03070145 (2) CITY OIs'CUPERTINO <<- � :-
BUILDING DIVISION PERMIT I4COWIRA"C�k,IN,O` RMATION:,;
BUII.DI"cADDRFss: CASTO ROOFING PFFRMIT"x03070145
l
' OWNER' NAME: 1935 OLD MIDDLEFIELD .WAY PERMIT ISSUE DATE
L ONE: (650) 961-8922 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
Bj.DG ELECT PLUMB MECH
X00
LICENSED CONTRACTOR'S DECLARATION JobDeSdR Q(P IIT0
U I hereby affirm that l am licensed under previsions of Chapter 9(enmmcncing u p `�•• n
n� with Section 7")ofDivision 3 of Ne Business and Prafcasna Code.AM my license is
Z�a Limaeclasfull form nd eSt '3q ..lt�l �9��,`�3 REROOF SEP 2 ZOOS
? License Class LIC.• '
�Fp Dae Contractor
qqq 7W ARCHITECTS DECLARATION
$ I understand my Plans sa hall he used Public records
U
3�g Licensed Pftial BUILDING
ro
OWNER-BUILDER DECLARATION
eI I hereby affrm Net I em exempt farm the Contractors License Caw for the
00 following mason.(Section 7031.5,Business and Professions Code:Any city or county
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$� which requires A Permit w Mnnmel.alter,improve,demolish,os repair any nruemre
r z'a Prior at its issuance.also require the applicant for such permit to Nc a signed statement
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that he is llcenscul puarant to me prevision of tate Contractors L3m�Law(Ch.ptn9 Sq. Ft. Floor Area Valuation
yF$ (commencing with Section 7")of Division 3 of the Business and Pmfessinns Code)or
Wt he Is exempt therefrom and the bate for the alleged exemption.Any violation of 35709038 . 00
Section 703 1.5 by any applicant for a permit ubjects the applicant to•civil Penalty of APN Number Occupancy Type
not mart than Bw hundred dollen($500).
❑1,u owner of the parpertY.M mY emPl.ycet with wages as Meir sole compeaaation,
will do the work and theswcture is not Intended or offered formic(Sm.7004,Business 305 _ FRAME
and Prefessiosu Code:The Conlnctor's License Law docs not apply w an owner of Re Mired Inspections
property who build,or Improves theseon.and whodoessuch work himselfor through big 307 - INSULATION
own employees,provided that such Improvements arc not intended or offered for tale.If, 6O1 — ROOF TEAR OFF
however.the building or improvement is told within mm year of completion,Ner
e own
builder will haw de burden of praying that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
salt.).
❑I.as money of the property,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
construct he project(Sec.7044,Business and Profusions Code:)The Contacror's Li• 604 — ROOF IN-PROGRESS
nae Law does not apply to an owner of property who builds or improves thereto,and
who contracts for such projects with a contactor(s)licensed pursuant w the Contractor's
License Law.
❑I am exempt under Sec. ��//. B k P C far this season
t371M
ner�trP A/I'j--ldy` De of
WORK 'S COMP NS ATION DECLARATION
1 hereby&Man under Penalty of perjury oro of the following declarations:
I haw and will maintain•Certificate of Consent silt-insure for Workers Comimm
an,u provided(m by Section 3700 of the labor Cade.for the performance of the
rk for which this Permit is issued.
1 haw and will maintain Worker',Compensation Insurance.as required by Section
of the labor Code.for the performance of the work for which this Permit is issued.
War YCoa moniInsurance carrierand Policy numbernter. C Policy No.:O' ) 'LT 1
_ CER IFICATE OF EXEMPTIONFROMWORKERS'
COMPENSATION INSURANCE
(Thissection neednot M completed lfthe Permit is foronc hundred dolbox(VW) t
nrless.)
1 unify that in the performance of the work for which this permit is issued,1 shall not
employ any Person in any mannerw as w hemme abjmuo the Workers'Compcnsnion
Laws of C.1if.Mia.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ccnifcate of Exemption,you should _
become ubjui to the Worker's Compensation provisions of the Labor Code.you must
,JO forthwith comply with such provisions at this wouiuhall decreed ticeed revoked,
Z CONSTRUCTION LENDING AGENCY
[+� Iharehy.ffna that there is s construction lending agency l M the Performance of
Cy the work(.,which this permit is issued(See.3W7,Civ.C.) -
fAti Q Lender's Name
z Lenders Address
U Q 1 certify that 1 have read this application and sac Net the above information is
It, torten.l agree to comply with all city and county ordinances and sate laws falling 10
Wilding construction,and hereby euthoria repres MALIVU of this city w calm upon the
h ahpurposes.
aw-mentioned property for inspection puoses
(We)AS.m taw,indemnify and keep hornless the City of Cupeniao againn
liabilities.judgments.costs And expenses which may in any way acme against aid City
V zam it.
APPLICAeNTeUNDERgranting
STANDStArND WILL COMPLY WITH ALL NON.POINT Issued b to
SOURCE EGULATIONS. y U
� �I ,LP&l , r- 7--17^ o9 Re-roofs
Signawre of Applicam/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle haurdous material
As defined by the Cupertino Municipal Code,Chapter 9,17,and the Health and Safety
Code,ScOCYu 75537(a)? 1 All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment of devise which If a roof is installed without first obtaining an inspection,I agree to remove
it haordous air contaminants As Jcfned by the Bay Area Air Quality Management all new materials for inspection. ,
lWr
m,w__r❑YcsI have mad the haardaus materials requiremcnu under Chapter 6.95 of the CalifoP Health K Safety Coco,Sections 755(15,75533 and 25534.1 undmuund that ifthe Wilding
s not currently hats A tenant that it iv my respa sthility m notify the occuPam of theuirements which must he mat poor to issunneeofa Cenifiew of OccuPury. Signature Of Applicant Date
"ILN I I A �� All roof coverings to be Class "B"or better
or authorisd agent pare
Community Development Deparhment
Building Division
City of Cupertino
+ 10300 Torre Avenue
Telephone: (409)777-3228
CM OF Fax (409)777-3333
qUPEkTINO
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 Y4" 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: rna Ju- VV al
Job Site Address: � ( � G
Roofing Company Name: 04'5TO itgo �
A plica nes Signature J21/`( -airy Date:
Greg
Building Official
Revised 1/30/03
- s
CITY OF CUPERTINO
REROOF
CUPER INO PERMTr APPLICATION FORM
APN#
Building Addres��l 15
Owner's Name: Phone 1p 4j
contractor: 69- 9@ License#: 5C/
Ca tn gontong Inc.
19 idd!efiel VuvuVeIPP!W E6l Cupertino Business Uoense#.
M ntain View, CA 94043.256 32
(0 o) 9®1.9922 Type'of Itoof Covering:
Esti dW. :
L3 Built-Up Roof o Built-Up roof
O Asphalt Shingles U Amt Shingles
&1/arood Shakes 9, Wood Shales
O wood Shingles v wood Shingles
El Other(Specify) l] Other(Specify)
pnmlaer of resisting coverings I o Provide W.B.O.Report W
Tobe Remnove d O Provide Mfg.Installation Specs.
• I Have Read,Understand and Will Comply With Cu o's Tear Off Policy.
Job Description: kt Vvi )-C-
Residential P Commercial ❑
Zone: Yes ❑ No ❑ Confirmed with P if
there are an 'ctions:,
Cost of Project: Type of Oocapan
Y. if
Applicable, Fee ID Fee Description FeeGfOUP
BPERMFEL Bldg Permit Fees BUILDING
BENERGY BURRING
BSMSMICRE Seismic Fee Res BURDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business license BUR DING
2 2 2-
x/ 78, 2 0
x/ 78, 20