03070144 CITY OF CUPERTINO sw'xr �w✓ •m nx M- � ,rt
BUILDING DIVISION PERMITICtONTRACTOMNF,�ORMMA ION,10,
-
BU ILDINGADDRESS: CASTO ROOFING PERMITNG03070144
E •S ME: 1938 OLD MIDDLEFIELD .WAY PERMIT ISSUE DATE
ONE: (650) 961-8922 SANITARY 0. CONTROL NO.
ARCHITECM,NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
X00 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm Nal 1 am licetued under provinces of Chapter 9(commencing p
i with Section 7")or Division 3 of the Business!34 Profmdons Code,and my license is ��(1❑�a
in full force and ctte Cj ❑lJ4
qz LlccnscClms_ - I Lie.N �' REROOF �
�� DeIC
C C'oSnEC LARATION
I understand my plans shall he ueda public records Hc PC.Ir
2003
D
u.t; Licensed Pnrfcssional .
1123 OWNER-BUILDER DECLARATION ��g1 f;�e��
A M 1 berehy effort that I em exempt from the Contractors LiceLI)I
License Law for the I
i mo following reuon.(Section 103 1.5,Business and Profession Code:Any city or county
- which mquiro a permit to cress ,slur,improve,demnleh.or repair any somelurc 3 1200
FZy frown its issuance.also requires the applicant for such Permit to file a signed statement
< tlmheislicensed pursuammthe provisions oflWComment's Lcenselaw(Chapter 9 Sq. Ft. Floor Area Valuation
gdi (commencing with Section 70110)of Division 3 of the Business and Professions Cogla)ur
IE 3 that he Is exempt Nemfrom sod the bub,for Ne tllegW exemption.Any Anledon of
Section 7031.5 by any applicant for a perch subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500).
❑I,Is owner of the property,or my employees with wages in their was compenadon,
will do the work.and the structure is not intended at offered rotten(Sec.7044,Business ns 305 - FRAME Required inspections
and Profeaion
Code:The Contractor's License dao Law rant apply to an owner of q p
property who Wilds or Improves;thereon,and who doeuuch work himselfar through his 307 - INSULATION
own employee,provided that such Improvements am not intended orofleeI for ak.If. 6O1 - ROOF TEAR OFF
however,Ne Wilding m improvement is sold within one year of completion.On owoor
builder will have the thrdcn of proving that he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
am.). 603 - ROOF BATTENS
❑1,a owner of the property,am exclusively innaconlawdng Cid:)The Ceohvaeun t.
seem La doene s
to an
andrty who Wionslds
Code:)The Comencon,Li. 604 — ROOF IN—PROGRESS
whom Law chs not apply je ts owner of properly who seIlls or improves thereon,and
whocontractsLaces for such projects with a emm�cmr(Q licensed pursuant m On Conu¢Nr's
01License Law.
Q lam exempt under Seo .Bit PCfor this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 thereby affmn under penally of perjury on:of the following helunlon:
I have and will maintain a CW Guu of Consent to selhinsum fm Workers Cumpcm
adon,as provided for by Section 3700 of the labor Code,for the perfmmanT of the
work for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code,for the performance of Ne work for which this permit is issued.
My Wmqlox,'ss�C,�n,m''ppppc�nss`qq`'��o��n''I�tro,,,n��cecsnivand Policy, mM��r3yam^:f �l
Cassier'.`t(g,�sS_�gmyy_Polity No_'�1s`<Y y'Q
CERTIFICATE OF L�KEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(This sections reed not be completed If the Permit is form=hundred dollars(SIM)
or Ica)
I certify Nat in On performance of Ne work for which this permit Is issued,I Ndl not
employ any person in any manner an Is to become subject to the Worker)Compenadon
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Cer iOeam of Exemption,you should
Mcome auhj.t m the Wodm'a CamPenatino provisions of the Leber Code,you most
.JQ forthwith comply with such provisions or this permit shall 4 deemed invoice.
yCONSTRUCTION LENDING AGENCY
14
F+ 1 hereby affirm that there is a con ruction lending agency for the performance of
lYi> the work for which Nin permit is issued(Sec.31197,Civ.C.)
6Wi Q Iander's Name
z Lender's Address
V C) I ceeify Na I have read this appliciern and state Net the a Wvc infom aiun is
n.P Worol.l agree to comply with all city and county ordinances and sore laws relating to
p V building construction,and hereby authoom representatives of this city to enter upon the
above-mentioned properly for inspection purposes.
W (We)agree to save,indemnify and keep harmless the City of Cupertino againsl
ver fn lull:flu,judgments,colo end expenses which may in any way occmc against all I
in V^
APPLICANT UNDERSTANDS of the granting Of t
UNDERSTANDSANhis D`WILL COMPLY WITH ALL NOWPO:NT Issued by: to 7 7�Q
SO CE REGU4ATIONSs
Re-roofs
Signature of AppliesniXontracmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant score or handle hoomme material
as defined by the Cupertino Municipal Code.Charter 9.12,and the Health and Safety
Cone.section 25532(.)7
Dyes �Nu 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
dl hazardous air contuminnIs m d rijncd by the Bay Area Air Quality Management all new materials for inspection.
❑Yes
I haw mad the baardous materials mquir menu under Chapter 6.95 of the Califon
nu Heal"SafetyCodc.Sections 25515.25533 and 25534.1 undcrnand the true building
does not currently have a tenant,that it is my rupmuihility to nOufy be occupant of the
require nu which must be cry poor m issuance of a cerifuau of Occu ancy, Signature of Applicant Date
l/T ( I A 4 Mme_ �—�T-C� All roof coverings to be Class"B" or better
Ow er tar authodred agent Date
Community Development Department
Building Division
r: City of Cupertino
10300 Torre Avenue _
Telephone: (406)777-3228
C OF Fax: (406)7T1.3333
4UPEkTINO
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 obtauted 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 Y4" 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: i410 �&a u-61
Job Site Address: �I D S aCl/>^ Cir Casto Roofing, Inc.
938 "IUM ddlefield Way
Mountain View, CA 94043-2503
Roofing Company Name:
(650) 961-8922
A licard Signature (i(� Date:
7-1-7—o3
Greg
Building Official
Revised 1/30/03
CITY OF CUPERTINO v 3 , 7
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date: , 3
Building Address:
Owner's Name: /'1/ )
Con 1938 Old Middlefield Way Phone#: U�7#. 23
Contact InInin Phone M. Cupertino Business License#:
65 �� E52-i-1
Type of Roof Covering:
Proposed:
o Built-Up Roof o Built-Up roof
E) Asphalt Sbingles o Asphalt Stec
A wood shaker '�
Wood Shakes
C1 wood Shingles O wood Shingles
a Other(Specify) O Other(Specify)
Number of existing coverings Ir o Provide LC.B.O.Report#
To be Removed a Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply with Cu o's Tear Off Policy.
Job Description: C n"I 1 IS , r � to/ �ai
� `
Residential t3 Commercial ❑
Fire Zone: Yes (I No ❑ Confirmed with P if
re
there aanyr!stM ns-
Cost of Pro' Type of Occupancygro
113c7 )
Qty. if
Applig" Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Ftxs BUILDING
BENERGY Enew BURDING
BSiEIMUCRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business license BURRING
49-�l 79. 2- 0