03080175 (2) CITY OF CUPEWI'INO ""�r s-•-.�r�d St, �» ' ", � "L" "r :
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION .4
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Bu1LDING ADDRM- : PETERSEN—DEAN INC PERMIT No 03080175
219 l2npl;l�
s OWNER'S NAME: 7980 ENTERPRISE DR PEaMrr taus DATe
ONE: SANITARY 0. CONTROL NO.
(510) 494-9982
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
i 0 o LICENSED CONTRACT'OR'S DECLARATION
£u 1 Mmby affirm Nal 1 am licensed under provisions of Clmpter 9(commencing lob Description
with Section H(0)of Division]of Ne Business and Professions Code.and my license is
infullfrecom
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u.nt s ,e, / • REROOF PINAL C3
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l l understand my plans hall used as public cords
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s tad Licensed Pn rcssional L l/J
5 OWNER-BUILDER DECLARATION
I 1 hereby affirm that 1 am exempt from the Contractor's License Law for the BUILDING O o following reason.(Section 08]1.5,Business and Professions Code:Any city or county
$ which requlrea a pi mil to construct,alley improve,demolish,or repair any aWctum
-xi prior to its issuance.also mquims the applicant for such permiuo file a signed statement
ss< Nal he is licensed pursuant to the provisions nfthe Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valu tion
(commencing with Section 70(y)of Division 3 o(Ihc Business and Professions Code)or
Nat he is exempt themfrom and IM basis for the alleged exemption.Any violation of
Section 70713 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type.
not more Nan five hundred dollars($500). "-- - - `- -"
❑L as ownerofthepmpeny,in my employes with wages mlMirsom compensation,
will do the work,and the swmum is not intended or Offered for age(Sec.7044.Business 305 - - FRAME
and Professions Cade:The:Comncmr's License Law rias not apply m an owner of Required Inspections
propeny who builds or improves Neuron.and who Mass such work himselfor through his 307 - INSULATION
own employees,provided that such improvements me not intended or offered for sale.If, 601 — ROOF TEAR OFF
however,Ne building or improvement is within an year of completion,the owner-
builder will hale the burden of proving Nat M did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
01. 603 - ROOF BATTENS
❑I.a owner of project
property. Business eulnsivnd professi n,with licensed ronvaaoss to
come act tnacesMEapplyoanowneorroprtywhoWidsori provestheno tor'sa 604 — ROOF IN-PROGRESS
who Law faces ownerofproperty who Wildarsimproves IMmon,and
whocontractsLat for such pmjecu with a conramoK)licensed pursuant to lM Contractor's
License Lxw.
❑lam cacmpt under See ,Bk PCfor this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hammy affirm under penalty of perjury one of the following declvetim s: -
I haw and will maintain a Cenifcam Of Continuo self-imum for Worker's Cmnpem _
1C.-Yo
on,u provided for by genion]700 of the Labor Code.for tho performance of the _
W
k for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as mquimd by Section
0 of me Labor Code,for Ne performance of the work for which this permit is issued.
Work omreasstiopinsypn.c.DiierandPolicynumberam;ier._ z/gal !A//YIJKa Policy No.:0""1;9
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CERTIFICATE OF EKEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section seed not M completed If tM permit is for one hundred dollen($100
or leu)
1 certify Nat in the perfornmcc of Ne work for which this permit I.issued.10.11 nut
employ any person in any manner an atm become subject to the Workeri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenificam of Eacmplion,you should
become subject m(be Worker)Compensation provisions of the labor Code.you must
�z fanhwithcomply with such provisions orhis MID I shall beammedrevoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm NU there is a construction lending agency for the perfurromce of
1' Ne work for which this permit is issued(Sec.1097,Civ.C.)
1 Lender's Name
z Lender's Address
1 certify Nat 1 haw mad this application and tuts,Net Ne above information is
y cORecl.I agree tp comply with all city and county ordinances and stile laws relating to
building construction,and hereby authorise repos semativa of Nis city to enter upon the
G almw-mentioned pmperty for inspection purposes.
L (We)aS..to mw,indemnify and keep hssmlem Ne City of Cupcniao against
h liebiliueajudgmenu casts and expenses which may in any way accme against mid City
j APPLIganc the gmmin oft ' rmu, v
APPLICA ND WILL PLYwVITH ALL DINT Issued by: Date
SOU fQp/�
O 5 Re-roofs
Signature of ApplimurContascmr Date
- HAZARDOUS MATERIALS DISCLOSURE"'.' Type of Roof
Will Mc applicant or future Wilding occupant mom in handle havardous material
as de0ned by the Cupertino Municipal Cade.Chapter 9.11,and the Health and Safety
Coke.section 25532(a)7
DYED, All roofs shall be inspected prior to any roofing material being installed.
L9'IA>"
Will the midiemLorfuture building=upon,acequipment ordevices;which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants u horned by the Day Arta Air Quality Management all new materials for inspection.
inner?
p Yea
I have mad Ne havanfnus mmeriatimquircmcnm under Chapter 6.95of the Califs
ria Health a Safcty Coo,Sectimu 25505.25553 amd25534.Iunhcrsund DOE ftM Wilding
rias not currtnLlyIt te t.thin it u y responsibility ED the occup of e Z
reairements von vMm ri i since or entre or«ca Signature of Applican Date
Owner at ialhorircd e� gcni pa r All roof coverings to be Class "B" Or better
Community Development Department
Building Division
EJ: City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
4UPEkTINO CITY OF 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: 6f _
Job Site Address: 3 9 oxoZ%a , biq:g41 n
Roofing Company Name: 07Lt
Applicant's Signature: Date:
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# �7 b/ � 6 Date: / 3
�' �-FfIO
Building Address: !3 o
Owner's Name: / Phone #t
71 z- s
Contor: Phone#: License#
rA -L� 4-L 57o y9y- 9 z `�GBii
Conta .,,. Phorle�#: Cupertino Business License#.
J' �tnti-tom
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Other(Specify)
Number of existing coverings Provide I.C.B.O.Report# Ek 2 6 S G
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job De cription:
Residential7 Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plan n' Wit.
there are any restric 'ons: LJ
Cost of Pro'ect: Type of Co ion: Occupancy group:
S/. 07)
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licab 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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