03060154 (2) CITY OF CUPERTINO r r �, a , .'
BUILDING DIVISION PERMIT CONTRACTOR=INFORMATION
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EU ILDING ADDRESS: _ WOODS ROOFING PERMIT No 03060154
ING RID
a OWNER'S NAME: r 2179 STONE AVENUE STE 22 PERMIT ISSUE DATE
DNe: (831) 637-5576 SANITARY NO. CONTROL NO.
ARCHIIELT/ENGINCER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
I00 LICENSED CONRACIOR'S DECLARATIONJob Description
m 1 booby off om Nat I Bm licensed under provis on.(Chapter 9(commencing
{)m
fU with Section 7000)of Division 3 of NC Business and professions Code,and my license Is �r g�?p�
ja_ Liens, And err t. 2 T/O SHAKES AND W/SHINGLES FONA�" :0
Date Cl a LM.X� —
e Date / c°^'rooter ADD DECRA STEEL TILE
ARCHITECT'S DECLARATIO L O O p v1doo9
�6< I understand my plans shall W used as public records JUT_
e C� Liccnscd Pmfcni^nal
OWNER-BUILDER DECLARATION BUILDING
<i I hereby affirm Nat I am exempt from Contractor's Li
e Contractor's Law for the
Q0 following mason.(Section 7031.5,Business and Professions Code:Any city or county
5$ which rcyuima a Permit to em oomt,alter,Improve,demolish,nr repair any..tore
iy prior m its issuance.also restsins she applicant for such Permit to file A signed statement
C that he is licenxdpursuant to the previsions ofthe C^ntmemr'sLicense Law(Chapter 9 Sq. Ft. Floor Area ValuQ,5tp1p000-
(commencing with Section 7NM)of Division 3 of the Business and Pmfesdo C.Jc)or
Nat be is exempt Nemfrom and the, N
basis for e alleged exemption.Any viohtion of
Section 7071.5 by any applicant for a permit subjects he applicant to A civil Penalty Of 3a2N20616erO0 Occupancy Type
A.,mom Nan five hundred dollen(5500).
❑Lu.wncr of Ne propcny.car my employcu wish waguutheinole compensa0on,
will do Ne work,and Newman Isom intended or offered for sale(See 70,14,B.sina& Required Inspections
lf
and ProfAa,iona Cade:The C.Onnscmr's License Law does nm apply to an net of 305 - FRAME q p
property who builds or improves thereon,and who does such work himxor through his
own employees,provided Nat such improvements Art not intended or offend for Ile.If, 307 - INSULATION
however,to 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 propose of 601 - ROOF TEAR OFF
01, 602 - ROOF PLYWOOD NAIL
1,a owner of to SO,.7property.,B exclusively contracting wish:)The
eCcnnbeclrs sec
construct project(See.7W4,Business and Profusion Code:)llm Contractors Li. 603 - ROOF BATTENS
ccnu law docs not apply x an owner of property who builds or impress,themnn.and, 604 — ROOF IN-PROGRESS
who contracts for such projects with a eomnnor(s)licensed pursuant 0 the CrnlOel.ra
License law.
❑1 am exempt under Sec. .B&P C for this rcawn
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby anion under penalty of perjury one of the following declaration: -
I have and will maintain s Cwfficata of Cement m self-inure for WOdei s Compere
Aid,As provided for by Section 37011 of Ne labor Code.for the performance of the
work for which Nis Permit is issued.
I have and will maintain Worker's Compares n Insurance,u respired by Section
3700 of the Lather Code,for the performance of the work for which his Pamir is issued,
M WorkchC eplionl nnc exaser and Polio number AR:
M mien. sf-G. Policy NoY —d3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(fhH semimr need n^t nc complcmd ifine pcmN is f^ranc hundred dmlas(giro)
less.)
1 comfy Nn in the performance of the work for which his permit is Issued.I shall nos
employ any torten in any manner an As;or become subjecuo the Wurken'Compensation r
Laws of Califomia.Date -
Applicant .
NOTICE TO APPLICANT:If.After making Nis Certificate of Exemption.you should
become subject to the Worker's Compcoution provisions of the labor Code.you must
.J z forthwith comply wish such provisions or Nis Permit shall N deemed revoked.
z CONSTRUCTION LENDING AGENCY
rN-r Ihemh affirm Nat here is a constroetion lending agency for the
(~ Y g Qc y perfurmancc of
Ci > Ne wad for which this permit is funded(gee.3097,Civ.CJ
If3 Q Lender's Name
D z Lender's Address
V C) I certify thm I have mad this application and state that to above information is ,
gL (~ correct.1 agree to comply with all city and county ordinances and&rate laws mlating to
V building construction,and hereby euthorire representatives Of this city to color upon he
r [t7 abovrmenti.ned properly foriupelon purpwses.
d (We)agree to save,indemnify and keep harmless the City of Cupertino against
N liabilities,judgments,costs and expenses which may In anyway accmc against said Ctry,
U z in mmxqucn<c.f the bog of this Pcrmi
APPLICANT UN TANDS- COMP WITFiALL NOPOINT Issued by: Date
SOURCER GU ONS.' f /-
G/iA�
3 Re-roofs
Signuurc of Ap Am..VC..hocmr I Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant.,fuwre building wcupanl nose or Irandle Mrardous material
as,de0ned by the Cupertino Municipal Code.Chapter 9.11.And the Health and Safety
Cod,Ie LionYes 15531(a)? �_ All roofs shall be inspected prior to any roofing material being installed.
❑
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
Is bu.ni Air c.nmmin.ma As deMcd by the Be,Ana Air Gushy Management
is dc'? all new materials for inspection.
❑Yes
Ihave mad the havaN.0 25505. 5533requiri¢nts it 5534,1 ndconard.95Of Ne Wilding
itisHno,CurSAfcry Cabe,Seeuou 155 it 25577.'red 4.lundouly Nuifhc Wilding
d^unomouswtly ,rcnen4 etil' cepof end CA puf Occ reap of Nc
rcyuimmcnuw asst ri uancc of cru cal fOccuPi Signature of Applicant Date
41�/
Owner or so norizcd stem 7DmO All roof coverings to be Class "$° Of boiler
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY�F' Telephone: (408)777-3228
*UPEkTINO Fax: (408)777-3333
Building Department
i
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:
Job Site Address:
Roofing Company Name,
l
A plicant s Signature: J Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
i REROOF
CUciao
EI�TINO PERMIT APPLICATION FORM
APN # 2 Z O Date:
� � L (.
Building Addres�//�
Owner's N7 , � � Phone#s 3 Vr-3 —/3 Y 9
Contract f Pho #: License#-
I I
s :roy a- o�()3 X325 /3 /
Contact: Phone#: / Cupertino Business License#:
;;,0F/0
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) )i Other(Specify) �c�A
7tuber of existing coverings z– ❑ Provide I.C.B.O.Report# 3
7o be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job De ription-
/� CLa.
Residential 7PC mmercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: IJ
Cost of Project: Type of Construction: Occupancy group:
I� 00V
Qty. if
Applicable 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
2 225
1
108 . 1 0