03090241 CITY OF CUPERTINO
BUILDING DIVISION PERMIT WONTRA6;T-0 INFORMATION rc
UU]LDING ADDRESS: CUPERTINO CITY OF PERMIT"x.03090241
OWNER'S NAME: PERNIU ISSUE DATE
. CUPERTINO CITY OF /-�n/2nni
NE: SANITARY N0. CONTROL NO.
ARCHITECTIENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
!00 LICENSED CONTRACTOR'S DECLARATION
{u C I hereby affirm that I am li¢nscd under provisions of Chapin 9(commencing Job Description
i]2w with scnion]Ofgpnf Divisian]of the Business end Prufcoion Crede.end myliccnse is
,moi In fall fo...Oil affect. REROOF (STORAGE SHED)
tqZ License CIasSLk.0
Date contractor NO PERMIT FEES FOR CITY PROPERITY
ARCHITECTS DECLARATION
i I understand my plans shall he used as public records
)yU
C Licensed Profeoional
R
OWNER-BUILDER DECLARATION
iX 1 hereby affirm that 1 am exempt from the Contractor's License Law for the ,
:n o following reason.(section 703i.S.Business and Profession Code:Any city or county
i$fl� which requires a permit to construct,alcor,improve,demolish,or repair any swclum
.xi priorto its issuance,ahmon obi the applicant forsuch remount file a signed statement
s—<
that he is licensed pursuant to the provision of the Commetor's Liecmc Law(Chapter 9 Sq. FL Floor Area Valuation $0.
2�to (commencing with section 7")ofDivision 3 O the Busincas and Professions Code)or 7
$ Net he is exempt Nerelrom and Ne basis for the alleged exemption.Any violation of �,ewv rat[,. 1e
Section 703 1.5 by any applicantfor a permit subjects lbc applicant to a civil Penalty Of 3eaasy YW�IOe100 Occupancy Type
not more Nen five hundred doll..($500).
I,as own.,mfdm propeny,or my employees with wages as their ante compensation,
will do the work and am structure is not intended or offend fonsie(Sec.]Osa,Business Required Inspections
and Professors Code:The Contractors Liana law docs not apply tom owner of 305 — FRAME q p
property who builds or improver Nemon,and who doessuch work himself orthmugh his
own employees,provided that such improvements are not amended oroffertd fmsale.If. 307ve — INSULATION FINALE0
hower,Ne building or improvement is sold within one year of completion,ac owner•
builder will have the burden of proving that he did not build or Improve for purpose of 601 — ROOF TEAR OFF
salt.).
❑ I.as Owner of the propeny,amexclusively contracting wish licensed contractors to 602 - ROOF PLYWOOD NAIL OCT 15 2003
construct Ne project(Sec.7W,Business and Profession Code:)The Conwactori Li. 603 — ROOF BATTENS,
cense law does not apply in an owner of property who Wilds or improves lhemon,and, 664 — ROOFIN-PROGRESS
who contracts for such projects with a contraclons)licensed personal to the Contractor's BUILDING
License Law.
I am coact 4 oder seer .B k�P C,for t�his�rcQnon
Da
WOR K ER'S COM PENSATION OECD N
I hereby arm under penalty of perjury sere or
o lowing declarations:
I have and will maintain a Ccnirmate or Covent to selfdnsun for Worker's Compere
...iun,as provided for by Section 370D of the labor Code,for the perrmmance of the
work for which this permit is vowed.
1 bars and will maintain Walkers Compensation Insurance,as required by Section
3700.1 ac labor Code,for Ne r mr.mornce of Ne weak for which this permit is issued.
My Workers Compensation Im ounce artier end Policy number art:
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE ,
(Thissection need not be completed if the permit is for one hundred dollars(5100)
or leo.)
1 certify Our in ac arfmmance of Ne work for which this Permit is issued,I shell not
employ any person in any manner sus as tar become subjceuo the Workins Compensatlon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenifreale of Exemption,you should
become subject to the Workel a Cam pcnsation previsions of Be labor Codi you mail
�z forthwith comply with such provisions mthis permitSollbcdeemed.yoked.
ZO CONSTRUCTION LENDING AGENCY
I hereby affirm an them is a construction lending agency for performance of
X> to work for which this permit is issued(Sec.STN),Civ.C.)
31 c Lender's Name
Z Lender's Address
;•J Q 1 cerdfy Nal I hast read this application and roto that the above information is
y (✓ coven.l agree to comply with all city and county oodinanas and stato laws relating 10
V building conlnction,and hereby authorise representatives of his city to enter upon the
N W "hove-mentioned property for inspection purimsea
�
(We,)agree to save,indcmnefy and keep harm leo the City of Cupertino against
�y liabilities,judgments,costs and expenses which may in any way accrue against said Ci ty
j in consequence of the granting of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE AZIONS.
Re-roofs
nmure of AppliemUCanvaclor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupant sure or handle,haboduus material
as donned by the Cupenino Municipal Code.Chapter 9.11,and the Health and Safety
I
aSection lssnl(a)? +_ . All roofs shall be inspected prior to any roofing material being installed.
❑YG �T
Will the applicant or future building Occupant sax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It In....dnus air coastal is as darned by NB Be,Arta Air Quality Management all new materials for inspection.
❑Yea NitIhA,Samtachaxanlnits ons Z5 i,255uimme5534.IerChostand 9sofba CaldngHealthave ad to hasection lSNIS,133JBandtuatclrCh:rstae,6dead.95fNB buildings not currently ban a tenant Nat it is my responihisly in noufy the occupant of aupmm ichmuslWmetpd.,I.uUuanaoraCmugcatoofQccupan �, Signature of Applicant Date
tom' �� �/''�11 -77 .All roof coverings to be Class "B"or better'
nor m auNori'rcd agcm Doc
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST A 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 st ed policy on re-roofing.
Homeowner's Name:
Job Site Address:
.Roofing Company Name: ,`
A plicant's Signature ate: O3
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
Iwo REROOF d
CUPERTINO PERMIT APPLICATION FORM
APN# I _ VOL Date: o ?
�V
Building Address: ) '
Lr4 I
Owner's Name: �(Ihone :
G ? Of Cv p�.rTt t& 717- 3x72
Contractor: Phone#: License#:
Contact: Ckels Orr
Phone#: - Cupertino Business License#:
1
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles `� Asphalt Shingles
ood Shakes �j Wood Shakes
ood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply Wit U ertino's Tear Off Policy: ElJob Description: K C _D /,
Residential E] V Commercial/11
Fire Zone: Yes ❑ No� Confirmed with Planning D f
there are any restric • s:
Cost of Project: Type of Cons tru Occupancy group
VC
Qty. i
Ap 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
SCI