03070064 ' CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFQRMATIQN
BU ILDING ADDRESS: IIALEYS ROOFING PERMITNO03070064
OWNER'S NAME: 4718 MERIDIAN AV PERMfr ISSUE DATE
JNE: - , (408) 281-0281 SANITARY NO. CONTROL N0,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUME MECH
0 0 o t�
IOp LICENSED CONTRACTOR'S DECLARATION Job Description
£�V 1 hereby affirm that I am licensed under,provisions of Chapter 9(commencing p
with Scmion](g10)nf DivlsionJof NC BusinFq and Pru(essinmC Jc andmyliecnacis
inroBm ser /V REROOF
Datanef" Lie
C F O
Data Cum
h to RCHITECI'S DECLARATION
;-U u 1 understand my plans shall he used u public records
gLictmsed Professional
. JUL 1 5 2003
` OWNER-BUILDER DECLARATION �'q p'�1g'�
<f I hereby affirm that 1 am exempt from the Contractor's License Law for the �U'L✓l1y�I
COO following¢mon.(Secdan 713 1.5,Business and Profession,Code:Any city or county
$ which requires a permit in casual alter,imprnw,demolish,nr repair any structure
iy prior in its issuance,also requires the applicant far such permilm Gle.,lgned statement
Y < that he islicenxdpursuant tothe pmvisionsnfthe Comrnaur'sLicense Law(Chapter 9 Sq. Ft. Floor Area Valuation
FC (commencing with Section 7")of Division 3 of the Business and PmWxions Code)or
y that he Is exempt dtemfrom and the basis for the alleged exemption.Any violation of 36910038 . 00
Section]031.5 by any applicant for a Permit subjects the applicant to a civil penally of APN Number Occupancy Type
not mom than five hundred doll..($500). ,
D I.as owner or Ne pmpeny,or my employee with wages as their.ole compensation,
will do the walk,and the structure is not Intended to offered f...I.(Sec.]wa.Business 3 b — FRAMReg ired Inspections
and Professions Code:The Contractor's Limineoes law dnot apply to m owner of 3 O 7 — I NSULAT 1-OaN p
progeny who builds or improves thereon,and who daessucte work himself or Nmugh his
awn employes,provided that uch improvements we not intended mediated for sale.If. 601 — ROOF TEAR OFF
however,Ne building or improvement is sold within sum Year or completion.the owner.
builder will have the Widen of proving that he did not build or improve for pumpers,of 602 — ROOF PLYWOOD NAIL
rete')' 603 — ROOF BATTENS
❑has owner of ct progeny,,Business s and contracting Code:)
Ccoactor.to
eonswnthe pmjenpplyman,wnorprodnywhoomds oriproe&Comon.Li 604 — ROOF IN-PROGRESS
exam oawdts porn such
apply tomoitha ondra y licensed
ldsorimpro the Neeson and,
who castrato for each projects with a contremor(q liccn,ed punuem to the ContrutoYe
Licence law.
❑ 1 em exempt under Sec. ,B A P C fonhis wsson '
Owner Data
WORKER'S COMPENS;UION DECLARATION
1 1 hereby affum under penally of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insum for Worker's Compen.
mlion,as provided for by Section 37M of the labor Code,for the performance of the
work for which this permit is issued.
D I have and will maintain Workeis Compensation Insurance,as required by Schon
37M of the Labor Cade.for the pantomime of Ne work for which this permit is issued
My Workee,Cnmpenmhon Insurance carrier and Policy number art:
Carrier. Policy _
CERTIFICATEOF E%EMImON OMWDRKERS'
COMPENSATION INSURANCE
(This section need not hccompleted Box,permit is forom hundred dnRars($100)
Ices.)
I certify that in the performance or the work for which this permit is Wood,I shah not
employ any
.an in any menrfp�so aass,u)h,Ecume subjecua the Workers'Compensation
Laws of Celifur alai;I F.x^,;
LaPli of �//'f
NOTICE TO APPLICANT:If, cr making this Certificate of Exemption,you should
become object to the Worker's om,.ti.D provision,of the LOW,end..you must
0 z forthwith comply with such provision,or this permilshall he deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-. I barely,affirm NU them is a cclauvctinn leading agency lot the Performance of
7 Ne work fur which this permit is issued(Sec.309L Civ.C.) r _\
1 Landefa Name
0. Z Lendeh Address
CJ 0 1 Certify Nal 1 have read this application and sate that the.bow infmmwim is
U. (, correct.l agree to comply with all city and county ordinances and sure law.mating to
O V building construction,and hereby authorim representatives of this city to enter upon the
FTt above-mentioned pmperty for inspection purposes.
(We)some to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,casts and expenses which may in anyway accrue against mid City
V z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by:iz 9 Date /74,
SO RCE REGULATIONS.
/Jh X "7'O? Re-roofs
Signwln1!.lot[m,fiCmu0Cemu r Data
HAZAR
Type of Roof
Will the applicant or future building mc.inal Dore ser handle havardon,maa i.1
u def ncd by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Court.EiYet zss3z(,)T All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant tato equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
dl hara mas air contaminants as defined by the Bay Arta Air Quality Management all new materials for inspection.
I
Dyes(have reed the huvardaus maarialsreyuimmenu under Chapter h.95 ofthe Calif.I emadthehoannmaterCandilily nndlythaoccupantofNquircmcntswhmh the Irriortnissumeeofa meofoccu.acy. Signature ofAp cant Date J
��
wncrm aulhari'ra gent �Q„c All roof coverings to be Class "Bt' or better
Community Development Department
Building Division
t+ M City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
*UPEkTINO 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 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: U6L1 136,G(/)(V\ '^
Job Site Address:
Roofing Company Name:
Applicant's Signature: Date:
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
OREROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 0,_% Date: O
Bui/AA3d 7 ss-LA
Ow N L Phone#:
-O-7S3
Con ctor: Phonep License#:
ZS,
Contact: , Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
)a` Built-Up Roof yiL Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ 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 Descri on:
Residential Ccfmmercial
Fire Zone: Yes ❑ No ) Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of ProjectorI O0T . Type of Construct Occupancy group:
Qty. if
Applic;I1'A 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
2 J
2 7
"� 7 7. 5-0