03040024 CITY OF CUPERTINO ° ' �#
BUILDING DIVISION PERMIT ;C� �TaRTNk'OIt1VIA.TION
Ll
DI G DDPERMIT NO.
a161EMPIRE AV R E ROOFING & CONSTRUCTIO INC 03040024
R' PERMIT ISSUE DATE
�MT WOLFF 15230 CLYDELLE AVENUE 04/03/2003
E:
(408) 925-9995 SANITARY NO. CONTROL NO.
HITF.CIrENGINEER: - BUILDINGPERMITINIG,
BLDG ELECT PLUMB MECH
0 0 0 0
mooC LICENSED CONTRACIOR'SDECLARATION JobDescri tion
u 1 hereby affirm that I xm licensed under provisions Of Chapter 9(mmanowing p
W with Sceuon 7000)of Dividon Sof NC Business eM puesutiou Co ,and my license'
+ y in full fortx andeRecl.yY �, �2'l54
;ga tie=nIycgy C REROOF
Dem 0 ARCIU CTSDECCninililor T REMOVE- EXISTING 1 ALYER, INSTALL NEW 1/2 " CDX
understand my plans N.0 we mDg 30# ASTM FELT & 30YR. ASPASCOMP .
>gu
1 Licensed Professional
S OWNER-BUILDER DECLARATION /sJ P�IALI
i1 hereby aiTOm Net 1 em exempt from the Cordoulm's License Law for[be
p o following mason.(S iion 4131.5.Busleess and Predications Code:Any city Or County
w which requires A permit to Conswct.Alun,impmvc,demolish.or¢pair any Moslem
prior N its issuenca.alm mquimstwepplieanl forsuch Permit to file a signed statement
i othat heIslicensed Mordant tothe protlsmnsnrthe cOnlmator'eldccrvseLaw(Chapter 9 Sq.Ft. Floor Area Valuation
m $ (commencing with Section 7000)of Division 3 of the Business and Profcuions Code)or
.. Net w'exempt therefrom and the basis for lie alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant 10 A civil penalty of APN Number Q u p�Y�I e
not mart Nan five hundred dollars($3011). �b�4 S Type
❑1,As vvnv of the properly,or my cmployco with wages As their role eampenssti.n.
will do One wank,and the structure la not Intended or offered for sale 7061.Business
end Professions Code:The Convactor',License Law does not apply to an owner of 3 2 6 2 4 0 4 9 . 0 0 Required Inspections
properly who builds or improsu Ihercon,and who dues such work hi muf f or i luough hta
owncmployeu,provided improvement suchUsemwithin not intended of oroObmd for ssuif.
hownemacror.ft oyces.dingordansuh improvements
mpr old vementar One yev of completing Ne ownv- 305 _ fi'RAML.'
wnda will here she burden of proving that ha did not wad or improse for purpme of 307 - INSULATION
sam .
❑1.As Owner of to property.am uclusively convecting with licensed eommec nes to 601 - ROOF TEAR OFF
construct Ne pmjen(Sec.70",Business and Profaslons Cade:)The,Contswur.Li- 602 — ROOF PLYWOOD NAIL
am Law does not apply m an owner of property who wilds or ImproaTJ Neuron
.and Nd
bow contrasts for such pmjeeu who.contra=mr(a)licensed pnew ntmNe ConvAmoYa 603 — ROOFBATTENS <
0
1Am Law.
Ism exempt undo Sm. .Bk PCfor this resort 604 - ROOF IN-PROGRESS
Ownat Dam
WORKERS COMPENSATION DECLARATION
1 hereby 911.under pushy of perjury was of the refusing declard orrc
have end will maintan•Cenlfiwte of Consent to tiff-moue for WorkafaCompen-
ZoIpmvided for by Section 3700 of the Labor Code,fur the performance of the
or which Nis permit is issued.
anave d will maintain Worker's Comnsss repcadon Insurance, quired by Section
f the Labor Code.for she performance of the work for which Nis permit is issued.
4 Caniv;rkeh Co.,.u�nlgsurantt wrri Policy No.:nu bene¢: 04 G
TIE 1 LATE WMONFROMWORKERS' a4`}—
COMPENSATION INSURANCE
(Ih'uctlon wed nothecomplekd If the Icrmit'foronc hundred dollars($100)
or lata)
1 certify that in the performance of the work for which this permit is is recd.I shall not
employ any Person Many mannerso As in become subject to the Workers Compensation
Laws u
of California.Da
Applican,
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject Ip the Worker's Compensation previsions of she Ichor Code,you must
.JO forthwith Comply with such provisions or this permitahall w dcemcd revoked.
z ^ CONSTRUCTION LENDING AGENCY
[-+> iherchyaRtm Nn them its construction lending Agency for the perfotmana of
C the work for which N'permit is issued(Sec.3097,Civ.C.)
B]A Lenders Name
Iz Lender.Address
u Q 1 certify Nat 1 have mad this application and sure that the Above information'
!L mwtt 1 agree 10 Comply with all city and county Ordinances and stile laws relating to
Cf> building construction.end hereby suborive mpmsenuusu of Nit city m COW upon me
�"rA shore-menuOnW prof est for Inspection, ns purposes
gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
h fiabitinto sa.juacofthec�ming expeoaMAY in MY wayemsk igaisw said City
f,z A APPLICANT
of the getting of this parent. �^
^ APPLICANT UANOS AND WILL COMPLY WITH ALL NON-POINT Issued by:S Date
SOURCE REGULATIONS.
Re-roofs
Signature of ApplieanUConvaetor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne Applicant or future building occupant store orhandle haxa dous mauriai
As @fined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code ection❑Yes 25572(x)7
gf-N. All roofs shall be inspected prior to any roofing material being installed.
dvll: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
.Ou air contaminenu u/rico d by the Bey Area Air Quality Management all new materials for inspection.
❑Yet u
have`0 Ne haraNDus maurials myviroments under Chepur A.95 of Ne Califon-
nieHul cry"Codc.Svtiors 25505.25533 and 25536.1 undmsund thatartP
aura not cu o lyhasnp¢nen,,that It is my roMensihility to nutty the axupent M Ne
requimmc wlid��ysal��y_\'lleIpoorto-Nesamm� ceNfiamoy�cuPenex, Signature3fApplicant Date
\<_ C o
Owner err euNonand epcnl i rye All roof coverings to be Class"B°or better
Community Development Department
Building Division
j City of Cupertino
10300 Torre Avenue
� I CITY OF Telephone: (408) 777-3228
C U P S kT]p ' Fax: (408) 777-3333
O
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: ��` tc� VV6 L (-f
Job Site Address: I I 0 I G P Q{
Roofing Company Name: 00I- t!J(� s C(j1� z,�( ,u� I 4j L .
~
A4plict's Signature. - Date:Gl
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
C REROOF v 3 ,:>
CITY OF
-UPEI�TINO PERMIT APPLICATION FORM
APN# � — 1 — 11 G Date:
Building Address:
0 G Ave, VOLT, til
Owner's Name: II I A /
SAW V�JOL I Phone#:q0&- 25q —
Contractor: Phone#: /I q License #:
40
Contact: Phone#: Cupertino Business
icense#:
��➢� e ��ttC 1, U�-`�2s-��`lh
2-0 l�7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �Asphalt Shingles
Wood Shakes ` ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings l ❑ Provide I.C.B.O.Report#
o be Removed ❑ Provide Mfgr.Installation Specs.
ave Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
ob Description:
SCM �XISTiti� ( �q^1eK, INS n( N(etiJ 112 CD X1 3-0-0 A;TM
ResidentialfYtT CEJ I �'
Commercial ❑
Fire Zone: Y o ❑ Confirmed with Planning De t. if
there are an restri ns:
Cost of oject: Type ofCozr st ctioT Occupancy gr p
Qty. if
A i- 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