07090166 CITY OF CUPERTINO
BUILDING DIVISION PERMITfl � QRM�TIEIN.
PERMIT NO.
"
BU"L 'TNPKIN DR AMERICA' S ROOFING 07090166
t5 U L PERMIT ISSUE DATE
OWNER'S NAME:
WELCH B B AND M A 535 N 7TH ST 09/25/2007
SANITARY NO. CONTROL NO.
NE: (408) 661 -6501
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 0 a a
p z0 LICENSED CONTRACTOR'S DECLARATION Job Description
m I hereby affirm that I am licensed under provisions of Chapter 9(commencing
U with Section 7 i''on 3 of the Business and ofessiuns C and my license is REMV 1 F;00 F & I N S T L 1/16 OSB W/PRE S TL 23 S Q S
t=y in full Coree and ftec� YZI
t n Z License ass Lie.S
p Date Contractor
F m ARCHITECTS DECLARA N
i aa
< I understand Loy plans shall be used as public records
,WU
U.F- Licensed Professional
:O a OWNER-BUILDER DECLARATION
j< I hereby affirm that 1 am exempt from the Contractor's License Law for the
.00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve.demolish•or repair any structure
J"ra prior to is issuance,also requires the applicant for such permit to file a signed statement Valuation
3 .Ft.Floor Area $8000
-z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �l
Z[_- (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
i $ that be is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 6 2 0 2 0 4 6 . Number
not more than five hundred dollars(5500).
0 1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended oroffered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractor's License Law docs not apply to an owner of
property who builds Or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale if.
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contrxtoes Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
0 I am exempt under Sec B&P C for this reason
Owner Date - -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for nth this permit is issued.
ve and will maintain Workers Compensation Insurance,as required by Section
00 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker s Ccompensatio In,Ipranc carti�d Policy number arc:
Cartier \ ` �rlicy No.:
CE IFiCATE OF EX PTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
..w
E-r I hereby affirm that there is a construction lending agency for the performance of
p;> the work for which this permit is issued(See.3097,Civ.C.)
�i]A Lendcr s Name
2 Lcnders Address
U 0 1 certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
above-mcnuuned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
c/) liabilities,judgments,toss and expenses which may in any way accrue against said City Z 0;7
U Z in consequence of the granting of this permit. a 11JJ
APPLI NT U STANDS AND WILL COMPLY,WITH ALL NON-POINT Issued by: Date
SOU LA NS. Z
Re-roofs
Signature of Applicant/Contractor Dam T Of Roof
MATERIALS DISCLOSURE Type
Will the applicant or future bujlding occupant store or handle hazardous material
az defined by the Cupertino Muni' al Codc.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
[]Yes No
Will
a roof .s installed without first obtaining an inspection,.1 agree to remove
ill the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0Yes �No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Hcalth&Safety Codc,Sccdons 25505,25533 and 25534.I understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements Itch must be met prior to issuance 9f a Certifiratc cupanc7._ Signaturt:of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorized agent Datc r—
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
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 appro-7al.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail i aspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new matE rial down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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 polic on re-roofipg.
c
Homeowner's Name: C
Job Site Address: V lJK
Roofing Company Name: Tr L u
Applicant's Signature. Date: r 2 S 3
Greg Casteel
Building Official
Revised 11/2/04