03050026 (2) CITY OF CUPERTINO '�`
BUILDING DIVISION PERMITCON�7CRAC7TUR YNF'ORIVIATTON '
vM,fzf+.a*s„x t*.4' # $u,tPr
auILDING ADDRESS: ECONOMY ROOFING PERMIT N903050026
OWNER'S NAME: 2988 NEAL AVE . PERMIT U7/ V7/2003
-CHU CHID NG WEN
NE: (408) 615-7200 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ua6 LICENSEDCONTRACTOR'S DECLARATION Job Description
�r 1 Wreby se Nat 1 am littmed under provisions of Chepmr 9(commcndn{ -
lit 0; with Section 70011)of Division 3aftW Bupnd(eyd Profculoru Code,and my lyse is
Hinfulla 1 on crfµ -1[ 2 !! REROOF (F���pl �[�®
License C Lk.M
nt- m Contruto
ARCNITEC,S EC ATION
¢ 1 undersand my plans shall be used puhlic records MAY 15 2003
38t; Licensed Professional
OWNER-BUILDER DECLARATION
F 1 hereby Amrm Ne,1 Am escort from the Conlraners Lear.Law for the BUILDING 1'1L.D'lkl�
EGO fallowing reason, Section IM 1.5,Business and Pmfessiem Cade:Any city or county 4/ NV
S which requires a permit to construct.altar.Improve,dcmo;M.or repair Any structure
F Z y prior to its issuance.else requires the applicant for such penmft to rite a signed summer,
< that he is licensed pursuant lr the provisims of the Conuactors Liana LAw(Clapter 9 Sq.Ft. Floor Area $r) tlOn
reFp (commencing with Section 713M)of Division 3 of the Busimss and Professinm CoM)or
my $ that be 0 exempt therefrom and dm buss for the alleged exemption.Any=of
Sectian 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of 36422aillibberO 0 Occupancy Type
not oort than live bandied dollar(5500).
❑1,u owner of W property,in my employees with wage As their sale compensation,
will do Ne work and the Raicrvre is not intended ora@red for salc(Sec.IDM,BusiM•• — kp�p�pyllTed Inspections
And Ptolicum.Cade:7be Comsactors License law dean an,apply m An owner,of 307 — INSULA 1 1 V 1V
property who builds or improves titanium.and who dma such work hfmulf or through his
own employees,provided that such improvements Arenot[memod orolfaraeforsala¢ 601 — ROOF TEAR OFF
however,the Wilding or improvement is sold within am year ofcompletion,the owner.
Wilder will haw Lie Wrden of proving last M did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale')' 603 - ROOF BATTENS
01,as owner of the property,am exclusively coruacting with Resound cantnmonu 604 - ROOF IN-PROGRESS
construct the project(Sec.7014,Earliness and Professions Code:)The Contractors Li-
anse law doe not apply m an owner of property who Wilda or Imp om thereon,and,
who contracts fm such projects with a com acher(s)Hanmd pursuant to the Contraaora
Like.Law.
❑I am exempt underSea. .B&P C err rete neuen
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby stand under penally of perjury am of the following dmlantiona:
I have and will maintain a Certifiam of Comcm usslf-iuum fm Wmko2Compcn-
737Mir,hcLa1mrC.m,
tim.u provided for by Section 3700 of the labor Code.fur the performance of the
rk for which Nis permit is issued.
I have and will maintain Workers Compensation Wurama,u required by Seeder
fa the perfarmana of the wv far whichNispermit4iumA.
yWarkeraCompeuadon luunme artier end Pol numberim:
roler S.* F,..weo Pol .: J1/7-,'OO
CEKDFICATE OF EXEMPTION FROM WORKERS'
14 COMPENSATION INSURANCE
(This section need ret he completed if be M mit Is foram hundraddollan(SIM)
or less)
1 certify Net in the perfor,mcc of the work for which this perati,Is issued.I shell oat
employ any person many mane,sn As to become subject to dm W.Acif Compeuatlen
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker's Cnmpenution provisions of Ne labor Came,you mut
.J z foMwiN comply with such previsirm or this permit hall be dccmM revalued.
zO CONSTRUCTION LENDING AGENCY
[-i I hemby amen mat there its conomcdan lending agme,for the Performance of
pt;
5: the work for which this permit Is issued(Sec.3097,Cie Q
WE lenders Name,
] z Landers Address
V O I certify that 1 have mad this Application and sum that the aWw Informative Is /v/^•
0 U bonding I a{ree to comply with all city reit county ordinates of and sum lawn mining a —
V abovengcononed ton,andhemby authorizepl representatives of this city menmrupon the V
W alcove-mentioned ptopeny for inspection purposes.
gy
(We)agree to cove,indemnify and tech May
in An the City of Me Against Wit
(n I.c.maegmagmenuecamAnd apeueswhtch may In any way varve against laid City
V,'� A APPLICANT
NDERSTANJISr,of A permit.
APPLICANT UNOERSTA AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO R REGUL
S Re-roofs
ign re of App ieuUConuulor De -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupanutore or handle huarJou material
defined by the Cupertino Municipal Cade.CMpter 9.12.and the Health and Safety
Cade.Section 255320)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes 0 N
W01 the applicant or future Wilding ecapenl on equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conaminanu ss defied by the Bay Area Air Quality Management all new materials for insp ction.
Diatrict7
❑tics ❑Nu
Ihave mad t the Wcoedouamaterials 5505, 5533amc 5534.1under Chapter6.95L if the Califon \ �, /� /�
dies arclth SafetyCodeWasSectitmsha50S 2myrand 25534.I le,
Ihe al if the,building r/ G/
Jas mol curten0y he }}anent.that h is my responsibility mroupent of me
re
5ich
ftbemet priortoiuumca ole Cenfficain of rsoc. Pature Of (cant Date
war ameri,.eaasenl „e All roof coverings to be Class "B”or better
CITY OF CUPERTINO v3 oS-�
(01TVREROOF
CUPEkTINO PERMIT APPLICATION FORM
APN #
ZDate:— s� 7 /d 3
Building Address: 1151
Owner's Name: _ C G
Contractor: dz
Pho
Ecot/� z Z icens #:
,vam ' � ,
0 3
Contact: Phone#: Cupertino Business License#:
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)
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:
✓. �j(65
20xrr p No
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed wit ning Dept. if
there are restricts tis: ❑
Cost of roject: Type of Construction: ^A Occup cy group.
Qty. if
A lic e 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
Community Development Department
Building Division
r ; lad'=1 City of Cupertino
.."'-
..:. 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C U P S kT 1 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 poli c on re-roof'
Homeowner's Name: �}.
Job Site Address:
Roofing Company Name: A ->r H Wg
AlA plicant's Signature: ' Date: ��03
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper