03060169 (2) CITY OF COPER'CINO � •� �w;: -, a.', +,r s � a;et•�`,y ''-
BUILDING DIVISION PERMIT
CON=TR'ACTOR�INFORMATIONN
UI
_ LISIN PATRICIA H AND ALE 5J9kND03060169
OW NER'S NAME: PERMIT ISSUE DATE
ONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+oo LICENSED CONTRACTOR'S DECLARATION Job Description
i 1 hereby affirm that 1 em licensed under provisions of Chapter 9(commencing
n< with Section 70f11Bof Diviaien3oftheBusinem.nd Professions Com,ndmylicenais
< is full force andeff=L REROOF
n.ZLicense Class Lk.N
p Dam Contractor
eeY^ry
ARCH ITECrSDECLARATION AUG 0 6 2003
eK I understand my plana shell ha used a public records
JyU
eo Licensed Professional -
9 OWNER-BUILDER r.annin f DECLARATION BUILDING
A 0 0 I hereby affirm that 11. exempt from tho Cnmmgm'a License Law for the
p O following..on.(Section construct.
Business and Professions Code:Any city Or county
3so which rcquires a pcmlit m cnmtruct eller,impmvc,demolish,or repair any structure
Z prior to its issuance.also requms,the applicant for such permit to file a signed statement
< that he is licensed pursuant to the provisions of the Connector's U=nseLAW(Chap¢r9 Sq.Ft. Floor Area Valuation
�$ (commencing with Section 7000)of Division 3 of the B usincss and Professions Code)or
.. that he la exempt therefrom end Ne basis for the alleged exemption.Any vOlmion of 35932051 . 0n
Section 7031.5 by any applicant for a penult subjects the applicant to a civil penalty of APN Number Occupancy Type
out mord than five hundred della,,(SSW).
IV.owner of the pmperry,m an,employees with wages as their sole mramnsatlan.
will do the work,and the structure is not intended or offered for sale(Sec.70".Business Required Inspections
and PmPoaiom Co ic:Th.Cmunaaft License law does not apply m an owner of q ns P
progeny who builds or improves themon,and who does such work himselfor through his 307 - INSULATION
own employ=.provided that web Improvements are not intended or offered for sale.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 Nat he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS .
...ttmm the projem(Sec.70as,Business and Professions Code:)The Contractor's Li. 604 — ROOF IN-PROGRESS
came law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractors)licensed pursuant to the Conwctofs
Licence law.
O l am axxemin under Sec ,B&PC for this rcazon
Owne,X Data
X_ WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury one of the following declerations:
I have and will maintain a Cenifeate of Consent m al6lmure for worker's Comport.
inion,as provided for by Section 3700 of the L W,Code,for use performace of to
work for which this permit is issued.
❑1 have and will maintain Worines Compensation Insurance,as required by Section
3700 of the Labor Code,for Ne performance of the work for which this permit is issued.
My Worker's Compensation Insurance moor and Policy number are:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not he mapplelW if the permit It for one hundred dollars($100)
or has)
1 cenify that in the perfmmance,of the amA for which this permit is issued.I shell not
employ any person in any manner so as to become subject to the Workeri Compmaatlon
Laweof Calmix.
Applies. r
NOTICE O APPLICANT:IL alter making this Cenificele of Exemption,you should
become subject 10 the Wolam'a COMWasatku previsions of the Labor Code,you most
•Q O foMwith comply with such proviainm or this permit be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
Cli E 4 I hereby affirm that then is comlmminn lending agency for the perfurmahm of
> the work for which this permit Is issued(Sec.3M.Co.C.)
Uj Q Lender's N.
a z Lender's Address
V Q I certify that I have mad this application and sum that the above information is `
IL (~ correct.1 agree to comply with all city and county ordinances and stale laws misting to
Q V building construction,and hereby stalactite ocirmsentatives of this cayur enter upon the
r {1l above-mentioned property,for inspection purposes
C (We)agree to ave.indemnify and keep harmless the City of Cupertino gains)
rF—rW liabilities,judgmenu,ms and espartos which may in any wayaccrue again.and City
U Z in consequence of the grand ng of this pc,mit.
r—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEGULATIONS.
Re-roofs
namrc of ApPlicaHAZAR OUtor Data r f
HAZARDOUS MATERIALS DISCLOSURE Type of Roof J S
Will the applicant or
future Wilding occupant store or handle hamdeus mmeriai
as defined by the Cupertino Municipal Code.Chapmr 9.11,and the Health and Safety
.We, r r.Is53x°? All roofs shall be inspected prior to an roofing material bei.
❑Yes P P Y g g installed.
Will the applicant dr future bnothns Occupant as equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
It hazardous air contaminants a doMcd by the Bay Area Air Quality Management all new materials for inspection.
triol? /
DYo, 2TJu {
Ih&Sact the ,mN6 25505,, 533rementau.1u Chapmr iffthe Wilding
nixs cmth&Smmy Code.Secdom ort it I myoand2ibiliy.hour tthmif thelmildina
dive n91 curtenlly have a senent Nal it u my responsibility m ntatify the acupat of the
requirements which�mug be met prim to issmnm or a ceni0ms or occupancy. Signature of Applicant Date
w rOrrmuhhmaedog,.i Dam All roof coverings to be Class nB"or better
Community Development Department
</ Building Division
City of Cupertino
�.{ s
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
4UPEkTINO 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 allinspection
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:
A pllcant's Signature: Date:
\�t/oSlJl1DC�
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
}
CITY OF CUPERTINO o ��
REROOF
CUPER INO PERMIT APPLICATION FORM
APN# O Date:
Building Address:
7_S'_Yo Ti/'roE Gnc
Owner's ame: one#: a _fit o 6
Gf,tw Ue'�' Gts/nom
Contractor: Phone#: License#:
Contact: G<S //X Phone#:69 f O E Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) �P 4
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 D sorption:
sed Amo m k pccry p-e
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: 15
Cost of Project: l�e� Type of Construction: Occupancy group:
Qty. if
Applical3l Fee ID Fee Description Fee Group
I 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