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03060026 CITY OF CUPERTINO BUILDING DIVISION PERMIT &CONT1U,'WA 1'NFO ATION, Pw.°2ff'F .P BUILDINGADDREss: CAL-PAC ROOFING PmA9TNO03060026 19661 DRAKE DR WNER'S NAME: 36 RAILWAY AVE �1dA41T"'M"3/2003 AN LAWRENCE K AND CANDY L NE: a 874-7784 SANITARY NO. CONTROL NO. ARCHITECT/BNGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 (� LICENSED CONTRACTOR'S DECLARATION Job Descri tl n — Nfi 04 Let 1 hereby I'-Nat 1 am licensed under p.A i..of Charm,9(commerding p with Section]0(10)of Drvhian 3 of rid Busi...d Profound..Code.snd my license is nz1 mmummeandefr T O SHAKES . RESHEET 1/2 �CDXJUN 17 2003 Data as �" c seen., �L ADD 50-YR. COMP SHINGLES ARCHITECTS DECLARATIO I unMraWld my plane shall hC used as public=m& BUILDING 3 C Licensed Prof..imoal i OWNER-BUILDER DECLARATION I hereby am.that I am exempt from Ne Contnno's License Law for the 09 following meson.(Section 71131.5,Business and Professions Cade:Any city or county 2� which requires a permit to construct.alar,imptom,demnikh,or repair any Structure in prior to its issuance.alm requires the applicant forsuch permit to file asigned summcm e Valuation < INtheialicenacdpurananuOddprovisionsOflheCom,setm4Limnselaw(Chapm,9 Sq.Ft.Floor Area (commencing with Section 7000)or Division 3 of due Business and Profusions Code)or $14015 — that he I.exempt therefrom and the basis for the alleged exemption,Any violation of Section 7031.3 by any applicant for a permit subjects the applicant In a civil penally ofA]�j�Numher Occupancy Type not mom then five hundred dollars(5500). 3 16.3 2 0 3 0 . 0 0 ❑1,n ownerof the property,or my employees with wages u Noir sole campenaation, .111 do he work,and thestrunure Is not intended arorfered for We(Sec.7044,Business and Pmfossions Cade:The Conuantors Ucense Law does ant apply to an owner of 305 - FRAME Required Inspections properywho Wildsorimprmea demon.and whodcessmh workhimselfor hmullb his own employrn,provided that such improvements are not intended oroQered foesad.If. 307 — INSULATION however.One building.,Improvement is to within..year of ComplCuon.the owner- 601 — ROOF TEAR OFF wieder will have die burden or proving that see did not wild or Improve for purpose.( 602 - ROOF PLYWOOD NAIL ❑I,as owner of the propeny,am exclusively contracting with licensed comranton to 603 - ROOF BATTENS conswcl the project(Sec.7041,Business and recitations Code:)The Contractors LL Ceara law does out apply to an Owner of property who builds or Improves lhemon,and, 604 _ ROOF IN-PROGRESS who conaacu for such projects with a conwemKU licensed pursuant to the Cnmmetora License Law. ❑I am exempl under Sce. .B k P C far this meson or Dau WORKERS COMPENSATION DECLARATION 1 hereby in.under Mostly of perjury one of Ne following dmlaruiou: ❑I he.and will maintain.Certificate of Consent inselbbnure for Workers Compeo. cation,as provided for by Section 37011 of the Labra Code.for the performance of the work for which this permit I.Issued. t❑I 1 haw and will maintain Workers Compensation Insurance,u requited by Section 00.f rhe Labor Cade,far Ne performanm of the wank far which Nis permit is Issued. My Worker's Cqj lustpgnce pensed.n Cartier and Policy number are Gr,� rtie ;" �/~` Policy No,:)I�I' X75 CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE Mis aemien need not he completed Bthe .It is Into.hundmEdrllan($147) .r lees.) 1 certify that In the perfotmancc of the work for which Nis permit is issued.I shall not employ any person in any manner so ae to become subject to the Workers'Compensation Laws of c.lifund a.Dam Applicant NOTICE TO APPLICANT:,IL after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions of the labor Code,you most '.7z forthwith Comply with such provisions or Nis permit shall Is,decreed revoked. 'Z O CONSTRUCTION LENDING AGENCY 1Imrohythan that Nem is construction lending agency lot NC performance Of (Yr work(ser which This permit ts issued(Sec.3097,Civ.CJ Le W Q Lender's Name �z Lenders Address IJ Q I certify that I have this application and toad Wt the above information is COMMI agree to comply with all city and county aNinu as and sum[am totaling to OV building construction,and hereby aoNorie mpmunmivu ofthiS city manor upon the 117 aMvcmemi,med prooxy,for lnspeedor purposes. (WC)agree to sem,indemnify ad keep hamod.Ne City or Coper ino aSeloSt N liabilities,judgments,costs and expense which may in any my me=against sold City t„)7 in consequence of the granting of Nis permit. f—i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO POINT Issued by:9 Date SOURCE REGULATIONS. $ 03 Re-roofs Signature of ApplicanVC.Ouna, r Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicam or future Wilding acevpant atom m handle hna mus material aggliju deRtud by the Cupertino Municipal Code,Chapter 9.12,and du Health and Safety cede, Oyu 25s3z(a)? Iso/ _ All roofs shall be inspected prior to any roofing material being installed. ❑rce Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? El Y. @H� I have mad the Wand us materials requirementsur&r CMpmr6.95 ofdm Califor. ria Health k SalotyCodo.Sections 25505.25533 and 23534.1 undemmvd that little Wilding \ 0 dust not curtendy ham a tenant.Nu it is my mapomihil0y to wtify Ne¢cup t of the mquimmc Aicgvn the met prior issuance ofac.mlicmof Occu Y'"1 a Date q°, � �, Signature of Applicant ,, �� Owner or auNoriaedq m o m All roof coverings to be Class"B"or better Community Development Department Building Division 'J City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 OUPEkTINO 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: '` ` `/�a_+ Job Site Address: If 0 ,/, / l0/1- /�/� k aLL/Lt�.u_e� Roofing Company Name: �pa O_r / /r/,r� Z �a /- X C. A plicant s Signature: rLJ• Date: 69/0-3 Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO G 002_ REROOF 4 CUPERTINO PERMIT APPLICATION FORM APN# --- 7-- , x Z7Z) Date: 3 1 Building Address: LQ,16 / n Owner's Name: L(/ Phone#: %'73 -Jz2S C It tor: p Phone#: License #: 7�/L -9a 5o 2 6 Contact: f Phone #: Cupertino Business License#: /!d GZ. X Al z S 98'2-a Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles .2f 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# ❑ To be Removed - ❑ Provide Mfgr. Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Descri io T a ��"�'/� . c�� .fid yt Residential ZO Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Pl rd g I) t. if there are an re i tions: Cost of Project: vd Type of Construe o Occupancy gr p: 1q 0/ Qty. if, AopfliFah,,�e) 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 z 2,0 C�3