03050116 CITYOFCUPERTINOw ",m «. �# za .zm-¢;
BUILDING DIVISION PERMIT CoNTRAGT®R IN "0RMATI,0 a,
.F*.. .a�l4h>•:
BUILDING ADDRESS: PERMIT NO.
03050116
M PERMIT ISSUE DATE
05/23/2003
SANITARY NO. CONTROL NO.
ARCHITEC77ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Sop LICENSED CONTRACTOR'S DECLARATION Job Description
Ii1 hereby el0sm Nat I am theoxed under pnorud as or Chapter 9(rommeneiot
< with Sutton 7IXq)of Division3.f da Bueinrsa end Professinm Code.ender locations
:5: Licevrc ands , s, Lk.a REROOF 9=
?F Dau: Conauor
ARCHf1ECTS DECLARATION CONTRACTOR: CENTRAL COATING CO.
aj I undersand my plena dull he used as public me urdt
JUL 2 9 2003
5 U
9.� Licensed Professional
OWNER-BUILDER DECLARATION
I hereby afllm that I em exempt from Me Corm clot's License Law for the Q.7�'���pg/±
�00 following reason. 71315,Businear and Pofendou Code:Any city or county ltl Vl
Sa which aqui.a Permit to cnnsuuct.alar.Improve,demoltah,or reptir any structure
- ^ prior an its issumae, lorequires lW applicant for such permit to file a algnedrtatemenl
£gyp that he is lieciod on....l to the provitlnne of the Comnerm's U..Law(Chapter 9 Sq.Ft. Floor Area Valuation
y $ (commencing with Section 7000)of Division 3 of the Business and Proraelou Code)m
that be is exempt Ncrefrom and Ne basis for Ne alleged exemption.Any vloleuon of
Sudan 7071.5 by a"applicant far a permit subjects Ne applicant a a civil penalty of APN Numberccupancy Type
not mom than five hundred dollars(1500).
(D I,u owner or the property,or my employ.with wages u Ncir role ampensa0on,
will do Ne work and de,aWeruTo isnot intended Manered for ask(Sec.704/,Business
and PoreWoas Code:The Communes Lt..law does nest apply a an owner of Required Inspections
property who build,.,improv Nereon.end who donat work himselfmduough his 305 - FRAME
awn employ.,provided that such improvements art not intended oroRend fWaele.If,
however,the building or Improvement Is sold witin one year ofcomplodon.Our owner. 307 - INSULATION
builder will have the bomcn of Moving Net he did not build or Improve for purpose of 601 - ROOF TEAR OFF
sale.).
D 1,u Owner of the property,am exclusively contracting with licensed conuumm no 602 - ROOF PLYWOOD NAIL
construct the project sec.7044,Business and Pro(easiou Cale:)The Cmdracah Li- 603 - ROOF BATTENS
cove Law does not apply Man owner of Property who Wilds or improves fere..,and
whowmmets for such projects wit a eonmetor(s)licensed pursuant to to Conmetor's 604 - ROOF IN-PROGRESS
License Law.
❑I.exempt under See ,B k P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby alfim under penalty of perjury one of Ne following declarations:
I have and will maintain a CerOcate or consent msalbinsum for WorkeM1C.mpen-
"it.,u provided for by Seat..3700 of On lobo Code,for the pe rfisma n n of Ne
work fm which this permit is issued
have and will maintain Woftes Compensation Insorano,Is acquired by Section
700 of the Labor Code,for Ne performance of Ne work fa which Nie permit is Issued.
y Worker'. am pe Non Insurancecarer end Policy number ase:
Carrier. Polity No.:
(FICA OF EX PILON FROM WOR
COMPENSATION INSURANCE
(This saeak n need not W completed if the peneis is for onchundred dnllam(SIM)
Or las.)
1«rfy Nn in Ne perrmmenco of drc work for which Nis permit is Wood,I shell not
employ any person in any menner an as in become subject to sac Workeri Compeueuon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after meting this Certificate of Exemption,you should
become subject to the Workei s Compensation provisions or No labra CMe you mune
.J,'Z fortwith comply with two provisions m this permit shall be domed revoked.
O
CONSTRUCTION LENDING AGENCY
f`4 l hereby affirm that Nert is a construction lending agency far the performance of
a Ne wart fur which this pemtll is morM(See 3097,Civ.C.)
Lonfice. me
Z)z Lender's Address
U0 1 cenify,that 1 have read this application and sum Net We above Information is
um ! correct.1 agree to comply with all city and county ordinances and aaa laws Totaling to
p[U� Wilding construction,and hereby suinorim repmeent or this city to enter upon Nc
W aWvt-(We) W property for inspection puga¢v
G
(We)agae o ave.indemnify and kap May
in m da City ru Carroll s nd City
nt
Lo) incoisequenc of theo,tsang expenses which may In anywyeceneagaiut aid City t")
C) A APPLICANT
of UNDERSTANDS
Sterling of this permit. -2
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NONr Issued by: Date
SOURCE REGULATIONS.
8 Re-roofs
Signaarn or Appliant/Comnctor Da
HAZARDOUS MA RIALS DISCLOSURE Type Of ROOF
Will the applicant or future building occupant not or handle huardous mnerial
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
Code,Sodium 25532(e)? o«� All roofs shall be inspected prior to any roofing material being ins ailed.
[3y.
Will to applicant or Future building occupant use equipment at dent.me which If a roof is installed without first obtaining an inspection,I agree to remove
craft hunmaus air contaminants as defined by Ne Bay Area Air Quality Management all new materials for inspection.
Diuin?
El Yes t
I have mW the haramnus materials requirements under Chapter 6.95 of to Califor.
tie Hcal"Sony Code.Sob.255!15,25573 sod 25534.1 undersand to left Wilding
does not currcn0y hoc a amts.that It u my resp nuihllhy t hour,dm occupant of Ne
mquiremcnu h etpd.r 'ssuan..r.ccMraaaofoccu .v. Signature of Applicant Date
Owner onuthoris gem ate
All roof coverings to be Class"B"or better
Community Development Department
/ h Building Division
Q' City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPE(�T1NO
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,
willrequire 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.
Herrmewrteris Name: W.D T -
Job Site Address: a ° f 9 5S` �¢"t,�, U
�K. h w c��t
Roofing Company Name: al , ap �%/t�r ashy Co. �h C�
A plicant s Signature: ` —f-�--�� Date: �/ C3
\rl�I�DC
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 03
REROOF
IT CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name: Phone#:
W 650 32-2 -2121
Contractor Phone#: License#:
a . ay `f58 8
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
�k 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 ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: t1
Job Description: 0_7 off
u• c✓ Cho w� i(o,�•� �'"'
Residential ❑ Commercial �J
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: LJ
Cost-of Project: „ Type of Construction: Occupancy group:
37, 1/o• n
Qty. if
]i le Fee ID Fee Description Fee Group
1 BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
1 BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING