03050009 CITY OF CUPERTINO ""' "" ��• �` " 'e" �^ ` -•` '%•'�
t
BUILDING DIVISION PERMIT CONT xc-,T Ii,INFORMATI- .r .
-`-'.:K�Lss,••k£;0. '.*J..-'
BUILDING ADDRESS: -� LOS GATOS ROOFING PERMIT ND03050009
Ll 7P RTAPPOPT-) FIR
OWNERS NAME: 1771 SMITH AVE. pEEbm"SSbTA u2/2003
4NNIO
( SNE (408) 298-9399 SANITARY NO, CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
1=3 o 0 0
oo LICENSED CONTRACTOR'S DECLARATION M
�i fflrm
Job Description
1 outcry eNet I me I evasod under provision (comm
of Chapter 9 eneing
with Section 7MB mf Division l of the Business ant Profca m.Coda end my licaulo is
n in full torte and affect. a 7 REROOF
Zrs� Lieenw Class Cal I. �G o7
t- Dam Co mon-
ARCHTIELTSDECLARATION FON /rel LED
I undersunJ my post Nell be used as public rtordi 1I vG/J'�Il lL—.a
3 u Licensed Professional
0 OWNER-BUILDER DECLARATION JUN 1 2 M3
f 1 hereby affirm that 1 am exempt from the Contractors License Law for the
EQ o following mason.(Section 7(D 1.5,Bounces,and Profession Code:Any city or county
$ which requires a permit to cnnwct,aller.improve,demolish,or repair any stromu a
FSS° prior to its issuance.also requires the applicant(nrsuch permit he file a signed statement h —_a.
pp C that he is licensed pursuant to the provision of the Comr ore's License Law(Chapter 9 Sq.Ft.Floor Area ,. Z��181ion,
K $ (commencing with Section 7")ofDivision J of the Business and Profession Coca)or
3 that he Is exempt Nercfroce and the basis for she a11cgW exemption.My vlalWun of a
Section 7071.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 MAIY'I Oibu0 0 Occupancy Type
not mom than five bundmd dollars($SWI.
❑I,as owner of the property,or my employees with was.v Heir sole compen.don,
will do the weak,and Nestsumune I,not intended of frercd for We(Sm.7044,Bud. — FKAME and Profession Code:The Contractors Liane Law does not apply in an owner of 3 0 7 - INSULA eq ON d Inspections
property who builds or Improves thereon,and who does such work himself or through his
own employe.,provided that such improvements tic not intended croffered for sale.If, 601 ROOF TEAR OFF
howmic,the Wilding or improvement is sold within one yeas ofcompletion,theowner-
Wilder will have the Wrden of proving dist he did nut build Or improve for purpose of 602 - ROOF PLYWOOD NAIL
sud.j' ' 603 - ROOF BATTENS
❑[:as Owner of the property,em exclusively contracting with licensed contrecmrs m
construct the project(Sec.7044,Business and Prafessian Code:)The Comsactors Li. 604 — ROOF IN-PROGRESS
cense Law does Out apply man mare,of progeny who builds or improves Neeson.and,
who contracts fm such po jeeu with a cmmrsemds)licensed pursuant in the occurrences
List.Law.
❑1 w exempt under Sec, B&P C for this reason
Owner Data
WORKERS COMPENSATION DECORATION
1 hereby affirm under penalty of perjury one of the following dedva0onn: .
�I Mase and will mainwin a Cerditcam of Covent m wlf-insum far WOak e$CDmPen-
ution,as provided for by Section 77W mf the Labor Code.for the perform Tea,of Ibe
work for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Suction
of the Libor Code,for the Performance of she work for which this permit I,issued.
My Workers Compensation Insurance tamer and Policy number vee:
Cartier. S7)OW 14440 PolicyNo.: 7,779' LOu3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ibis semien need not becomplelod if the permit u furore hundrcddolhrs(SIM)
nr seas.)
1 eenify Nat in the performance of the work for which this permit is issued.I shall not
employ any person in any manncno at to become subject to the Worlans Compensation
Laws of California.Da¢
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exc n,tion,you should
become Subject to the Workers Compensation provisions of the Labor Crude,you must
�Z forthwith comply with such provision or Nis permit Shall be deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
[r IbembyalOrm Nat there h a construction lending agency(or lo,perfurma,ue of
C,7 the work for which this permit Is issued(Sec.5097,CO.C.)
Qundch Name
z Lenders Address .
r,0 1 ani(y thv 1 have reed this application and sate that the above Information is
{T.F correct.1 agme to comply with all city and county ordinances and sum levet retstut to
�(J building construction,and hereby authorize representatives of this city to color upon the
[31 above-mentioned p.pcny for inspection purposes
(We)agree in save,indemnify and kap hummas the City of Cupenino against
ccAA liabilities.judgments.costs and eapen.which may in any wayaccmu against aid City +
V 7 in comegnnce of No gaming of this permit.
fi APPLICANT UNDERSZANDS AND W4L COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGU . �7 ,/7'13 .
/ J Re-roofs
Signamm otAppihartoCantractorDam
HAZARDO
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Willy t e Cupent v future Wilding e.Chapter
m handle h Health and Safety ss dented by six Cupertino Municipal Code.CNpmr 9.11,and Ne H.IN and Sa(ery
,gNILCode,Seehon 15551(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑YCS (INu
Wel 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
mit haxamous air contaminates,as defined by the Bay Am&Air Quality Management all new materials for inspection.
,f Disuic17 �}
❑Ycs Lrywb
Ihave mail the ht,Sectusmamrialsrcquimmems 5534.1 usnuand.95 ofthe bolifmr-
vies non Co Stificlentlyhave.Smvauhat it i myna,5533 ss53a.I unsnuM le up ,ifthe
dos notem s whit have a tenant then it u my rcapo(a ccatY a to OfY tbe aauput of the
rcyuimmcnty sow= ierpriyr vancc o(s Ccnificalo of Occup¢ / Signature of Applicant Date
Owner Or,uNodzed agent // Oslo All roof coverings to be Class"B"or better
Building Division '
r 10300 Tom Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
• CUPEkTINO Pax (408)777-3333
Building Department
Subject: Reroofing policy for the City of Cupertino.
I. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of W"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: i (Al n n
Address: IM ��� Fago rd O F .
reroofing Company Name: b-O S
Applicants Signature: b Date 2
Joe Antonucci
(Chief Building Official)
6MI01
CITY OF CUPERTINO
GQ REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 2 — i I ODI Date: O O
y3 3
Building Address:
11 '7 8 S�'a v r D
Owner's Name: Bill n I `Y Phone#: , 6? Z52-2667 S2-2667
Contractor: �os /��OS one#:�I/� ^9G 399 License#: �OO 707
19— boa Ih /U �( 0
Contact: Phon #: Cupertino Business License#:
7ina ��� ��� ; Db' r�-9 9 z3y81
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
;2!C Wood Shingles ❑ Wood Shingles
❑ Other(Specify) /'d Other(Specify) 41b .301b Fel
Number of existing coverings ❑ Provide I.C.B.O.Iteport#
X To be Removed ❑ Provide Mfgr.Installation Specs. S Six
I Have Read, Understand and Will Com2ly With Cu ertino's Tear Off Polic :
Job Description: �� �, v' 7� ' T4 y
0.6a � . -,.?-
Residential Commercial p
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: Ll
Cost of Project Type of Construe ton: Occupancy group:
Qty. if
A li e Fee M 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
1 ? g . Z�