03090197 CITY OF CUPER'rINO
�t BUILDING DIVISION PERMIT i CONTRACTOR,INFORMATION
Bu1LDINGADDRESS: KEITH ROOFING CO INC PERMITN003090197
t
WNER'S NAME: 920 LINCOLN AVE PERMIT ISSUE DATE
HENRY 09/24/2003
NE: (408) 295-8616 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i O D LICENSED CONTRACTOR'S p DECLARATION
I U 1 hereby affirm that 1 am licensed under provisions of Chapter Y(commencing Job Description
wiNll"r o n7(N10)of DivisionJoftM BusinnuM Profeuiom Code.and mylianx is �'N s ��
n L License REROOF T•- pBI�qLED
i Liana class Lic.N
Dam Contractor y b
1q-.',�` ARCHITECTS DECLARATION oV I
F @ U 1 undersand my plans shall W used as public records 1NgT
so Licensesio
Licensed Profesnal 3,200�ay�
3
1
OWNER-BUILDER DECLARATION
2 2 1 hereby affirm that 1 am exempt from the Contractor's License Law for the �Y��■ �tr tw1�
O0 (allowing mmatch.(Section 703 1.5,Business and Professions Conic:Any city m county YYY M
<m which requires a permit m construe],alar,improve,demo .'B .■lish,nr repair any structure � O O O
uZY prior o its issuance.also requires the applicant for such permit to Ble a signed statement
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that he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area' Valuation(commencing wi th Section 7000)of Division 3 of the B usincas and Professions Code)or 31631030 . 00
that he is exempt therefrom and be basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for s permit subjects the applicant to a civil penalty of APN NUmber. .. . -.. _ OGGn anC T e
not more than Eve hundred della.($500). - - - P y yp - -
❑Lo the work,the Property,ter myempleycm orNwagaz as (SM.
044,8 sins, '
will do Newark.ands: he Cmuisnotintendedors.do Torula(Sec.7oim wninua g��
FRAME—
slid Professions builds
The improves
m0 Um.Law does not apply lf an owner of 3 07 - INSUT.." w Inspections
property who builds or impmvcs Nercon,and who does such work himself or through his
own cal loyces.provided thatsuch improvements are nminlended mdRered forule.If, 601 — ROOF TEAR OFF -
however,the building or improvement is sold within one yea of completion,Ne owner-
builder will have the burden of proving that he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
le')' 603 - ROOF BATTENS
❑1.as owner of project
property,.Business,ssad contracting with licensed adulators to -
com.Lawcroult ue.jm(Sec.a.scoamrorprop Profmaiemorwo,mve,Tha onecar'a Li- 604 — ROOF IN-PROGRESS .
arae Law docs not apply to ts owmr,of properry who Wild.p or ant to the Comma sod
who contracts for such projects with a comnnm(p licensed pursuant m the Cone¢tors
License Taw.
❑ tato eaempt under Sec. ,B&PC for this..an
weer Dam
WORKER'S COMPENSATION DECLARATION _
I hereby anion under partially of perjury one of the following deelarationa:
1 have and will maintain a Certificate of Content to scif-asum for Worker's Compere
ion,as provided for by Section 3700 of Ne Labor Code,for Ne performance of the
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work for which this permit is issued.
ve and will maintain Workers Compensation Insurance,u required by Section
"D of NC labor Code,for the performance of Ne work for which this permit is issued.
My Workcf�s'(rbym�.It�n�tio sunntt Tier and Policy a -
Clorma, Jfn 1 taf Policy No.: ��/
CERTIFICAPf]ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed fire permit Is furonc hundred della.(5100)
,it leas.)
I certify that in But perfommec of the work for which this permit is issued.I shall not
employ any perm in any manner sa u to Wcome subject to the Workers Compensation '
Laws of Califnmia.Data
Applicant
NOTICE TO APPLICANT:lI after making this Ceniacam of Exemption,you shoo to
become subject to the Worker's Com pematinn provisions of the labor Code,you must
D O forthwith comply with such provisions or this permit shall W deemed revoked.
Z .�~.. CONSTRUCTION LENDING AGENCY
I hereby affirm Nat Nem is a emutructinn lending agency for the performance of
la Nc work for which this permit is issued Sec.3097,Civ.C.)
't]Q Lendcrs Name
z Lenders Address
J 0 1 terrify Nnt I have read this application and sate that Ne above ofotmniun is
Fcorrect.I agree to comply with all city and county ordinances and sale laws misting to
0U building construction,and lately authuribe reps ruentatiwof data city to enter upon Nc
Ualmvomeminned property for impaction purposes.
(Wc)a w,indemnify and keep harmless the City Of Cupenind.agaiml
h liabilities' me olividexp=meswhich may in any way.cane agaimtuid City
;J z in c quarte Nc granting of��J��JhMMMhhnnnsss perm'
LICA UNOERSTND L PLY WITH ALL N NPO Issued by: Date
SOUR
ED,
I. 1
Re-roofs
Slgi%yftc IicaHAZARamdr, De
HAZARDOUS TERIALS DISCLOSURE Type of Roof
Will Ne applicant ser future building aecupanumre nr handle hazardous material
as deOned by the Cupenino Munipi 1 Code.Chapter 9.I2,and Ne Health and Safety
Alifipala. 1i5Jz(a)7 /No— All roofs shall be inspected prior to an roofing material beim
❑Yea p P Y g g installed.
wn the applicant dr metre building Occupant are equipment or dcvfom which If a roof is install d Without first obtaining an inspection,I agree to remove.
it hazardous air contaminants as defined by the Day Area Air Quality Management all n", r3 for inspection.
7
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I have arNms materials requirements under Chapter 6.95of Ne Caiifor.
Bin HcalN afe disc,Sections 25505,25533 am125534.1 undersand NUI if Ne Wilding
duct cu y have s tem Nat b is my tespmui lility m noufy IM upset of the
m rem hichmust atom issuanccof ' cam c ancy' S' aur Applicant Date
net r oro=d ase• ora= roof coverings to be Class "B"or better
Community Development Department
Building Division
t � City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E kT I N O 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 com ly with the above stated policy on re-roofing.
Homeowner's Name: V✓ ,
Job Site Address:
Roofing Company Name: t , W
A plicant's Signa e: 1r711 Date:
Greg eel
Building Official
Revised 1/30/03
Pdn(ed an Recycled Paper
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CITY OF CUPERTINO
` REROOF 7
CUPER ANO PERMIT APPLICATION FO
APN# / � � D
Building Address: 3
1
Owner's Name: Phone#:
C� ,4 —_ 6,S3G
Phone#: License#:
Contractor:
�
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles -OL-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 Des c in�tiqn:
u ` / 1 p �114 '6S& jr
✓
Residential Commerci ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plannin t. if
there are anrest ons:
Cost of Project /^ Typ Cons cC Occupancy g p:
Uu KJ /
Qty f
A is 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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