03080104 (2) CITY OF CUPERTINO. Vis, Rc*�� -✓ +' '� ^°=t` '" = �'
BUILDING DIVISIONPER MIT CONTRACTOR INFORMATION
BUILDING ADDRESS: SIGNATURE ROOFING INC
PERMIT"03080104
OWNER'S NAME: - SSS O 'NEILL AVE, #16 , PERMIT ISSUE DATE
Alk WRIGHT WHITELAW AND BARBARA 14
NE: _ (800) 644-7410 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
(� O
±o0 LICENSED CONTRACTOR'S DECLARATION
1 C I by airlinemm
that 1 am licensed under previsions of Chapter 9(commencing Job Description
her
2;toU with n.Section70(10)of OivisionJ dtc Businoa end Pro c. myylicd is A,a
in full ferment!cffec a @ylJ 1"1`m C71
i Llano Class Lie.• �o o REROOF
F p DamContractor
1 "I ARC111TECI'Sbe DECLAR I SFP 2 2��3
V 1 understand my plans shall used as public,Gere,s
'05; Licensed Professional
OWNER BUILDER DECLARATION BUILDING
<� 1 hereby affirm
that 1 am exempt from the Contractors License Law for the
�OO following,catch.(Section 7(131,5,Business and Professions Crede:Any city or county
which requires a Profit to construct,alter,improve,dcmolish,nr repair any structurelinno
320 prier to its l4Uance,also requires the applicant for such Permit tO file a signed'umment
< thathcislicensed nauseam unthe pmvisimmofthe ContmnursLicense Low(Chapter Y Sq. Ft. Floor Area Valuation
rj 0 (commencing with Section 7000)of Division J or the Business and Professions Core)or
tis, $ Nat he Is exempt bcrefrom and the basis for the alleged exemption.Any violation of 32637012 . 00
Section 7071.5 by any applicant for a permit subjects be applicant 10 A civil penalty Of APN Number Occupancy Type
not mom man five hundred dollars(ML
El I,as owner of the property,or my employees with wages As their sole compensation.
will do the work,and me structure is not intended of offered for sale(Sec.7044,Business
and Professions Code:The Commitment',License Law duets not Apply to an owner of Required Inspections
propenywhh builds or imprhvv thereon.and whodoessuch work himself or brought his 307 - INSULATION
.we emplhyces,p,Ovided,h.r such improvements..not intended moffered or sale.If. 601 — ROOF TEAR OFF
however,me building or improvement is sold within one year of completion,me owner.
' builder will have the burden of proving mat he did not Wild or improve for purpose of 602 - ROOF PLYWOOD. NAIL
sal`')' 603 - ROOF BATTENS
❑1,as Owner of be progeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Connectors Li. 604 — ROOF IN-PROGRESS
ecve Law does not apply to an owner of property who Wilds or improvesthemon,and,
who contracts for such projects with a conrector(s)licensed pursuam to one Character's
License Low.
❑ I am exempt under Sec. .B At P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby afEtat under penalty of perjury one of the following dnlarationst
1 have and will maintain a CertiMsa of Consent o self-insure for Worker's Cumpem
..tion,As provided far by Section 37M of me labor Code.for be performance of the
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3707of the LAW,Code,for the performance of the work for which this home it is issued.
M Worker' roe/pkm^satio ce eerier and Polio n/ymsb�ar/a�rt: /��s
Catrin: r ^I / 2 Policy N.,Y�ts1
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissectitm need not be completed If the permit a fnrane hundred cellars(5100)
M mss.)
I ccnify Out in the per4emanec of the work for which bis permit is issued.I shall nut
employ any person in any manner an As to become subject to be Workers'Com,emation
Lows of California.Date
Applicata
NOTICE TO APPLICANT:If,after making this Certificate Of Exemption,you should
become subject to the Worker Compensation previsions of the Leber Code,you must
JO berthwi to comply with such previsions or this Permit shall be decmcd hawked.
ZCONSTRUCTION LENDING AGENCY
^
t.+ I mmby affirm that there is a construction lending agency foster Performance of
a M me work for which this permit is issued(sec.3097,Ci¢C.)
{al Q Lender's Name
z Lenders Add.
U O 1 cenify met 1 have read bis application and sum that the above information is
w'P correct.l agree to comply with all city end county(entireness and state Iowa relating to
C U building construction,and hereby authorize ropremmatives of this city to enter upon da
} above-motioned propeny(or inspection purposes.
H (We)agree to save.indemnify and kap harmless the City of Cupertino dismal
z liabilities,judgments,costs and expenses which may in any way accrue against said City
U in consequence of the grants ng of this permit.
'-" APPLICA UNDE STAN ND WILL COMPLY WITH LL NO -POINT Issued by: Date
SOURC GULA Ns. �
Re-roofs
igmt c ApplicanoConractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
be applicant m Bothe building occupant care or handle M Arduus nu anal
ex dcOnce by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
C, seetmn nsu(')7 All roofs shall be inspected prior to an roofing material being installed.
❑Yea P P Y g g
I Will the applicant Or
(uwrc Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haeardoua air conmormants a defined by the Bay Arca Air Quality Management all new materials for Inspection.
nrict7
❑Yes
IhavedmtNaos,S.o.nm25505.2553 imme5534.1crdhm.h.95Ofmc Wilding v
nits Hcalm& mWCode,Saccus35505,smqui mcnuun uChapwrJthmifthebuilding s(✓(�!/L
dam nm cutremly haw a anent m t it my respensihibly m andl'y t occupan of me
requirements ihmuv meth r issuance of aCcstificam upancy. Ig IApplicant Date a
net or th rixed agent ate All roof coverings [o be Class "B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
� CITY OF Telephone: (408)777-3228
UPERTkING 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: t3A 7-
job Site Address: 1032f 5-1v ry x Gr 4'1e
Roofing Company Name: � ) �1 ✓t a 7 u r, P °u ' i `� 7->fiG
A phcanYs Signature: C � Date: zo�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
wo REROOF
CUPEkTINO PERMIT APPLICATION FORM
AIN # . 3 2 3 7 O ( 2 Date: (5 _ 3
Building Address:
ro 3ZS S �oN olale DrCt of Tti �
Owis Name: Phone#:
nXors Wr % tiT . 3,ob-23z -�t��3
Contractor: Phne#: License#:
SIG,VATUAE /�udGii�6 c .0 65J - SX9r 5—}/ K �O f Q
Co act: // Phone#: Cupertino Business License#:
60 C ge(Wek• ,5- V-5���
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )e 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: pp mitis /� f // CQ ��
V lCPmu✓e Shote, r� :
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: �U Type of Construction: Occupancy group:
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