03100141 i CITY OF CUPERTINO • . +.m.K ;r.� s,!.'i; ,= . -z,�-
t BUILDING DIVISION PERMIT CONTRACTQRjNFORMATIO,N.°°.I
6tt BUILDING ADDRESS: EL CAMI'NO ROOFING CO INC PERMITNO'03100141
m ,rT ^_T
OWNER'S NAME: 1650 S 7TH ST PERMITISSUEDATE
BOAN ,TVTTF.—MTN F.T AT. ) n-/)n-/)nnz
NE' (408) 292-7644 (SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I0o LICENSED CONTRACTOR'S DECLARATION
i 1 hereby efn,.that I am licensed under provisions of Chepmr 9(commencing lob Description
With ectWn]IXXry n(Division 3 o the BYSlnes]an PrinessiunACo and my itmsois
? � inml$1�f9�r'andr�factrL G` REROOF
LicenSg 1 Lie.N
) � DA_COmr.�n.
ARCHTIECTS DEC�ION /
i < understand my plans ANII be used as public mcnrdA /
iyU
-ol Lkcnad Professes.]
s 3 Oat I am exempt R DECLARATION
8 I hereby alarm
that I em exempt from the ComnnoM1 License law for the Q
.D o following reason.(Section 7(1]13,Business and Professinna Code:Any my of country
$(ri which requires a perm,to construct.alter,improve,demolish.or repair any structure v C] n o n n
•Z'� prior to its issuanca,also requires the applicant for such Permit o flc a Agned samurai, a
as�s< that he is licensed pursuanu n the provisions of the Contractors Lamnse Law(Chapter 9 Sq. Ft. Floor Area Valuation
iFe (commencing with Section 7W)at Division J nfthe Business and Prufcsaimis Code)ur
he Is exempt thcrefmm and NO basis far the alleged exemption.Any violation of C1 !2 O O
Section 7031.5 by Any applicator for a permit suh)ecu the applicant to a civil penally of APN Number Occupancy Type
not mom than five hundred dollars(SSW).
❑1,as owner of the property,or my eoni with wages u their sole compensation,
will do the work and the mmemm is not intended or offered for ale(See.7044,Business
end Professions Code:The Cantracers License Law does not apply in an owner of Required Inspections
properly who builds or improves thereon,and who does such work himself of through his
Own employees,provided that such improvements art not intended oroRered(orsale.IL
however,the Wilding or,mprovement is sold within am year of completion,the owner-
builder will hew the burden of proving that he did not Wild or improve for purpose of
sale.).
❑I.as owner of the property.me exclusively contracting with licensed commerce.to
construct the project(Sec.7044.Business and Professions Code:)The Commission's Li.
aloe law does not Apply to an owner of property who Wilda or improves thereon,and,
who contracts for such projects with a con"ctor(s)licensed pursuant to the Conmactors
License Law.
E3 1 ten exempt untie,Sec B&P C for this..an
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penally of pegury ow of the following declarations:
JI have And will maintain a Certificate of Consent to salf-insom par W.fte.Compen-
Jscion,u provided for by Section 37W of the tabor Code,for the performance of the
work I. hich thts permit isiuued
�}�-�JAywwAnd wdl maintain Workers Compensation lasurana,u acquired by Section
JTW O(the labm Cade.he the Performance of the works for which this pearch is tssad.
MY Work Cast time Ituupna carriv q pt_ a 1 J jb�l
CERTIFICA ,"_EXEEMPf1 OMJWORKERS'
f
COMPENSATION INSURANCE
This Account wed notaccompleted if the Permit Is(Orono hundred author($100)
or lass.)
1 certify that in the perrmmance of the work for which this permit is issued.I shall not
employ any Person in any manner coo as e become sub)ecuo the Workeri Compensation
Laws of California.Dr-
Applicator
NOTICE TO APPLICANT:IL after making Ibis Certificate of Exemption,you should
become sooner to the Worker.Cwpn cnuuon pmvisions of the labor Caw.you must
�Q forthwith comply with such Provinces or this Permit shall w deemed hawked.
z o CONSTRUCTION LENDING AGENCY
1 washy 0.that the.I,.cmmmctina landing.,my I.,the pc,rummmm ter
Y the work fur which this perms is issued(Sec.3097,Civ.C.)
rice Q (Anders Nam-
5.z Lender.Addra-
C) I certify dial I haw mad this application and sate that the show information is
F comet.I agree to comply with all city And county ordinances and sou Isws relating Ire
�U budding construction,and hereby authorize repmsemadvas of this city to comer open the ^
4T7 above-mentioned property of IMPecuon PurPOWS. II
(We)agree a aaw.indemnify and keep hmmless rho City of Captain..&.last
h
liabilities,judgments,costs and expenses which may In any way Accmc against laid City
J� in'nnseyucnee of the gaming of this Permit.
F7 APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
`�OURCE J�ATIONS/� ,,/
J C.— (P( 2 Re-roofs Q
Signature of ApplicanJContrmtor
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant more a handle hair fous maerial
as de0wd by tW Cupertino Municipal Code,Chapter 9.12.and the Health and Safely
Code.Seemo.355324)" All roofs shall be inspected prior to any roofing material being installed.
❑Yes [1-iv'o
Will the applicant or future budding occupant sax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it he micas err contaminants as&fined by tho Bay Area Air Quality Management all new materials for inspection.
me7 / 3
Cl Yea
I have
&Safel Cow,Secuoma 5505,srequimmenu 4.Iu Chrstood otifthe Califon. /�' Q () 2,(�
nicer Outh grSafely Cute,tecuans2el it my responsibility a.manly to ne,op Wilding � G;
Jaa tool currently hew a tenant,that it is my mepanslhility m nuuly tM ixcupant of Ne �
regairon awh most be met poor or imuama of a ccmW.m of as cv. gnature of Applicant Date t
C �l C 1{vl All roof coverings to be Class"B"or better
wn�crur Amhoriied agent I me
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U PEI�TINO 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:
a -II
Job Site Address: L /�, � 6"n -
Roofing Company Name:
I
A
p"" Signature: Date:
Greg eel
Building Official
Revised 1/30/03
r
Printed on Recycled Paper
ow CITY OF CUPERTINO
REROOF o3 l °
CUPER INO PERMIT APPLICATION FORM
APN# 3P� �2 �-7�i] I Date:
Building Add
Owners e:` C`� Phone#:
C �r a r� �� t f t �� Phone# �� `ly' License#: o a
Cont Phone#i l Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles .EB Asphalt Shingles
„gam Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I I Have Read, Understand and Will ComvIv With Cupertino's Tear Off Policy: I❑
Job Description: (� J / _ 4 L4� r�O� -1-'l�l
Residential �/ Commercial ❑ f Y
Fire Zone: Yes ❑ No ❑ on firmed with Plann' t. if
th re are any restr' tons:
Cost of J i o ' Type of���Zti Occapancyrpu Z/�
y f ( r/�`
�
if
Applicl;le Fee ID Fee Description Fee Group
(� BPERMFEE Bldg Permit Fees BUILDING I
/ BENERGY Energy BUILDING
BSEISMCCRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License I BUILDING I
I I I