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03060106 CITY OF CUPERTINO , ' + BUILDING DIVISION PERMIT �ONTRA OR IN,�'ORMAT10 MSxT BUILDINGADDRESS: R E ROOFING & CONSTRUCTIO PYD03060106 OWNER'S NAME: 15230 CLYDELLE AVENUE "T'eg' 16/2003 )NE: (408) 925-9995 SANITARY NO. CONTROL NO. ARCHITEC MNGINEER: BUILDINO PERMITINFO BLDG ELECT PLUMB MECH :oo LICENSED CONTRACTOR'S DECLARATION 1 barony affirm Nat 1 sm de licensed unr provisions of Chapmf 9(rommorcing Job Description �i wiNSecdan 7000)af D' fNe Busineuang cfWans�_ d licevei+ < in full force end effay�'py�q -l/Z V � ? Lkenm Cl s "� Lk.N REROOF ARENT Con Dic-or PAz`. 1 underss d y plans Nall used s taw PRIMA 5� u4, LiccnscdPndcuionel 2��3 yp OWNER-BUILDERexemptnn the JUN 2 `N I I hcrcby affirm that 1 am exempt Gose Ne Conuattor's License Law for IM -a o following mason.(Section 7031.5,Business and Pro Icstions Code:Any city or mumy $ra` which roquirta•permit m construct,ober.Mprove.demallsh,Or roped,any structure -Z� prior in its issuance.also requires the applicant for such Permit m file uigned ammonia g G that MI,licensedp anent m the provisions of use Contractor's 1-mm.Lew(Chapmr9 Sq.Ft.Floor Area lOn yxC$ (commencing with Section 7000)of Division Star LM Business and Professions Code)or Q 3.• that he is exempt therefrom and the buts for the alleged exemption.Any violadon of Settlor 7031.5 by sty applicant for a permit subjects the applicant to a civil penalty of 3 AFN M&l1er 0 0 Occupancy Type not more than foe hundred dollars((500). D 1.as .of Die property,or my employes with wage u astir Bole compenadon, will do Ne work and the suuctum isnot Intention]orolfertd for We(Sec.7041,Business and Frofesions Cods:Tbe Conuamora License Law data Out apply m an owner of Re uired Inspections propeny who milds m impmses Marmon,and who does such wart himself or through his 307 - INSULATION awn employes,provided that such Improvements sm nal intended or offered for sale If. 601 — ROOF TEAR OFF however,the building or improvement is mid within au year of completion,Ne owner. builder will have the burden of proving that M did not build or Improve for purpose of 602 - ROOF PLYWOOD NAIL "k')' 603 - ROOF BATTENS D 1,as owner of Ne property,am exclusively conducting wit licensed contractor In coutmct the project(Sec.7W,Bmineu and Professions Cade:)The Contractors U. 604 — ROOF IN-PROGRESS cause law docs not apply man owner of property who builds or Improves themon,ad. who warrants for such projects,with a eonvanar(s)licensed pursuant m Me Convector's ' License Law. D l am umap,under See .B k P C for this mason Owner Date Am WORKERS COMPENSATION DECLARATION 1 hereby affirm under pushy of perjury are of the following declarations: 1 have and will maintain eCenlOnte of Consent m self-lea re for Workers Compcm sslon,as provide!for by Section 3700 or the Labor Cade.for the performance of fee work for which this permit ds issued. D 1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the LOMCode,fm the performance of the workfar which Miis permit is issue. My Wmker'a Campesuatian lnsu`nAn/cr artdm end Policy n be use: Can, m: M l+/' pollry No.: V CERTIFICATE OF •J EMITION FROM WORKERS' COMPENSATION INSURANCE mils sccdon need trot kcamplowd If the pmmh is fm onchundred Mllua(SIM) or loss.) I certify that in the performance of the work for which this permR is Issued,l shall not employ any person in any manner an as m become subject o the Workers'Componaatlon' Laws of C.Ifomia.Data Appli.L NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become subject to Ne Worker's Compensation provisions of tM Labor Code,you mus foMwith comply with such provisions or this Permit shall k decmeA rooked. z O CONSfBUCnON LENDING AGENCY I therebMr.rebMr.Nattkrt,sacanstmctinn lending agmuy for the per(ormaOcc of . re > the work for which this permit Is Issued(Sec.3097,Civ.C.) YQ Lender's Ns m Z) z Lenderi Address; J Q I certify that 1 have need this application and sum that the above information is L F cocoa I agree to comply with all city and county oNlneneas and sum Is.mlatleg to V G buildingconumctiogsudbemby euNodm . utivtaof this city mcnmupon m awe- ed far inspection purposes (We)age to a",indemnify ena keep l hasmku Ne City of Cupcnino agaiust ~fI1 li c 1.1i.1es Judgmenu.cosuud expoispe which may in anyway accrue against coil City J mcaa( bting of this permit. W APPLIC a .� IDS WILL COMPLY WITH LL NON-POINT Issued by: Dat SOU CE R Re-roofs Sign llIicanUCa�or s -"HAZARDOUS MATERIALS DISCI OSUREType of Roof Will the applicant or future building eccuPanumrc or Mnd n huardous material as,defined by de Cupertino Mu ,pal Code.Chapter 9.12.and the Halt and Safety W e.Section 25532(e)? All roofs shall be inspected prior to any roofing material being installed. ❑yta Nu Will Um appl,cut r(us,wilding occupant use equipment or&vim which If a roof is installed without first obtaining an inspection,I agree to remove It harsitlnm air contuninanu foci by IM Bay Ama Air Quality M+na tat al w materials for inspection. trin7 Dy. Iheve mad Ne basardlnsmamr,nlsmquimmenuundcr Chapmr6.95ofthc Califon Htu N:SafciyCo ,Sccdom25M5,25533a U534.lundem dNuif Ncwilding a tap all a tenant,N my osporuihility m nofy the Occupant oftw- uircmc me n m anceoraCcull M t. Signature of Applicant Date Owner oraulhm em Date All roof coverings to be Class "B"or better Community Development Department Building Division L 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: �. /d ti N A Job Site Address: U LUU< W U U 9 R Roofing Com Name: �vLT(- t s ST t I A plica t'sSignatur i Date: Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper • CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN# -3q 2 — I q _ 09 q Date: Building Address: I !).310 LOtC WOOQ _IL. Owner's Name: < II / Phone#: �o M 46ma U8- 2C) 3 — b Contractor F4�� Plaone#: L jt)�- .915. License#: —72- -7591 Contact: Phone#: cl2,5_ Cupertino Business License#: iU+t_ clel a Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt ShinglesAsphalt 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 Description:'FOKOV10 w06V S-)�KKet Tj v z' C D K i 3.O iKT -P lt/k-t $ 1 N Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning,pept. if there are an restri i6ns-llJJ Cost of Pr t: G�j ` ype of ConstruE6� Occupancy grou „3 Qty. Appl'c 1 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 l S�