mpreaematives of this city to enter upon the
>L
W ahovcmon iened properly for inspection purposes.r, t.4 (We)agree to save,indemnify end keep harmless the City of Cupertino against
:.y v) liabilities,judgments.costs and expenses which may in any way accrue against said City
of the grandflog of do
U 7 iAnPCPnu NT UNOERSTANDS As WILL COMPLY WITH ALL NON,7POINT Issued by: Date
7 SO RE
-5 Re-roofs Cl
Ig azure of Appteam/Contracor V Dau
HAZARDOUS MATERIALS OISCLOgURE`/ Type Of Roof
Will Heapplicamorfuturcbui:dingowcupantstomorh� ch us material
az defined by the Cupenim Municipal Code,Chaplet 9.12,and the H.Ith and Safety
Calc.S nion35532(.)? All roofs shall'be inspected prior to any roofing material being installed.
Ycs Na
Will the applicant or fur building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it harardous air contaminants as dcfmd by He Bay Area Air Quality Management all new materials for inspection.
iatric:?
❑Yea, Nu
Ih&SIM1 th)heaardnusm '5,2553and25un,1 u Chapter therif He Cilifan + �
hie Health ry Safety Code,Scctiun 255(15.35533 and 25534.1 unJerstmd thuirthe Milling O
vA�O, l it is my responsibility w uouty rbc oecul nr He
rcy
In
Of to issuance Ora CCMFICZw at Occupancy. gnatu a of Applicant Dale
'�3-U All roof coverings to be Class"B" or better
caner ar aDow
ot
1Community Development Department
Building Division��' City of Cupertino
g
10300 Torre Avenue
'CITYOF Telephone: (408)777-3228
Fax: (408)777-3333
CUPE�TiNO
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: Paul P o p e l k a
Job Site Address: 10353 Scenic Blvd . Cupertino
Roofing Company Name: Dan liott ' s Roofin Co .
A plicant'(s Si�g^nature: Date: 6/23/03
\SOW
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o 3 RTV 0 a o
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# �ry Date: 6/23/03
Building Address: �--� /v
� /3
Owner's Name: 103S3 So c i Phone#:
Mr . Paul _Popelka 408-253-2536
Contractor: Phone#: .License#:
Dsn Elliott ' s Roofing
Contact: Phone#: Cupertino Business License#:
Louise Elliott 408-559-7327
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof C[ Built-Up roof 1/12 500 sq f t .
❑ Asphalt Shingles IR Asphalt Shingles 4/12 1900 sq f t .
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) '
Number of existing coverings ❑ Provide I.C.B.O.Report#
EX To be Removed ❑ Provide Mfgr. Installation Specs.
1H ave Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: remove shakes and wood shingles remove 1/12/patio cover(hot
asphalt) install l 2" CDX install #30 f y
Residential ,� Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plan ' g De t. if
there are any restric s:
Cost of Project: Type of Constructions Occupancy group:
$8619 . 99 reroof
Qty. i
A 1' a Fee ED 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
Install torch-down @flat over #23 base , install Celotes Presidentials
22236