03030023 (2) CITY OF CUPERTINO yya*eVp`/^. �r'n - 'f
' BUILDING DIVISION PERMIT �CiTI2ACT�I2INFoxMATIoF,
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iBUILDINGADDRESS: KNIGHT ROOFING CO PERMITNO.
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OWNER'S NAME: 42035 OSGOOD RD PERMIT ISSUE DATE
MEI' CHANG
NE: - 5104389077 SANITARYNO. CONTROLN.O
ARCHIIECrABN01NEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
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300 LICENSED CONTRACTOR'S DECLARATION Job Description
eo'0 I hereby affirm that i am bounced under provisions of Chapter 9(Commencing
with Sation 7qp) for vidon5of tlm BudrRu� �r reWon Codc,end mylittnsem
A^�g Infullforeea de ' r 7 X794 REROOF
x ucenm aas "� 3 �I are.g
111--- oa T/O 'EXISTING ROOF, INSTALF:1027i-'9I1UGCOMP . 50
a .ARCHITELTSD
i; 1 undersand my plane shall be meed u roma public Rccds ,
Zoe LicensedProreadonal MAR 2 5 .2003
OWNER-BUILDER DECLARATION
<I I hereby arum that 11. exempt s m the Canine Co License law for the -
p o which ng ores a permit
IIo s5,Business and Profession Code:Any city or roomy BUILDING
$ which acquires a pcmB re cores the altar,Intfrow,.permit,m e a xis any e I BUILDING
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pdmfn its WusedpuruaRquihe applicant forme such Conpemi'ro Nora Law Assumenl
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that hertlinnsed pursuant tole or Division
of tite eBear mer adformer.(Cl Cods)or SCI.Ft.FloorArea Valuation
$ that he Is exempt Section)And of Divisions the
Al a ed exe and on.Any nCede)or
Nal k b exempt therefrom and de baste(m the NIcjW exemption.Any v1olNon of $14000 '
Section 7051.5 by arty applicant for a pemluubjecu the applicant m a civil penalty of APN Number Occupancy Type
net men than five hundred dollars($500).
37223008 . 00
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❑I,As want of the Property,or my employees with wages as their compensation,
will do the work and theswcture m not intended or onered for%is(Sac,7044,Basrses Required Inspections
and Professions Code:The Cenuactoe,Limon law does hot apply le an everter or - 305 — FRAME 9 P
property who but Ids or improves thereon,a ad who does each work himse if of mrough his
awn employees,provided that such Improvemenu are not Intended or aRrrW for sam.It, 307 — INSULATION -
however.she bullding or Improvement le held within am year of completion,the owner-
' builder will haw the burden ter proving that he dm not build or Improve mer purpose of 601 — 'ROOF TEAR OFF
")e')' 602 - ROOF PLYWOOD NAIL
❑1.as awoer of site properly,am exclusively contracting with Iiansed coneacmn m 603 — ROOF BATTENS
contract mtract the project(Sec.7014,Buinand Profession Code:)The Contractor's tr-
acelawdonnetapplytoanownerorpropertywhobundsor improve.thenar,and, 604 — ROOF IN—PROGRESS -
whocontracufor such projects with a contractor(s)licensed perswm to the Commune,
License Lew.
❑I am exempt under Sea. .B&P C far this mann - -
Owner Dam
137lMWORKERS COMPENSATION DECLARATION
I hereby eBim under penalty of perjury am of the following declualiorm --
Ihaw
eadwill maintain
aCenlOcamofConsent toselFlmomfor Worker's Comma.
i
en,u provided far by Seedon 5700 or the labor Code,far me pedomence of The
rk for which this permit is issued.
1 have and will maintain Worker,Compensation)nmmem,u required by Sudan
of me Labor Cade,for the perfaon ofdae wodcfer which this permit is Issued.
Work ompepaadan tmm�na reuse ryolicy num4r re:_.,P/ i (b--yA d No.:o�1�030o7.�.F1 1L le
CERTIFICATE OF '(E7.MDN FROM WORKERS'
COMPENSATION INSURANCE - -
mas Auction heed nm Mcompleted lr the Permit is foram huMRd dnlmn(5100) -
_�..._
I certify that In the performance of the work fm which this permit m lashed.I shall not ..
employ any pawn In any manmrso As to become subject to tis Werkcn'Compensation
Laws of Catifornla.Dam - -
Applicant
NOTICE TO APPLICANT:IL after making this Cenifrcam of Exemption,you should
Woman subject to the Worker's Comm sa0on provisions or dm Labor Code.you must
.Jz forthwith amply with such provision or this permit shall be deemed ranked. ,
zO CONSTRUCTION LENDING AGENCY •
[.a 1hereby.Irmo mat then is A eonmuctinn lending agency rot the pedomame or
fl.7
the work for which this permit H Wood(Sec.5097,Civ.C.)
0.Q Lender's c
.7 z Lender's AddAddress
U Q 1 anlfy that I hew nod this application and stem that the above Information I,
IL comm.1 Agra to comply with all city and county oNmstmes and sten law misting To
O V Wildingeonsuunion.andherebyauthorinrepremntallmofNucitytoenterupondm
W shove-mentioned property for inspection purposes.
(We)agree re an,indemnify and keep harmless the City of Calamine againf
ffA babillfaijudgmenls,emus andinimses which may in anyway amue against mid city
fJ 7 in conseguem,of the grating of this permit
F7 APPLICA` NDERSTANgs AL COMPLY WIT AL N� NT Issued by: Date
5 RCE ATIO
Re-roofs
sijnuurc o(Appi/Con Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building mcupant anon or handle havardous material
As defend by time Cupertino Municipal Code,Chapter 9.13,and the Health and Safety -
sae.seNe,zss5:(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea o
Will the applicant or rut building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
If haaardous dr conuninanu m defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yrs
I haw read the hvsrdous matends mouiiemenu umier Chapter 6.95 or de CAlifter. K 3z
'
nit Health&Safety adc,Sued.75505.15555 Arm 25534.1 undemand muff de buildi
tl�ummly ora1,171 riium Car,cmumnosily eau tot Nc
n9uiR nu won bo oris seance pfacrnifim3m ter eau gnature of App ate
Ownerm.athemad f p,m All roof coverings to be Class "B" or better
aw�07g
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
CFax: (408)777-3333
U PEkTINo
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.
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Homeowner's Name: V"'e t C 4 G.l
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Job Site Address: 1 Z � ) W e7y�7O�!/1
Roofing Company Name: ��' 41"I Roo9''I �o.
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plicanYs Signature: Date: 3 S�
Greg eel ,
Building Official
Revised 1/30/03 "
Printed on Recycled Paper