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CITY OF CUPERTINOy
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
SECURITY ROOFING AIR SYSTE
4,F111ND03050042
103 3 TORRE AVE
OWNER'S NAME:
677 KINGS ROW
PB<eM1T Is[IU75,Bf9/2003
/V
IVIC CENTER PROFESSIONAL
NE:
(408)971-1777
SAN ARY NO. CONTROL NO.
ARCHI7ECDENOINBER:
- BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
1 Wrcb AT Mail am limned under pmvision of Chapmr 9 (commenting
with Section 7 Ivlsion 3 of the Bounce' ells Pmfcuions Code, and my licenre is
in lull too on Qt �I�U�C��%O
REROOF
License qus Lu. R
Dem_COmrsetp
ARC CTS DEC�'ION
and my eoa eh W used u c rtenrds �
Lk:feutonai
OW NER-BUILDER DECLARATION
1 hereby affirm Nal 1 am exempt from the Contractor's License Lew for the
following mason. (Section 703 1.5, Business and Profession Code: Any city or county
which requires a permit to cansuuct. alter. improve, demolish, or repair any stmctum
prior to its boance, atm requires the applicant farsueh permit to file a signed summmi
is licensed the Contrseur'slicense Law (Chapter 9
Sq. Ft. Floor Area
$16V§b*tion
that he pursuant o the provision of
(eommeneing with Section 7000) of Division 3 of Ne Business and Promashom Cade) or
that he is exempt therefrom and the huh for the alleged exemption. Any violation of
3 6kTNQ4bWZer0 0
Occupancy Type
Section 7031.5 by any, applicant for a permit subjects the applicant to a Civil penalty of
nm mom than five hundred dollars ($500).
-
0 1, as owner of the property, or my employers with wages as their role compensation.
RR dins actions
p
Will do the work. sad the aWCWR is not intended or ORCmd faraale(Sec.704I,BuelMal
and Professions Cade: The Communes Liana Law cora Own apply u an owner of
307 - INSULAT
progeny who build, ar i mpmvesthermn, mad who doea such wok himself or through his
ownemployeu. provided thvsnh improvements are not intended ooRered(mute. If.
601 — ROOF TEAR OFF
however, the building Cir improvement is old within ane yearof mmpmeon, the owner -
602 ROOF PLYWOOD NAIL
Wilder will have the burden of pmving that W did not Wild or improve for purpose of
-
wale.).
603 - ROOF BATTENS
0 1, as Owner of the property, am exclusively contracting with licensed contractor, to
604 - ROOF I N- PROGRE S S
conauucl the project (See. 7014. Business and Pmfassian Cade:) The Contractor's Li.
Cense Law data not apply io an owner of property who Wilds or improve thereon, and.
who contracts for such projects with acontracto m) licensed pursuant to the Conusemh
l
Lice. Law.
❑ IamexemptunderSec. ,B&PCfothisrtaon
`,
wner Dau
mw•
WORKER'S COMPENSATION DECLARATION
y
I hereby affirm under penalty of perjury ON of Me following declmatiana
-
I have and will maintain a Certificate of Consent to self -inure far Worker'sCompen-
.e. u provided for by Section 3700 of the Lour Code, for the performance of the
IC37730"ll,
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rk for which this permit is issued
I have and will maintain Worker's Compensation Wurance, u required by Section
of the Labor Code, for the performance of the work fir which Owin pc mit isIssued.
My
My cy number gr� Ll
",mg,. ✓�
pull �''11'1OIR¢¢IO�gM
�SA770N1NBURANCE
IFl TE OF . WORKERS'
('ITh section wed not he completed If the permit Is far one hundred dollen ($100)
or Ina)
I comfy that In the performance of Ne work for which this Tomtit h Issued. I shall not
employ any perms in any mouser se as u become object to the Warkcn'Compcnution
Laws of Cali(omm, Data
Applicant
NOTICE TO APPLICANT: If, aficr making this Ccoificate of Exemption, you should
become subject an the Worked Compensation provisions of the labor Code, you must
forthwith comply wife such provision or this permit shall he dcemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby ihrm that there la a construction lending agency forth performance of
(Sm. 0
theLe work for which this permit 8 isswd (Sec. 3097. Civ. C.)
Leader's Name
Lenders Addrrsa
j 1 Certify that 1 have mad this application and tau that the soon information is
' coned. 1 agree u comply with all city and county ordinances and sum laws relating to
Wilding convection, and hereby othodm representatives of this city to enter upon the
above-mentioned pmpeny for inspection purposes.
(We) agree to save, indemnify and keep homeless the City of Cupcnino against
Ilabllltlea.judgma ds, costs and expenses which may In my way seem against Hid City
I. I 'PPL CANT UNDERSTA gaf of the 1.A D WILL COMPLY WITH ALL NON -POINT
Issued by:9 Date
SOUR GULATIONS
Re -roofs
neuro a pP mmUCan Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future Wilding wcupanutom ohandle huallom materia
as defined by the Cupertino Municipal Code. Chapter 9.12. and to Health and Stacey
Illils.dr, Saauan 2553x,)7
All roofs shall be inspected prior to any roofing material being installed.
Yu u
If a roof is installed without first obtaining an inspection, I agree to remove
Will IN applicant or fu``ure buskin{ occupant use equipment or devices which
mit, "O'dnun air conumina dcfmcd by the Bey Arca Air Quality Management
all new materials for ins action.
Gimlet?
O Yea u
I have mad the hazardous materials requirements under Chapter 6.95 of 0u Glifor-
niaHcallh&Saletycodc, Secd11,1,1,.2,,5533.d25534,lun&nmd�ifft Wildindocs
totnayhawu ney responihility a nouly ted occupanta(th�mgoi
tswmanmaR c,umccoracadr.C.I. Cir.
ignatureofApplicant Date
All roof coverings to be Class "B" or better
auNorizc0 agent oOm
Ro",
T,\:
CITY OF
CUPEIDT ]NO
IV,
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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 Y4 " 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: C'„J -C l eJc(- &0�r-55toG---1 (0(odp
Job Site Address: /0 34''3 �1U f (C 6(-) en✓ -
Roofing Company Name:SeC—IZOL 1' r -N
A plicant's(Signature:
Greg eel
Building Official
Revised 1/30/03
Prinfed on Recycled Paper
•
•
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
o) o P" tl 2—
APN #
Bldg Permit Fees
BUILDING
Date:
3(.>q -Ho- 6ao
BUILDING
S- -03
Building Address:
3�i3
BUILDING
BSEISMICOM
10(�e �P-vlj
BUILDING
Owner's Name:
CIVIL Ce kq-r (o
aril fU✓
o
Phone #: _
Contractor: ,
S ec.0 s � \Zxr�k-n
Phone #:
t**, q'1 l-
L 17�i
License #:
�v�U0510
ntact:
Phone #:
Cupertino Business License #:
11CY6 T71-
llS
Type of Roof Covering:
Existin*
P Built Roof
Proposed•
-Up
uilt-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: ❑
Job Descri tion:
L'
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j
1 CG U
Mt�J L
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Residential ❑
Commercial E]-'
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project:
Ic� 3t(6
Type of Constmc y.on:
Occupancy group:
e—(bc�'1"
Qty. if
AnnlV� 1e
Fee m
FPP r1PCl9intinn
FPP �Th11T
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
0- Z (I -o