03080077 CITY OFCUPERTINO
BUILDING DIVISIONPERMIT CONMA`GTORUNFORK -ION
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BUILDING ADDRESS: PERMIT ND0 3 0 8 0 0 7 7
OWNER'S NAME: PERMITISSUEDATE
COWGER AGNES
ONE: SANITARY NO. CONTROL N0.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ioo LICENSED CON-MACIOR'S DECLARATION
I h reb afrom in',I em lia"cdo nder provi,ions of Chapter 9(commencing Job Description
i with See io�m�Y�a Ihof Divi,ion Jnf Ne Busin". Professions Cdc,and my license l+
< in full(.Yard tyeclp p ^y�
License Class _Lic.g $8 REROOF ��u
Date Camra CONTRACTOR: CAL-PRO ROOFING
ARCHITECTS D -RATION
f u ypimsA A d U no AUG 2003
Limumqonficssimid
OWNER-BUILDER DECLARATION Sa I
30 hanchy,(firm on I am exempt from k Contractors Co An, Law for the ®)J L�Att,�
-0 0 follwhich
cores a permit t IDJs r t.alter,
and improve.
arroli Code mrso city or county unegg ft
`ed$t2 which require+apermitmennal dhe alter,tit for such
permits car¢pairany+UYClurt
-
¢t2 that heor its issuance.pursuant
to ru thevision sof the Commurmit m @e sc Law ststemcnl
mm< (commencingwith
dpurwam mthe provislo"n(thc Conuumfbnd Prore�w(Cum)or Sq.Ft. Floor Area Valuat g000
that he 4 exam it theraion7000)of Division]nf the
eged axe pion.Auia"Cale)of
that k u exempt therefrom and the bub for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penally of 3%?S[9Q615er00 Occupancy Type
not mort Nen five hundred dollars($500).
0 I,"owner or the property.a my criteria"with wage as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.70",Business Required Inspections
and Profc"ions Code:The Conu reme,Lica",Law doa not apply m an owner of 305 - FRAME q P
property who bu ildsor improves thereon.and who dos s uch wak hi mself or through his
own employs,provided that such improvements are not overcast oroffend for ale,It. 307 — INSULATION
however,the building or improvement is sold within one year of complcdon.the owner.
builder will have the burden of proving that he did not Wild 9r Improve for purpose of 601 - ROOF TEAR OFF
.1.1.
602 - ROOF PLYWOOD NAIL
❑I,as owner or the property,am exclusively contracting with licensed contractors to 603 — ROOF BATTENS
contract the project(See.7014;Business and Professions;Code:)The Conu swori Li.
cause Law doss not apply man owner of property who Wilds or improve thereon.and, 604 — ROOF IN-PROGRESS
who contracts for such projects with a commuor(s)licensed punuem to Ne Contractor's
Lic w Lew.
I am umpI un der See.1 BA PCar th num.
Owner I Date
WORKER'S OMP N ATION DECLARATION
1 krtby allure under pe"uy of perjury arc of the following dee vnio":
I hoe and will meimain a Certificate of Content to self-insure for worke's Compen.
cation,u provided for by Section 37W of the Labor Code,for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workars Compensation Insurance,as sequined by Section
"00 of Ne Labor Code,for she Performance of the work fa which this permit is issued.
My Workml Compensation Insunnm carrier and Policy number are:
Ca Polby No.:
CE RTIFICATEOFE%EMPIION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not kepmplemd lithe Permit Is for..hundred dollars($I00)
or less.)
1"nify Nat in the perfnrmence or the work to which this permit is issued,I,holt am
Ini anYa mym �+ Lilo�ec sub Muck Workeri Compcnsnion
Laws of Cali i.Date yT— tee'
pplicant fC 4
11 a
M.CE TOA LICANT:IL after making this Ceni�ime of Exemption,you should
mot
e subject to the Worker's Comm or provisions or the Lou...Code,you mutt
.,,Z, forthwith comply with such provisions of this Permit Mall be deemed revoked.
? O CONSTRUCTION LENDING AGENCY
1 kmby Mo.thin there I..construction lending agency for the performers of
Yd? the work for
which this pemnit is issued(Sec.3097,Ci,C.)
37 Q IeMCYI Namc
z Lendcr't Address
J I eerily the 1 banply reed this application and sum that the above m oclatiun is
y building( omtocomply withAll City and countyordinancesmJ cuss law+relatingto
Wildin.mmhmuctiomand hereby nuthod IvorNs onutiva or this reenter uPnn the
C above-mentioned to save for inspection keep b
(We)agree m cove,indemnify atm keep harmless the City of against Ci
ti py li+bilitics.jeexpensesrymue
m .costsand expenses which may y way accregaiagainstDid mid City
J Z in consequence of the granting of this Permit. /3>
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S0� REGULATIONS. �. �����
t- 1M If/� Re-roofs
i azure pphcmVConua ser ate
HAZARDOUS MATERIALS DISCLOSIIR Type of Roof
Will the applicant our room Wilding occupant store or hen Ic hafcdous material
"defined by the Cupertino Muflicipal,Code.Chapter 9.17,and the Health and Safety
(d0.gcdipn 235J2(e)7
❑re,
.)511-
Na All roofs shall be inspected prior to any roofing material being installed.
Wiil the applicant
or future building occupent use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hoordnus air conorammus as dcfincd by the Bay Arta Air Quality Management all new materials for inspection.
i,vicR y'
❑Yet Lgpiu
7 � mD f� y]
Ikwmadthe Wpardo.255)5,2553and1534.1 uChatandthartheCalding [2� ��
are HeelI h&Socad Cmk,Sactu"25 W5.33577 and m�i voo urClo,un 6.95.the Wilding
J net curtentiy hew a tic anI,that it it my responsibilityw notify the rccupem of the
immcnts which mumpdon coraCcnificiacof cupan Signatu ofApplicant Date
Q �oa3
owe 9r.athatrcJegem Date All roof coverings to be Class"B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
��'�O Fax: (408) 777-3333
UPEBuilding 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: °� M eL S Mn v
�4' 0 4U e
Job Site Address: / 6 Q � ,�N f
Roofing Company Name: C/�
A plicanYs Signature: Date: I S� 2J 0 P
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
1
CITY OF CUPERTINO d , -7 7
40 REROOF I
CUPERTINO PERMIT APPLICATION FORM
APN# i ,U Date: S
Building
d eS :(P c R M N
Own is Name:
Phone#- if o
2.T ] y y3SVW
CO�tWe r: p9 � 1 Phone#: Lice
a : 7g (3
Contt� M�� PhoLl ne,# 3 7 y a / Cupertino Business License#:
Type of Roof Covering: /
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles IX Asphalt Shingles
X Wood Shakes' ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings• _ ❑ Provide I.C.B.O.Report#
1;P To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
-t-
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed With Planning De t. if
there are any restriction .
Cost rl ject: Type of Const o Occupancy group:
sono
Qty. if
A lic 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
a� 7 � o .