The URL can be used to link to this page

03090130 (2)CITY OF CUPERTINO ='Ma s x=v BUILDING DIVISION PERMIT CON�TRACTO INFORMATION ' R BU ILDING ADDRESS: T D ROOFING PERMIT "003090130 OWNER'S NAME: 3540 MARGATE AVE. PERMITLSSUEDATE LEE MERTHOTOR Q2/17/2003 NE: (408) 892-8872 SANITARY NO. CONTROL NO. ARCHM-CTIENGINEER: BUILDING PERMIT INFO BLOC ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (mmmense P is with Section Division NC Businw and Pmfcuinv Code. and myliccnu is ' in rwl force ane «x.39 REROOF Lic<na°lata Dale Contractor ■ FINA AR Ht DECLAR 01 TS DEL - E D Ocuse I understand my plana shat I W mcC as public recnNs - SEP 2 9 2003 Licensed Profeasponal OWNER BUILDERtfr DECLARATION 1 hereby affirm 1 Comfrom me Contractor's License Law for the .exempt Code: Any city m county ng tion.. (Section Business and Pre o reaso on dennna Which cre..5, Which alma improve any ewcmm wo a permit na inn hPermith, fie BUI 0 Sq. FL Floor Area Valuation its re quites the applicant for suchpermit mice signed Cerement s; the for such a sig prion to itswomen.pursuant that W pSection fume none Cotmm�mr sandPf.i.(Chaptered: (commencing With of Division (commencingwpm Station of Division3 of the Business andor ser 34215055.00 on. Any Bud he u exempt therefrom and Ce baso for the alleged! exemption. Any violation of and ane APN Number Occupancy Type —' P Y- Section 703 1.5 by any applicant for a permiuubjects the applicant to a civil penalty of — not more than five hundred do]].. (x500). -- - --- - ❑ I, in owner of the property, or my employees with wages As doon sole compensation, will do the work. and fie swcluu is not intended or offered for safe (See.JW4, Business and Professions Code: The Contractor's License Law Coca not apply to an owner of —g�� d Inspections p property who Wilda or improves thereon, and who does such work himself or through his 3 0 7 - INSULATTYJ own employees, provided that such improvements are not intended or offered for sale. If, 601 — ROOF TEAR OFF however, the building or improvement is sold within one year of completion, the owner builder will have the burden of proving Nal he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL aala.1 603 - ROOF BATTENS C] 1. as owner of me propany, am exclusively contracting with licensed contractors; to _ 6O4 ROOF IN covWho. lmet the pmject (Sec. W. Business and Professions Coci The Contractor's Li. — -PROGRESS . cove Law does not apply to an owner of progeny who Wilds or improve Ihemon, and who comracts for such pmjcm with a commefonq licensed pursuant o the Contractors License Law. ❑ I am exempt under Sec. B h P C for this moron Owner Data WORKER'S COMPENSATION DECLARATION I hereby, affirm under penally or perjury one of the following decimations: 1 have and will maintain a Ce1d0Cme of Consent to self-made for Worker's Compcm smOn, m provided for by Section 370 of me Labor Code, for the performance of the work for which this permit is issued. 1 have and will maintain Workeri Compensation Insurance, a required by Section ]00 of the Labor Code, for the performance of me work for which suis permit is imued. My Workers Com pevation Insun!tn carrier and Policy number am: Canner Ci e.�C, /_{-Lv1�Policy No.: GERTIF PITON FROM WORKERS' COMPENSATION INSURANCE (This section need not Mcomplcted If the permit Is for one hundred dollars ($INB car leas.) I certify that in the performance of the work for which this permit is iuued. I shall not employ any person in any manner u a to become subject in the Wodttt Compensation Laws of California. Dare Applicant NOTICE TO APPLICANT: If, after making this Cenifcate of Exemption, you should become subject to me Worker's Compo when provisions of IW labor Code, you must forthwith comply with such provisions or this permil shall W deemed rcvokcd. CONSTRUCTION LENDING AGENCY 1 hetchy oMrm dam, them is a coastmction lending agenry I'or the Ierfurmm. of the work fur which this permit is issued (Sec, 3W7, Civ. C.) Lcndcri Name Lender's Add. 1 certify mal l have read Nis application and stem that me above information is coned. 1 agree to comply with all city and county ordinances and slam laws relating to building eonaWction, and hereby mullorile replan tativea of this city to enter upon the above-mentioned property for inspection purposes. (We) agree la ave, indemnify and keep harmless the City of Cupertino against liabilities. judgments, costs ntl capcnus which may in any way meme against aid City Iheg APPLICANTeU T NDStAND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCEREG ATI 1 �3 Re -roofs Type of Roof Signature ofd piican Contractor Dam HAZARDOUS MATER ALS DISCLOSURE WIII the applicant ser fomro Wilding or handle Health and az Canned by the Cupertino Municipal Code, Chapter 9.i2, and me Health anJ Safely e, Charter , code, Section zsslz(a)+ All roofs shall be inspected to any roofing material being installed. prior If a roof is insta led without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment tor devices which it hv.erdnus air contaminants a CCIincC by me Bay Area Air Quality Management all new ma[eri for[ion.mhalYesI havemad mchaamtmsmaWhalsmquimmenaunt rChapmr6.95ofmcCaliror- nix Heallhs, SafCt ats25505.25533md)55Jo.luntl Wilding 4ins I I g I O 3 9 U �ma mifine Jars not currcml) In k thm it is m espovihility m ooufy tW am"Ian of me mquimmenu lure n I ceafa Ccrdfmam ser Gcu aney. t 9 Ir. 03 Signature of Applicant Date All roof coverings to be Class "B" or better Owner m mmoriecd spent Date Building D Subject: Re -roofing policy for the City of Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 16 1. Prior to permit issuance, you must agree to comply with 11 UBZTStandarrr and manufacturers specifications on re -roofing. 2. New roof coverings shall not be applied without first ob . g all inspection and written approval from the building inspector. A fin I 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: L e,e h') e V f W o Job Site Address: a A 'Ey fo N) 9-�1 i i1� a of Roofing Company Name: I D R o�-H Nt q A plicant's Signature:1 Date: q t { 0 9 3 • GregOteel Building Official Revised 1/30/03 Printed on Recycled Paper �-1 LJ i] aCITY0 CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM /I/ APN # 34a ISbSJI Bldg Permit Fees Date: I 7Z Building Address: �t Mctl%na e �� er p 23706 BSEISMICRE Owner's Name: PP lYiz�� 1o�bt' BUILDING Phone #: d e BUILDING t(03 4u Contractor: Phone #: i R BUILDING License #: n oo 4 o .1A-9 t o 4- ro 6 6 -:1- Contact: Phone #: Cupertino Business License #: Stvv% D Hit\ 4og 64-6 8350 Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles X, Asphalt Shingles A Wood Shakes L3 Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report # To be Removed L3 Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: ` I-er„ove wood stLQ, i kr �I lac.2 I avi i'� So yt� '-C V, .-, `y..ili,cti Residential ® Commercial ❑ Fire Zone: Yes ❑ No (jj Confirmed with Pla Dent. if there are any re tions. Cost of Project: Type of Construction, Occupancy g u Qty. i� . Annitjable�-, Fee m Fee. Descrintinn Fre r7rnnn 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