03060152 (2) CFPY OF CUPERTINO ?h^% > �' ' -
t
BUILDING DIVISION
PERMIT tCONTRACT.®RINFORMATIONN
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BUILDING ADDRESS: PERMIT NO
COS MOS ROOFING 03060152
• OWNER'S NAME: 1901 OLD MIDDLEFIELD ,WY PERMIT ISSUE DATE
BILL LIN-LIN REAT-TY nr,/24/2003
ONE: (415) 493-6373 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� 0 0
±oo LICENSED CONTRACTOR'S DECLARATION ] b Description
�a Fp he
I reby affom that l em licensed on&,provisions of Chapter 9(commenOesGrlP
cing
;V, with Section 7")of Division S of NC Business and Professions Code,and my license is
� in full force and Qc
��z Llccnx Clu Lk.X '1Y44, TSO SHAKES f�
Do I,:S Contractor RESHEET 7 16 OSB, 30#FELT IFOG�ALED
ARCHITECTS DECLARATION I understand my plans shall he used as public records & 30 YR COMP SHINGLES
gu.o Licensed Pmfessionel
JUL 1 0 2003
g OWNEm exempt
DECLARATION
EMO I hereby affirm that 1 1. exempt from Ne Contras o License c Lew for the
EMO following r 7051.S,Bualless and are.demolish,
Code:Any city or County BUILDING 5Z whish itsisssapcmstreuires de,applicant
for such
Permits or repair anyswcmre NV L gV�,nl
iy that prior
its issuance,c,avu requires the thovisio sof the Con pctoi's cense Law statement
that me cing licensed pursuant 7")of Division 3 the Contractor's License Law(ChspurY Sq.Ft. Floor Area Valuation
(commencing with Section 70W)of Division]of the Business and Professions Cade)or
1.59 Nat he is exempt thetefrom and the basis for due Alleged exemption.Any violation of $11880
Section 7051.5 by any Applicant for a permit subjects be applicant to a civil penalty of APN Number Occupancy Type
notmore Nan five hundred dollan(M). 316310,29 00
C1 I,as owner of the property,m my creploycn with wages u their sole compensation,
will do the work,and the aWCtam is not Intended of Offered for sale(Sec.7014,Business Required Inspections
and Profmiampa Code:The Convictions License Law dace not apply m an owner of q p
property who builds or Improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not founded cr offered for ale.If. 3055 — FRAME
however,to building or improvement is sold within we year of completion,the owner.
builder will have the burden of proving Nat he did not build or improve for purpose of 307 — INSULATION
sale')' 601 - ROOF TEAR OFF
❑I.as owner of the progeny,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
eonstnct the project(Sec.7(44,Business and Professions Code:)The Contractor's Li
cense Law does not apply to an owner of progeny who builds or improves thereon,and 603 — ROOF BATTENS
who Comncts for such projects with a contractor(s)licensed pursuant o the Convactor's
Lleemx Law 604 - ROOF IN-PROGRESS
1 nn exempt under Sec. .B Ar P C for NIA reason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby afflmt under penalty of perjury one of the following declarations:
I have and will maintain A Ccnifint,of Consent 1. NOW.for Worker'.Compcm
73C1111
ion,u provided for by Section 77080(the Labor Code,for the Performance of the
b for which Nis permit is issued.
1 have And will maintain Worker i Compensation Insurance.u reignited by Section
0 of Ne Labor Code,for the performance of du work for which Nis permit is issued.
Workse n pensation Insurance carrier and Polity number are:
rtier, = Policy No:..��—.assn 02-4r
CERTIFICATE OFEXEMPTION FRO WORM KERS'
COMPENSATION INSURANCE
(Thu Auction need not becompleud if the Permit is Toros hundreddollan(SIM)
of tea.)
1 certify Nat in the performane=of due work for which this permit a Issued,I shell not
employ any person in any manner an as to become subject o the Workcre Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL atter making this Coni icau of Exemption,you should
become subject to the Worker's Compensation provisions of the Libor Code.you must
.Jz forthwith comply with such provisions or this permit shall be deemed revoked.
Z M CONSTRUCTION LENDING AGENCY
[—� I hereby affirm bar there is A Comtmninn lending agency lot the Performance of
!Yi
be work for which this permit Is issued(SCC.301 Ci,C.)
ALender's Name
]z Lender's Address
U Q 1 minify Nat I have read this Application and sum that the above information is
Iy F' correct,1 agree to comply with all city and county ordinances and sou laws relating to
0U building construction,and hereby mthofise MPtesenutiw of this city m enter Ligon due
W
above-mentioned property for inspection purposes.
(We)agree to save.indemnify and keep harmless the City of Cotonou Against
rFi N liabilities,judgments,costs and expenses which may in any way accrue against said City
U 7 in cnnseyucncc oft arcing ufl 'sP
F7 APPLICANT U STA L CO WI ALL N-POINT Issued by: Dale
SOURCE
Re-roofs
Signawte of
HAZARDOUS
ApplicaOat,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum buildings.Chaptatorcor handle Health and
As,defined by the Cupertino Municipal Code.Chapter 9.12.and the HCJN and Sa(cty
21kft,Se=dan 255326T?__,,,,. All roofs shall be inspected prior to an roofing material being Installed.
❑res P P Y g g
Will the applicant at future building occupant sex equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove .
0mints as
t h..,d..s air a andefined by NC BAY Area Air Quality Management all new materials for inspection.
isUi=tO ep'4�� •ir/�
Yos
I have read the hasaNnus materials reyuimments under Chept,r 6.93 of the met mitring
nue.nelth&Safcryhe ASccdm, 25505,235]7 and235n undcrsmnd Wet iDhc hl of the O
time not currently
he a t,nant,Nat fru spunlhil' m nnury Nc occupant of the '
requirements whit IZ.cl r Cerra 'Etat,of Occuevt y. Signature of Applicant Date
Owner ser authonscU egcm I DOS All roof coverings to be Class"B" or better
Community Development Department
Building Division
1'
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
1UP' EkJ1N0
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:
Roofing Company Name: 7(�*�
A plicant's Signature:' Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
CITY OF CUPERTINO �3D� 060
Ito REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 3 o2— Date:
Building Address:! 99 y� eraA,� C,,f--
Ow is Name: 7 / /� Phone
7 #:
ractor: None#: License#:
/,5c' 99 ?-7L62
28Sy�/
Contact: Phone#: Cupertino BY'F*L_icpnse#:
Type of Roof Covering: d `7"�
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ';6� Asphalt Shingles
it Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
3$' To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job D scrt to
� 0 • �Ce�C< Tib Ssg ! J- 'ZO 0 t�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning D,-e,Pt. if
there are any restrictions: u
Cost of Project: Type of Construction: Occupancy group:
// t ag 67 Utz
Qty. if
Applicable Fee ID Fee Description Fee Group
f 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
ZZ S'