03020037 '! CITY OF CUPERTINO ,'-r r "1
BUILDING DIVISION PERMIT CON CRACTOR INFORMATION: .'.
BUILDING ADDRESS: FALCON ROOFING PERM] NO.
10128 MYER PL 03020037
\ OWNER'S NAME: 13088 POTTS DR APPLICATION SUR DATE
RICHARD & DIANA LORDEN 02/11/2003
NE: (408) 225-1705 SANITARY NO, CONTROL NO.
AROUTEC IENGINEF.R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�Op LICENSED CONTRACTOR'S DECLARATION
m uZ F I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
ywith genion]I 1)uf Division 3nf NC Bum.sanJ Pnsfcasions Code,and my is
H=N in full fore elle}. X. RLi'ROO Fi'
y= Licen Ln p
?mow Dam rnm7032 LT6
octor REPLACE W/ 1/2 " OSB & 50 YR. COMP. SHINGLES
ARCIIIIliCTS R TIO
a:,.< I understand my plans shall be used as public rttnrQr F'N r/`/ay
L 'E
30.E Licensed Professional
'=0, OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt hour the Contractor's License Law for the MAR 1 8 2003
a a 0 C fallowingre, a(Secuun 7131.5,Business soil Profesxions Cove:Any city nr county
w 5l� which requiters a Permit to construct,alter,improve,demolish or repair any structure
prior to its issuance,elan requires the applicant for such Permit to fie a signed statement
Facthat he is licensed pursuant to the provisions of the Contractors License,law(Chapter9 Sq. Ft. Floor Area B,uI � O❑
ret_ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i 3 Nat be,B exempt thercRom and Ne baso for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant 3o a civil penalty of APN Number Occupancy Type
not man than eve hundred dollars(ssan. 31623044 . 00 p Y Yp
❑1,a owner of the put or my employees with wage m their salt compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7814,Business
and Pmfeuions Coda:Tim Contractors License Law does not apply to an owner of 305 - FRAME Required Inspections
properly who builds or improves Orman,and whodoes such work himulf or through his
own employees,provided Out such improvements are not intended ofoRered latitude.If. 307 - INSULATION
however,be building or improvement is sold within one year of completion,the owner
huildcr will have the burden of proving Wal W did nor build or improve for purpose of 601 - ROOF TEAR OFF
scale). 602 - ROOF PLYWOOD NAIL
❑1.as owner of the properly,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
construct the project(Sec.70,14,Business and Professions Code:)The Contractor's Li-
ceneseLaw does not apply to an owner of property who Wilds or improves duction.and 604 - ROOF IN-PROGRESS
who coraco for such projects wit a ennvactor(s)licensed pursuant o the Contractor's
License Law.
❑I am exempt under Sec. ,B&PC for this remain
wrcr Dam
WORKER'S COMPENSATION DECLARATION
1 hereby alRrre under penalty of perjury one of the fallowing dcclarniuns:
I have and will maintain a Certificate of Consent m If item,fur Worker.Co.,..
sation,as provided for by Section 3700 of the Labor Code,for We performance of the
work for which this permit is issued.
I have and will maintain Workers Compensation lavorce,a required by Section
3700 of the labor Curie,for the performance often work for which this Permit is reJ.
My Workers Compensation/In.surance carrier and Policy number am: UN[I
Carrier: �'�OT Tmla,/eJ Palmy v.: - -
c / CERTIFI�"IWI • OM WORKERS'
J�( COMPENSATION INSURANCE
Grossection need not M completed if IM permit is fnmmc hundred dollars(Slip)
or less.)
I cenify Oat in the performance of the work for which this permit is issued,I shall net
employ any person in any manner ser as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cer ificam of Exemption,you should
Become subject to the Worker's Cumpcnaation provisions of the Labor Code,you mail
0 forthwith comply with such provisions or this Permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-. .�. I hereby a0irm tat there is a construction lending agency l'unhe Performance of
the work for which this Permit is issued(Sri.3097,Cie C.) V
Q Lender's Name,
z Lender's Address
O Q I certify tat l have read this application and sum that the above information is
Ly P curtect.I agree to comply with all city and county ordinances and state laws relating to
O U building construction.and hereby submiec representatives of this city to enter upon the
above-mentioned p.,try for inspcninn purposes.
y (We)agree to save,indemnify and keep harmless the City of Cupertino against
fA Imbiliria,judgments,costs and expenses which may in any way action againsrsaid City
U z APPof the granting of ts Permit.
LICANTrarqucncCUNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Dat
SOURCEREGU nobs
Re-roofs
nam fApplicanVComranor a
IIAZARDOU SMATF.RIALSDISCLOSURE Type of Roof
Will due applicant or future building occupant store or handle heallous material
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
cure,Section 25532r>7
0exs XNn All roofs shall be inspected prior to any roofing material being installed.
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
n it handous air cunrami units as dclinel by the Bay Area Air Quality Management all new materials for inspection.
DislricR
❑yes
1 have read Oc hummous materials requirements tinder Chapter 6.95 of to Callum.
iia Health as Safely Cale,Sectors 2.5.515.25533 and 25534,I understand that if the building
does not currently have a mmol.Ont it is my responsibility m notify the tccupnnr of the
requirements which must M mel pdnnolssu cola C-rsicmnn Otic Pwcy Sign uaf re of Applicant I? (C
All roof coverings to be Class "B" or better
0 oraurhnrivndagcnt Date,
1
,...a Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkT1NO
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 c1i �—� L a✓�r nl
Job Site Address /�Z/2i/ P�
Roofing Company Name/ /
Q
A plicanYs Signa e: Dat
• Greg teel
Building Official
Revised 1/30/03
Printed an Recycled Paper