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
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