03100002 (2) ' CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACT(1R INFORMATION F4
BUILDING ADDRESS: LOS GATOS ROOFING PERMITNo.03100002
OWNER'S NAME: 177.1 SMITH AVE . PErsMrr Issue DATe
ONE: (408) 298-9399 SANITARY N0. CONFROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
I� 0 0 0
;Op LICENSED CONTRACT'OR'S DECLARATION Job Description
V 1 hereby affirm that I am licenseld under provisions of Chapter 9(commencing P
?z2 with Seetion7 )of Division SofNC BusincuanJGofcuinns Cnde,and my license is -
'
in] force effect.
>qz L
Lic.
iccnu a /f1�707 REROOF
Date in TS contractor-
4IOAL FINALE®
qq �,/ ARCHITECTS DECLARATION �]
I'u', (undertund my plans shall he used u public records 8 2OOv�
'u.D OCT 0
"OG Licensed Profcuianal
j'�,a3 OW NEmexemDER DECLARATION
00 1 hcmby.(firm Net I oro exempt from the Cantons;Co License Law for Int
00 following rens a Permit
t 7101.5,Business and improve,
Professions;Code:Any tiny or county BUILDING
g$ which requires a lurnit n,construct.alcor,impmw,dcmolixh,m repair arty structure
nno
prior In its issuance.also wel the applicant forsuch permitlo file a signedauumem
s—< that he is licensed pursuant to Na provisions of the Contractor's Liccow Law(Chapter 9 Sq. Ft. Floor Area ' Valuation
C (commencing with Section7(1W)of Division 3 of the Business and Professions Court or
that he is exempt therefrom and tm basis for the alleged crampoon.Any violation of 36218062 . 00
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of APN Number Occupancy Type
not more than five hundred don ars(5500). P y YP
d 1,as owner of the propeny,or my employees with wages as duir sole compensation,
will do the work,and Ne swnme is not intended at offered for ale(Sec.7044,Busiws
and Profusions Code:The ContncL.es License Law docs not apply to an owner of 3 0 7 - INSULATlq ONd Inspections
property who builds or improves Nercon,and whodoes such Work himself or through Ms
..employ..provided that men improvements rte not intended muttered for ale,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 dol k did not build or Improve for purpose of 602 - ROOF PLYWOOD NAIL
61e')' 603 - ROOF BATTENS
1,construct owner of the property,am exclusively ca trusi n s with licensed contractors to
=Ladoes notapply to
Owner
and Protrusions who
Cotla)The Conumeon. Li 604 — ROOF IN-PROGRESS
cents Law dote ml apply a an owner of property who builds or imptovea comm and
who contracts for such projects with a contractor(s)licensed pursuant m tk Contnaofa
Law.
0 am 1 am exempt under Sec. ,B 6 P C for this moron
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby aRmt under penalty of pe jury one of the following declarations:
1 have and will maintain a Certificate of consent to selfdnsum for Worker's compete
1371W
on,u provided for by Section 3700 of the Labor Code,for the pedmmance of the
rk for which this permit is issued.
I haw and will maintain Worker's Compensalion Insurance,ss...bed by Section
of Ne labor Code,for the performance of Ne work for which this permit is issued.
Worker',Compensation Insurance cannot and Policy number am:
S i &-vo Polity No.: Z_7 g` ZI'd3
CERTIFICATE OF EXEMPTION FRO
COMPENSATION INSURANCE
(Thu secninn nerd not m completed HIM permit is ror one nurchod dnllus(g100)
or Ica,.)
1 eer iry Nat in the performance of be work for which this permit is issued,I$hall not
employ any person in any manner so a to become subject to the Workers'Compensation
Law,of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Worker's compensation provisions or the Labor Code,you must
0 forthwith comply with such provisions or this permit shall m deemed mvnked.
Z rtesCONSTRUCTION LENDING AGENCY
1 hereby ofTrm that Imre is a construction lending agency for the Mrfurmance of
La the work for which thot permit is issued(Sec.3097,Civ.C.)
YQ Lender'$Name
Z Lender'sAddnv„
")Q I certify Nat 1 haw read this application and auu that the show inlmmation is
Fconed.I agree to comply with all city and county ordinances and sou laws totaling to
U building construction,and herebyavthofim represenutiwa of this city m enter upon the
4 ahow mentioned property for inspection purposes.
(we)egme to sew,indemnity and trop harmless the City Of Cupertino epi try
rq Ilabililiese)-mcin costs indemnify
and laws
maylnany wayaccmcapertino id Cily
J Z in eonsequenca of the granting of Nis permit. �,g
SOURCE
UN� SAN L WITH ALL NON PO�� Issued by: Da[
SOURCE REGULATI S. /l]/_
Re-roofs
Signal or ApplicaAZARDO Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof .
WIII the applicant or future building occupant stem or handle haotelaus material `
as dennetl by theCupenno Municipal GOJc,Chapter 9.13,and the Health and Salary
Code.Scrtien25ss33(a)7
Ya "14oAll roofs shall be inspected prior to any roofing material being installed.
' ❑ .
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It huvuNoua air conuminunu as JcMcJ by the Bay Ama Air Quality Managemem all new materials for inspection.
ruin? s�
dyes gNu .
I have read the hmardtmsmaurials mquimmenu under Chapter 6,95 of the Collins,
riaH.M&Safety Code,Scctions355B5,35533and35534.1undcrsnaWthmifdu minding
doss not curmnlly haw a unana it a my res tuibility m nod fy tM txeupant of dto �� ' I
requirementsw � morel rIn issu ,raccee fi`maf0wopmee.J gnature of Appliean —.� Date
_ All roof coverings to be Class "B"or better
Owner ser awhmixcd agent Dane
Community Development Department
Building Division
City of Cupertino
R: 10300 Torre Avenue
4 CITY OF Telephone: (408)777-3228
UPEkTINO 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 comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: 7-7 Q 6-.ii ` Com/`
Roofing Company Name:
A plicant's Signature: Date: 717-5-103
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# _3 2_/E !OZ 6 Date: y 03
Building Address:
732- QLI'diQn. OIL
Owner's Name: Phone#:
I& le Wa- ya819�- 063�
Contractor: Phone#: License#:
G� ko in goo 7 0 7
Contact: hone#: Cupertino Busines License#:
Contact, ki,q � o� �s 348
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
`jd Wood Shakes X Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) V Other(Specify) .
Number of existing coverings / ❑ Provide I.C.B.O.Repo #
�( To be Removed � Provide Mfgr.Installation Specs �
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: ' u Gto 't�
� 6
ResidentW Commercial ❑
Fire Zone: Yd's ❑ 'No Confirmed with Planning De . if -
there are any restrictions:
Cost Project: Type of onstruction: Occupancy group:
� 160ao � Y=4
Qty. if
Appli bl 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
z333 �