03070127 (2) a z.
CITY OF CUPERTINO «* +t«
BUILDING DIVISION PERMIT a CONTRACT®R INF ,RMATI 0N' '
RUILDINGADDRESS: LOUIS AND REPARRETTI INC PERMIT NO 03070127
AME' ICERGY GT 2964 C SOQUEL AVE /16,12 PERMIT ISSUE DATE
ONE:. SANITARY 0. CONTROL N0.
(831) 477-7270
ARCHITECT/ENGINBER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
y00 LICENSED CONTRACTOR'S DECLARATION Job DCSCTIpIlO�aV 9s� A
u C 1 bunchy affirm In.,1 am licensed undcs NrAsions of Chapter 9(commencing g(9rV y�. p
^j N! with 5ee1.07 Buf Dwiaion3of Ne Businuse�f Nor c�` Iv.Code,andmylicenseis aus
q� iIsimpnraRunm rc L . r006i a REROOF AUG G Z ZOOS
z= Date - Cun ar
RCHITE SDF ADON
�i 1 under s y n h II used a public recur BUILDING
G Literati Prof sionel
BUILDING
OWNER-BUILDER pErho ATION
.�0I 1 tachy.(firm the 1 1. cusin Bum de Comns Co Liccnu Law for the
O o following rearm.(Sudan 711715,Business and ova,Professions Code:Any city s worry
X m which myuims a permit m cnnzlmd elteq improve,demolish.nr repair any structure
Don
,Zof prior In its issuance.also requires the applicant for such permit to file a signed statement
m that he is licensed pursuant to the previsions of the Contractors LiunuLaw(Chapter 9 Sq. FL Floor Area Valuation
1-$ (commencing with Section 7")or Division 3 of the Business and Professions Code)or
Nat he is exempt thcmfrom and the bais for the alleged esemption.Any Aclnino of
Section 7031.5 by ary applicant for a permit subjects the applicant to.civil penalty of APN Number Occupancy e
not mon them five hundred dollars(S500).
P Y�YP
❑1,a owner of the property,or my employees with wages u their sole compensation,
will do the wad.end deawcmn is not intended ser offend formic(Sm.7044.Business 30,5 - FRAME Re aired Inspections
and Pmfncsions Code:The Conmmors Limom law does not apply to.n owner of p
property who builds or improma thenen,and whodusauch work himelfor through his 307 - INSULAT ON
own employees,provided that wch improvements au not intended or offend for sale.If. 6O1 — ROOF TEAR OFF
however,de building or imprommem is mid within one yea of completion,the Owner-
_ builder will have de burden of proving that be did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
ale,). 603 - ROOF BATTENS
❑1.us owner of project
property,emexclusivelyBusiness
nd contracting with licensed ntraanon m
constructaLm,des..apply Loan OOurofs andn, he
Code:)The Contractor's Li- 604 - ROOF IN-PROGRESS
cense Isw docs not apply ecu owner of property who sed p or improve thenen,and
whocontractsLa for such projects with aconmmortq licensed punuemmthe Contractor's
License Isw.
Lm exempt under See. .B h P C to, name
Owner Date
10500WORKER'S COMPENSATION DECLARATION
1 hereby.farm under Penalty of perjury one of tite following declarnions:
1 have and will maintain a Certificate of Consent a ulFinsure for Woderi Camper.
.f
ber,m provided for by Section 3700 or the Labor Code,for de performance of the
rk for which Nis Permit is issued.
1 have end will maintain Workers Compensation Iosunnu,u required by Section
do lAbor otic,for de performance of k for which this permit is issued.
yWorker' naaJinn lnsunntteenicnnd cy numhcnnter: Policy No.:
CERTIFICATE OFEK MITIONFROM WO KER 'COMPENSATION INSURANCE
(Thu section need not W compieud ifthe permit is for one hundred dollen(Slip)
star
1 certify duet in de performance of the work for which this Permit is issued,l shell not
employ,any Person in any manner to as in become ubjeel to the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
become subject to the Worker a Com pubo tiro provisions of the Labor Code,you must
.JO forthwith comply with such provisions or this Permit shall he counted mvoked.
'� " CONSTRUCTION LENDING AGENCY
� I hereby affirm dal dere is comuctinn lending spot,(or the perfurrumm of
the work(a,which this permit is iaued(Scc.3097,Civ.C.)
ls1 Q Lender's Name
= z Lender's Address
U Q 1 certify that I have reed this application and state that the above information is
Ig,U correct I agree to comply with all city and county ouinancea and sum sews relating e
'0 V buildingconstruction,iooand hereby emhonp rposesemetivea of dais city to tour upon the
rW shove-(We)are properly for ndtm inspection keep hs.
(we)agree m um,indemnify and keep ha in
the City of Cup:nine against
H h liebilitim,judgmenu, sat and caresses which may in any way¢trot against aid City
C)^ APPLICAeNTe th SnuNOS sNorrit. 63
ND WILL COMPLY WITH ALL NON- DINT Issued by: Date
SOURCE R L 9
Re-roofs
Ignewrc ofApplicant/Ccontractor Il
HAZARDOUS MATERI LS DISCLOSURE eta Type of Roof
Will the applicant or future building occupant some or handle hamudous material
as dcOned by he Cupenino Municipal Code,Charter 9.12,and the Heath and Safety
Calc.SccdeYea t 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Nu
Will the applicant. faun building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit ha ardous air contaminants a defined by the Bay Area Air Quality Management all new mat r als for inspection.
Diorict7
❑Yea p]Na
Ihavcrad de doraNtmsmamrislsrequimmenm under Chapter 695 of the Caliun / l
ria Heal d B:SuclyCode,Sections 35505,25537 and 75534,1 understand that if the building l(/n v
does mol currently hem.mN(It that It is my nspmmlhlllly to mldfy Ibe occupant f do
rcyuircmcnB which most,
Mmm Pnonnissumce of CcniOcate of upµeg SI nature of Applicant Date
Owne,or ar1h.n rad Open( Dau All roof coverings to be Class'B" or better
Community Development Department
Building Division
5w
City of Cupertino
` 10300 Torre Avenue
CITY Of Telephone: (408)777-3228
Fax: (408)777-3333
�UPEI�TINO
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: RL
n rVr�� �- ..
Job Site Address: t� v pl
n LT
Roofing Company Name:
l
A plicant's Signature: Date: 7,f6 ,6
Greg teal
Building Official
Revised 1/30/03
Printed an Recycled Paper
I
CITY OF CUPERTINO D 3 7 2
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# r I Date: 14
Building Address:
Owner's Name: Ot�\ f P�to(AAsn�e �6 _ /
Contractor: } 2 Phone#: (Liicense#:
c,:S (ZC. (83(-
Contact'., ` Pho e#: Cupertino Business License#:
�f2 H ���
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )Ef,Asphalt Shingles
,E�, 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:, I \
Residential Commercial ❑
Fire Zone: Yes El No ( Confirmed with Planning D
there are anrestriction .
Cost of Pro76; Tyne of struct' n: ccu ncy group:
Qty.
A 1' 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
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