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03060021 CITY OF CUPERTINO CONTRe'C'109INFORMATION BUILDING DIVISION PERMIT ,, ,- BUILDING ADDRESS: DAVE SMITH ROOFING PERA9717 N003060021 20121 FOREST AV WNER'S NAME: 1052 KELLY DR PB`B"""W"3/2003 HIN HIU H AND CHU MAY I NE: 5 973-9427 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH I� t 0 0 u00 LICENSED CONTRACTOR'S DECLARATION JbDescription i u F I hereby affirm that 1 am licensed under provisins oof CNpmr 9(roo mmencing a¢ with Section 7(OR)of Division 3 of the Business and Profession¢Code,and my license is . ase in full forteandefrect. (-- Sa� REROOF �� 5 z Lucca.Class 1 Lk.II .] �® �— Detc� = Cuntracmr — "' AilNl I'S DECLA ON �i Iundersu.d my plana¢hall heused u public me.,& JUN 0 2003 a.�yU G Licensed Professional OWNER-BUILDER DECLARATION I 1 thereby affirm that I am exempt from the Contractors License Law for Inc BUILDING p O following mason.(Section 7031.5.Business and Professions Code:Any city or county $ which mquires a pmmii to colulruct,slier.improve,demolish,or repair any stmctum F Z< prior in its issuance.also requires the applicant for such permit to file a signed statement that he is liconaed pursuant o the provisions of the Contractors Lico,vc Law(Chapter 9 Sq.Ft. Floor Area $8`QQQtion Ad (commencing with Section 7")of Division 3 of the Busiacm and Professions Cade)ser that m u exempt therefrom and the basis for the alleged exemption.My violation of SeNon 7031.5 by airy applicant for a permit subjects the applicant w a civil penalty of not mom than fnvo wMred dollu.(95f1o). a Occupancy Type 0 1,as owner of the Property.or my employe"with wages As them sole companssdon, will do the wad:and the suacture is wt handled ca offerW for sato(Sec.70".Business and Profossio"Code:The Contractors License law does,wt apply to an owner of 307 - INSULA jfd Inspections property who builds or improves thereon.and who does such work himself or through his own employees,provided teat such improvements Are not intended oroffered for sale.If, 601 — ROOF TEAR OFF however.the Wildmir.,improwment is sold within aro year.fwmpletion.the owner- 602 — ROOF PLYWOOD NAIL Wilder will haus the burden of proving that he did oat build or improve for purpose of .am.l. 603 - ROOF BATTENS 0 1,As owner of the property,am eaclusively contracting with licensed contractors in 604 - ROOF IN-PROGRESS cotswct the project(Sec.load.Business and Professions Code:)The Contractor's Li- cesue law dors not apply to an owner of property who builds or improves thereon.and who contracts for such projects with a cunarmum(s)licensed Pursuant in the Contractor's License law. O L am"Amid under See .B k P C for this reason nor Data WORKERS COMPENSATION DECLARATION I hereby affirm under pe"Iry of perjury,arc of the following declarations: I have and will maintain a Cenifiam of Consent m self-insure for Worker]Compen- sadan,as provided for by Section 3100 of the labor Code,for On Performance of die work for which this permit is issued. 1 haus and will maintain Workers Compensation Insurance,ss required by Section 310p f the labor Code,for the pvfarm ncc of the wort for which this pcmit is issued. My abets Co pensation Imunnec canter end Policy number am: mer. C Policy No.: CERTIFICATE OF EXE ONFROMWORKERS' COMPENSATION INSURANCE (rds section need not w completed if the Permit is for one hundred dollars IS lib) m kss) I unify that in the perfomanee of the work for which this parent,is issued.1 shall not amp in any manner an As In are subject to the Warta.'C Laws of ompensation glifo am Applica 11' NOTne LICAI�Fi(' penkmg this Cisions of of Labor Exemption.you usmoW a= become subject to the worker's Compensation orthis pmvialoaa ofd a labor Code.you mus .J,� Forthwith comply with such provisions or this permit shall be deemed revoked. Z O` CONSTRUCTION LENDING AGENCY 'ce: I hcmhyafffm the,them ismed(Sac. lending .) Porth Performance of a dm work fur which this permit is issued(Sam.7091,Civ.C.) aQ lender's Name z tendert Address U C) 1 ccnify that 1 have mad this Application and sure that the above information is Coma I agree to comply with all city and county ordinances and ante laws mhting to 0U building construction,and hereby ausodm representatives of this city to enter upon the W .wvetmcnuoncdpropcc fond epcetion purpowhich (we)agree m save,indemnify and keep harmless the City of Cupertino against h liabilidu,judgmcnu,coca and ea pc"N which mayin Any way ucnm against mid City C.) z m earthsg""ANDfthis permit. Issued by: D APPLICANT E ANDS AND WILL COMPLY WITH ALL NON-POINT SO CE EGUL S. Re-roofs bignunumsaPeapplicarmontractor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building uecupant nos or I Ic hva doom nal u deB"d by the Cupertino Munitlryl Cade.CTapur 9.12,and the H"Ith and Safety ode.Section 35332(x)? All roofs shall be inspected prior to any roofing material being installed. [3 Y. Will the applcant or mum wilding aecupaat am equipment or device,which If a roof is installed without first obtaining an inspection,I agree to remove ami,he,Mus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Disvin? P KYce _--�No I have sept Ne hvaNsmsmaurials rtquiremcnu under .Chapurd.95 of the Califon nie Hcolth 65afc,yCoM.Secuo"25505.25577 and 25574.1 untkrsund this irdo building d ady have a moan this it is my mapmuibility b noufy do occupant of Ne re rose ts n.tw a vdartoI....at.Caruf"uAIOcca Cy. Signature of Applicant Date -D3 Owner Atauthorivedagent Dam All roof coverings to be Class "B"or better Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 IUPEkTINO 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. G 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: / r U 1 1 Job Site Address: z CJ I `Z Fd2 e 5 + t� Roofing Company Name: A plicanYs Signature: I Date: Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper r CITY OF CUPERTINO o oKo o 2-1 REROOF CUPEkTINO PERMIT APPLICATION FORM APN# //_ 3 2 L/ � Date:O Building Address: J J Owner's Name: Gh 1 r� Phone#: U Contractor: Phone#: License#: Contast, Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt ShinglesAsphalt Shingles _ M 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. SI Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: �q S `,Q Inc S _-Di s+9 I �4-e I Z D.S�3 Residential--g] Commercial ❑ Fire Zone: Yes ❑ Confirmed with Planning De t. if there are anv restrictions: LJ Cost of Project: Type o Construction: Occupancy group: g Oct V 2 Qty. if Appliw6e 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 i �37_ 00