03100079 f CITY OF CUPERTINO
BUILDING DIVISION PERMITC ONTRACTORINFORMATION.`
BUILDINGADDRESS: RESPONSIBLE ROOFING INC PERMIT Na 03100079
9r2n TA MAR QT
OWNER'S NAME: 2882 SPRING ST Peamrr Lssue Dnre
)NE: (650) 969-6151 SANITARY ND. CONTROL NO.
ARC((ITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
!00 LICENSED CONTRACTOR'S DECLARATION O O O O
td F 1 hereby affirm shut I am licensed under provisions of Chapter 9(commencing .lob Description A/
.zjW wrh5enion7 )Zivieion3oflheliusinw apd Professions Code,end my license la
in full force a ccs ci. ✓ o, REROOF
q^ License Clogs -'— Lic.N1 (�
qqq
Data Cumracmr RA
1 qW ARCHITECTS D �I
ut< l unticrst my phnsshali W used a public records
o
0 Licensed Professional 3
v,3 Oat I am exempt
from
DECLARATION
1U 0 i naso .firm on 1 am exempt from the Contractors License Lew for the
O o following reason.Section 703 1.5,Business and w.de um Code:Any city or county
$ which its issuance.
apermit re,aims the nhcgimprove,h leorilt ore a sig oilysuucmu
tprior hat he
s issuancpuralso reyn the hinisli cant for sucCont=miuoflcae Law ned(Chapter
(commencing
wit retortion puntion 700)of Divinvof rhehe Business
usies iLi¢nsessor C Conn)or Sq. Ft. Floor Area Valuation
2 $ (cat he Is exempt therefrom
Tr an)of basison3nf theegedexeand
on.Any
Codc)ur
JJ Nut he Is exempt therefrom and the basis for the alleged exemption.Any vimatinn of 36925040 . 0
Section 7831.5 by any applicant for a permit subjects the applicant to a civil penalty or APN Number Occupancy Type
not more than fns hundred dollars(S500).
0 1,u owner of the property,or my employees with wages as their sole compensation,
will do to work and thesbucture is not intended or offered for sale(Sec.70 ,Business 305 — ME
and Professions Codc:The CantracmM1 License Law does not apply to an owner of Re wired Inspections
property who builds or improves thcrehn,and who dura such work himselfor through his 307 - INSULATION
own employees,provided that uch improvements are not intended or offered forule.If, 6O1 — ROOF TEAR OFF
however,the building or Improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not Wild or improve fur purpose of 602 - ROOF PLYWOOD NAIL
Calc.).
0 1.as owner of the property,am exclusively contracting with licensed characters to 603 - ROOF BATTENS
consumer the project(Sec.704k4,Business and Professions Code)The Cormwtorb LL 604 — ROOF IN-PROGRESS
cove law does not apply in an owner of property who Wilds or improves Neuron.and,
who contracts for such projects with a contractor(s)licensed pursuant to the Conu xCtots
License Law,
0 l ern exempt under See. B A P C for this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Corti ficate of Consent to self-insum for Worker'sCompen-
Ily
on.ss provided for by Section 37W of the labor Code,for the perfo.....f the
rk for which this permit is issued.
I have and will maintain Workeh Compevuion Insunnm,as inquired by Section
0 of Ne labor Chile,for the performmce o(Ne work for which Nis permit is issued.
Worker.Compensation lnaumnce ca ¢rand Policy number art:
Me':
� X hlicy No.RO:`N/,
C R CA NS NFRAN RR'RS'
COMPENSATION INSURANCE ,
(This section need not W completed if the permit is for one hundred dollar(S1RB
or less.)
I certify Not in the porromtonce of the work for which this permit is issued,1 shell not
employ any person in any manner m as to become subject to the Worked Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:if,after making this Cerifmam of Exemption,you should
become subject to the Worker's Compensation provisions of the lahor Code,you must
�0 forthwith comply with such pmvishim nr Nis permit 0.11 W deemed revoked.
z'� CONSTRUCTION LENDING AGENCY
1 hereby affirm that Neu is a Construction lending agency for the performance of
Yrs the work for which this permit is issued(So,.3897.Co.C.)
31 Lender's Name
=3. z Lender'sAdd=
;J 0 1 certify Nat 1 have read this application and sure that thc above information is
y U chiming I ague to comply with all city and county ordinances Of and sou lens relating e
V building construction,tioneand hereby inspectionrzreprnenutiws Of this city to enter upon the
„ ahnvc(We)agree
properly for inspection purposes.
(We)agree Ih cove,indemnify and keep lournicts;
an the City of Cupensts ageinm
rZ liabilities,judgmentse gracing expenses which mayinanywyeccmc against said Ciry
Z in APPLICAeNTeor UNDERSTANDS of Lhis AND WILL COMPLY WITH ALL NON-POINT Issued by: (/ lU(�V Date
SOURCE REGULATIONS
Re-roofs
Si sou of Apphcm onrrumr Date
HAZARDOUS MATERIALS DISCLOSUR? Type of Roof
Will the applicant ser future building occupant store or handle ha/ardours martial
as defined by the Cupenino Municipal Code.Chapter 9.12,and the Health and Safely
Code,Seelion 2553](.37 10< All roofs shall be inspected prior to any roofing material being installed,
' ❑Yrs
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
ifhavaNn I air chmaminanst as defined by the Bay Area Air Quality Management all new materials for inspection.
uuict?
❑Yrs V.
I have mad Ne WraNnus mamrialamquimmcnu under dersw 6 atof Ne building nitss noth55afmyCode,Count,
iti my responsibility
in nouly the
Wilding
does not Currently haw a tenant.Net itis my rcspnnsihility ar nouly the rxsupant ar the
requimmenu which Must hi poor to hourenc or a Ceafeam of metifout . Signature of Applicant Date
s�Owcr ser autheir agent Dau All roof coverings to be Class"B"or better
,
Community Development Department
km�` Building Division
va
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
U P E IST I N O 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: M✓S • R-i Adel
Job Site Address: I q CD2.O LC rr-)CAv- C6 -
Roofing
6 -Roofing Company Name:
yKes p }n/ S_1_bl-e KCX'li-1 ra -ri'1C..
A plicanYs Date:
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO o3 ( a 0--b 7
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # D
ate:
.loci-z5 -04C 0-1
Building Address:
1CJLQZn Lct M(tr- C4— .
Owner's Name: Phone#:
Mr 1 � (4ce) ( 7 —
Contractor: Phone#: License#:
2e r15 b S C s P�- 32• O
Contact: Phone#: Cupertino Business License#:
ea —
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof Er�Built-Up roof
®Asphalt Shingles Gas Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O.Report#
aYTo be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: 9—
Job Description:T2cav o-F( 4 dispose ex i 5-1-tvtr) rocs . A PF> to r\.t w ODry1p�,Si inch
:4 f7i e I -S rOU�
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning a t. if
there are any restricts
Cost of Project: Type of Construction: Occupancy group:
t o� IZ e-rorX
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