03070214 a CITY OF CUPERTINO
BUILDING DIVISION PERMIT V CONTRA TOR INFORMATION
BUILDING ADDRESS: MAXIMUM ROOF CARE CORP PERMIT N003070214
497 KTNqqRTTRV PT.
OWNER'S NAME: 423 QUEENS LN PERMIT ISSUE DATE
BUCHHOLZ GILBE
NE: (408) 441-0933 SANITARY NO. CONTROL NO.
ARCHITECIDENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MF.CH
E 0 0
fop LICENSED CONTRACTOR'S DECLARATION
�wp 1 hereby affirm that I am liunud under previsions or Chapter 9(commencing Job Description
6W wiNScaion)otkp sf DivixionJof Nc nusinuss ad�.Prurcssions Cndc,andm Bcnse is It=8lll1 61 ti 2^
A. in mu,t2z Limit,m ,n fife /�' ' OJ REROOF F n V da'P Lr=n ••
-=a DamC' Cuolactor
f R I7ECTS DE N AUG 1 ? 2003
2 n U u demand my plans shall w used as puhli rnNs
e o.U; Licensed Pmfessioml
u D,g OWNER-BUILDER DECLARATION BUILDING
UI6. Vt
DIN^
1 hereby affirm Nm I am exempt from the Contractor's License Law for the LI
OO following mason.(SCsvon 7031.5.Business and professionCode:Any city or county
5 m which requires a pe,mit to construct,eller,improve,demolish,or repair any suuctum
_ie prior to its issuance.also requires the applicant for such permit to rile a signed statement
-Zta NathcisLice nuJpursonnunNepmvisinnsnfthe ConuacmriLimnuLaw(Chaprer9 Sq. Ft. Floor Area Valuation
21 (commencing wi N Section 7000)of Division 3 of the B usiness and Pmifcoima Cook)or
2
that he is exempt therefrom it the basis for the alleged eaempion.Any mustno of 36229024 . 00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not mom than five hundred dolhe($500). - - - - _ Occupancy Type . _
0 1,As owner of the prepeny,ar my employees with wages as Nei,sole eompensmioo,
will do the wort.and the swcture is not intended or offered for sale(Sec.7064,Business ������
and Professions Code:The Comaaofs License Law docs not apply to an owner of 3 0 7 - INSULA"8Vd Inspections
property who builds or improves thereon.and who dussuch work himself or through his
own employres,provided that Such improvements are not mmnded or offend for sale.If. 601 — ROOF TEAR OFF
however.Nar e building or improvement is wild within one yeofcompledon.Neowner-
builde,will have the burden of proving that be did not wild or improve ter purpose or 602 - ROOF PLYWOOD NAIL
ala)' 603 - ROOF BATTENS
co I,as owner of the property.am exclusnessively contractingss with:itched contractors i-
caa0uct shoes not pplytoancormaSm.70414. rofprnprywho bur Co orJThe Cs tractorsftmon.And. 604 ROOF IN-PROGRESS
cense Law docs not apply to an owner of property who builds or improve Centra.and
whonse Laces for suchprejecu with a conmaor(s)liunud pursuant to the Convenors
License Law.
❑lam exempt under Sec. ,B&PC for this moon
Owner Date
WORK ER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one Of the following declnrniom:
I have and will maintain a Certificate of Consent to self-insure for Worker's Cumpen.
urian,as provided for by Section 3700 of Ne labor Cade,for the pe,farana of de
work for which thi,permit is issued.
0 1 hoc and will maintain Worker's Compensation Insurance,a required by Section
370E of Ne Labor Cade.far the pedarmuce of on,work for which this permit is issued.
My Worker's C`�•peosationa l�nsunnuc ler and`Policy number am
ClrtisR: �7'TP a,.f,4NA,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(Thu auction need not hecamplAu:d if the permit is fm one hundreddnllan(SI00)
m less.)
I ceniry that in the perfn,manu of the work for which this permit is issued.I shall not
employ any person in any manner an az In become NbjWL to the Workers'Compensation
Laws of C.lifomi..Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should -
become subject to the Worker's Compensation provisions of the Labor Colic,you most
=O forthwith comply with such provisions or this perm itshalI w deemed revoked.
.Z.'y CONSTRUCTION LENDING AGENCY
I hereby affirm that Vert is a coauuetino lending agency for tw Nrrurmane,of
Y, the work fur which this permit is issued(Sec.3097,Co,C.)
13 Lender's Namc
Z Lcnde,'s Address
J Q 1 certify that 1 have read this application and sure that the above intonnatiun is
cora 1 agree to to Comply with all city and county ordinances and state laws relating to
JU building construction,and hereby authorim reproenodives Of Nis city to enter upon the
D. (We)agree to save,indentnl ry and keep harless the City of Cupertino against
N liabilities.judgments.casts and expenses which may in any way accrue against said City
Jz APPLICANTe NDERSTAf the Nufthispermit.
APPLCE UNDERSTANDyyAND WILL COMPLY WITH ALP NON-P INT Issued by: Date
SOURCE RE Ul,m')ONS. 1 / �
�/ v
Re-roofs
yature Of ppl Date H ZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam ser future wilding occupant stem or handle ha'vrduus material
As dented by the Cupeni no Municipal Code,Chapter 9.12,and the Health and Safety
code,section 25532(a)a
❑Yea All roofs shall be inspected prior to any roofing material being installed.
will the applicant or tore building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hamrdous in comammanya defined by Nc Bay Arca Air Quality Managcmcm jnewaterials for in ection.
isuicR ly}/'��^,',
0 Yee
I have mad the h.mous ntawthils mqui emenu under Chapter 695 of Ne Califo.
ma Health Safcty Cook,Scctiva 25X15.25531 and 25534.1wdcrstand NaifNc wildin
docs not cury have a tenant N t y reapomihilily w notify the occu ant of
requirements iGh uu be met r eeofecenlficateof Ocean .
u Signature of Applicant Date
o rte aria ,gen,
are All roof coverings to be Class 'B"or better
Community Development Department
Building Division
City of Cupertino
'Ulu
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
U P E IST I N O
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:
Job Site Address: ,`7 p
q 7 KI n-.0 th�c, Cid'
0
C /+"
Roofing Company Name: (_ mj ry p lam!-rr
Aplicant's Signature: / Date:>7`d.3
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 7 i
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# / (" -z- _ .Z G_ O 2—, Date: , v
Building Address:
Owner's Name: Phone#:
cn�k6
Contractor: Phone#: License#:
�yv�,L �vr• � Cn� yfve-14,1-0933 S os�4(-G
Contact: S L Phone#: Cupertino Business License#:
-p �---Cola - 5%to-7 C.
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings IE Provide I.C.B.O.Report# i-.K. Shy
To be Removed Z ❑ Provide Mfgr.Installation Specs. ,� c"
. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
K.c reb'F t.441 CL k 3-Or Qtr , 3 f44,n 0 <,r
Residential f Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are an restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
1
Qty. if
A li Fee ID Fee Description Fee Group
/ BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
-2,
7 S