03060020 (2) CITY OF CUPERTINO �n •-
BUILDING DIVISION PERMIT �., R[�. QR I1t7RMA"CTQ, ,
au TIDING ADDRESS: TERRY BROWN, GEN CONTRACTO ERMITN"03060020
10491 SCENIC BLVD
WHER'S NAME: 14510 BIG BASIN WY . r Pm TITWfT3/2003
SRRY BROWN
NE: (408) 868-1640 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO -
HIM ELECT PLUMB MECH
A O p LICENSED CONTRACTORS DECLARATION lob Description
u I hereby"an Wet I am Ilecnsed under provisions of Chapter 9(commencing p
^¢ with Section 7")of Division 3 of the Business And Profassiuns Code,and my license is<�� infull roroeand Affect. RE-ROOF HOUSE AND COTTAGE FINAL
Licenu Clus Lk.Y
z ■ A O
sl Dam
ARCHITECTSTS DECLARATION DECLARATION
�� lundcrstand my plans shallMusetlueuhlic mcnrN JAN 1 3 2004
�6
3 G Licensed Pro(casional
OWNER-BUILDER DECLARATION
1 hereby maso affirm that 11. exempt from the Contractor's License Lew for the BUILDING
p O following mason.(Section 7 construct,
Business and ars.demolish,
Coda:Any tiny or roomy
$ which rcquima a email m construct.alter.improve,demolish,nr mesh any structure
poor roits censed%aim nt Wthe ma,applicanto for such Permi'to rile aiecase Law
(Chmmem
that he licensedpursuanttotheprovisionofthe be
ndProfLaw(C Code)or Sq.Ft. Floor Area $6'Qt@f�[lon
As C (commencing with Section]fp0)of Divasian7of nhc Businmaand Profcuiona COM)ur
$ deet he is emmpt Rundown and We baso for We alleged exemption.Any violation of
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of
non mart Wan Ove hundred dollars(M). a Occupancy Type
❑1,as owner of the properly,or my emplayees wide wages As thenmle compensation,
will do the work.and We structure is nut intended ormffmad potato(Sec.7014,Business
and Fatim , Code:The Connector's License Law cones Wn4I apply to an owner of 3 0 7 - INSULA� ed Inspections
property who builds or improves thereon,and who does such work himself or through his
own employee,provided that such improvements us not intended or offered for sale.It, 601 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the owner. 602 — ROOF PLYWOOD NAIL
builder will have the burden of proving but he did not hldld at improve for purpose of
tele.). 603 - ROOF BATTENS
❑I,an owner of the property,am exclusively contracting with licensed tonnetan to 604 - ROOF IN-PROGRESS
construct the project(Sec.7014,Business and Professions Code:)The Camractor's Li.
cense Law docs not apply to an owner of property who builds or improves thereon,and.
who moment for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am Amman under a See 'ek PC fo t a tion
wner9///�// �(J� Data 3 d
ER'S OMPENSATION DECLARATION
I hereby&Man under penalty of perjury ow of tin following declarations:
I have and will maintain a Cenifncmc orCmomm to self-insure far WmkelaCompen-
senion,u provided far by SeNan 3700 of the labor Code,far We Pat....of dee
work for which this permit is issued.
E31 have and will maintain WorkInsurance,As Walker's Compensation Insura , tequited by Section
3700 of We Labor Code,for We performance of We work far which this permit is Issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section need not he completed if dee pearl is Parana hundred dollars($101)
or Icer.)
I certify that in We perfomtenco of dee work for which this permit is issued,I shall not
employ any person in any manner an As to become subject to tie Workers'Compensation
Law s of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Esempnionn,you should
become subject to the Worker's Compensation previsions of the Lebo Cod%you must
�O forthwith comply with such previsions or this Permit shall he deemed mvnkad.
D5 CONSTRUCnON LENDING AGENCY
"rr Ihereby aim that these is a construction lending agency far the performance of
the wuA fur which thin permit Is issued(See.3097,Civ,C.)
W� lender's Name
z Lender's Addmm
U 0 1 terrify that 1 have read this applicmian And stem that the above h4commun is
I, F correct.I agree to comply with all city and county ordinances and atsm laws mhting to
O U building construction,and hereby authodae represtnmtims of this city to enter upon the
W ahovumenuuned property for inspecuan purposes.
g� (We)agree to save,indemnify and keep harmless dee City of Cupertino against
Vj liabilities,Judgments,casts and expenses which may in any way acme against said City
[„)4 in consequence of We granting of this permit.
�r APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL NO POINT Issued by: Date
SOU CATIONS./ 6' s.3
Re-roofs
Signature of ApplicanuComeactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy t applicant or future building e,Chapter
smrc or handle Health
material
As defined by du Cupertino iciest Code,Chepmr 9.12,and the Health and Safely
ode,Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
❑Y.
If a roof is installed without first obtaining an inspection,I
Will the applicant or future building Occupant sax equipment or devices which g agree to remove p
cmh huvardam all contaminants As defined by the Bay Area Air Quality Managcmenn all new materials for inspection.
District?
❑Yes 1'1a'Ay� /` /p
Ihaw&Safeneed Code,She kocsmamsialsmquimmcnts under Chapter6.95tha if the Glding '/ Iry ?/d3 s
ria HealthLtacSafctyhe.A aunt, owns myram18334.I understand theifthe building I
docs no rely hero a anent.down is my responsibility to testify dee occupant of the
myalkm hich must's poor to issumm ofa CeniRcau oj,Qquff�cy./
(el /70/0 Signature of Applicant Date
Owner or Authorized agent Data All roof coverings to be Class"B"or better
rCommunity Development Department
Building Division
City of Cupertino
• �s{ 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
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) ht-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: ✓D /et—c
Job Site Address: Lir-( f C-
L
Roofing Company Name: 77f20 ✓�
Apli
cant's sSignature: ��/// / Date:
Greg t
eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
top
CITY OF CUPERTINO 3
REROOF
• CUPER INO PERMIT APPLICATION FORM
APN# Date:
357 - 06 - 001 �—Z/G o
Building Address:
Ceic-
Owner's Name: Phone#:
2ovjd I`� �tctcSc
Contractor Ph ne#: License#:
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existir►g: Proved:
Built-Up Roof Built-Up roof
❑ Asphalt Shingles ❑ 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:
O 0 jC CD
Residenfial Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there . restrictions: i5
Cost of Project: Type of Construction: �- Oc pancy r up:
o -Lip (Z0
F
Qty. if
A le 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
�0-3
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