03050031 (2) CITY OF CUPERTINO -'-"'�"^ aA r^ ew7RRP^ms �'
BUILDING DIVISION PERMIT CONTRACT,URINFURMATION:,:
But ADDRESS: R E ROOFING & CONSTRUCTION P NO03050031
7-47 MTNTRITY-P TA
OWNER'S NAME: 15230 CLYDELLE AVENUE P"l"`G� 8ISEy7l8/2003
NGFU HSU
"E` (408) 925-9995 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMITINFO
BLDO ELECT PLUMB MECH
+sop LICENSED CONTRACTOR'S DECLARATION Job Description
1 booby+(Rom that 1 un licensed uMer provisions of CWpmr 9(commoncing ■
wWi Smuon7 )of Divisim3.fdm Bud limfesdons Code.and myliccnse is
in f.,Such leo anU n
V'N z Licnsc Clegt ��'H sae 1��9 REROOF
AF Des ARCHITE DEC NAY 2 2 2003
Y 1 undersand my plana shell be use c mcnrda
33m
0 Licensed Profudonel
x. OWNER-BUILDER ER DECLARATION BUILDING
I hompy.(Tinton 1 am exempt from the Contractors License Law for the
o O following masa.(Section 703 1.5,Business and Profeaduns Code:Any oily or county
which requires a permll re enres th, almq Improve,demolish, file
mash any structure
FZSe pdoamiBiensedpurvontinWeWovisiosofhfor mContrmmismfienseLawChaptcnl $61"O
itxx< the hmendn wid Smsansmtcprovisinnsn of ComracmrandPme Law Chapter Sq. Ft. Floor Area 4 V'OtlOn
i-n (commencing wit Suction 70W)of Division Jof the Budnwand Profcuinns Cadc)rir
$ Nn he is exempt Wem(rom and IIs bei for the Weged csemptlon.Any violation of
Section 7071.5 by any applicant fro.permit subjects the applicant to a civil penalty of 3 9&N6-0"cr0 0 Occupancy Type
out more in.five hundred dollen(SSW).
1,as manor of the property,or my employees wit wages as their able compensation,
will do to work and to structure is not immnded or offered for sale(Sm.7041,Business
and Promoshms Code:The Common,License Law does not apply m an owner of 3 0 7 - INSULAT pON d Inspections
pmMnywho builds or improve,themen,and whodoes such work himself orlhrough his
ownsmployses,provided that such improvements me not intended motioned(resale.If. 601 — ROOF TEAR OFF
however,me building or improvement is sold within one year of eompleum,the owner.
builder will nava We burden of proving mal be did mon build or Improve for purpose of 602 — ROOF PLYWOOD NAIL
est')' 603 - ROOF BATTENS
❑1,as owner of We propeny,am exclusively contracting with licensed contractors to
construct the pmjca(Sec,7044,Business and Professions Code:)The Conlrecter's Lb 604 — ROOF IN-PROGRESS
cera:Law dots not apply m an owner of property who builds or improves Women.and,
who contracts for such pmjects with a comacsor(s)licensed pursuant m We Conuecsoh
License law.
❑ I em exempt under See. .B&P C for this reason
Ow er
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aBhm under penalty of perjury one of to following declarations:
1 hive and will mainiln a Cmrfresm cremation mself-insum for Worker's Crimper-
author,
rimperuhon,as provided for by Section 3700 of the labor Code.for We performance of We
work for which this permit is issued.
❑1 have and will maintain Worker's Compenaadon Insurance,as required by Section
37W of We labor Code.for me performance of We work for which this permit u issued.
My lWorker's Compensation Nsunnce aria and dP�Policy m a^rt: ^_
Grrl�: ��a't�`F�1v.hil7PollyTl6.: I t l 111 v
fQ/\ CERTIFICATEOFE% PfIONFROM WORKERS'
COMPENSATION INSURANCE
(Ibex aced..,it nor becomplesd lithe fermis u foram Wedineddolin($HXE
or Isar)
1 certify that in We performance of We work for which this permit is issued,I toll not
employ any person in any manner an as to become subject to We Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should _
become subject In We Worker's Compensation provisions of We labor Code.you must
.J O friMw th comply wiN such proviaiom or this permit tall be dec ped howled.
Z ti CONSTRUCTION LENDING AGENCY
[—i I hereby affirm that tem is a construction lending agency for We perfoncence of
!Yi rte„ the work for which this permit is issued(Sec.3097,Civ.C.)
Q lsndcr's Namc
w7 z Itmim's Am=
V Q I certify mat I pars mad this pandcoun and,iso Wat and
shrive information teng u ( '�Y
LT�C) correct.(✓ WokiI agree et comply with all city and county nNiwsof and city
hwa mining e
C)U movingeononedpm.and penny authon purposes rwive,of mi,city mento upon the
W +pave-mentioned propcny fm immiryi ankepha
(We)agree m save,indcmntify and keep harmka the City of Cupertino against
jj liabilities,judgments.costs and expenses which may in any way seems agamm mid City p
C.)7 In conuquence o(she Pruning of This permi6 7
G 'AVI'M NT DERSTANDS AND WILL COMPL WI H ALL NON-POINT Issued by: Date
S.
Re-roofs
;.k.
oat ucmU�o mr Date
—HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant at fuum building occupant store or handle hmmdous metrial
defined by We Cupertino Municipal Code,Chapter 9.13,and We HcdN and Safety
SeNrin 35532(.)7 All roofs shall be inspected prior to any roofing material being installed.
[I Y. Na'
Will the applicant or feuho building occupant ie equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
il hamm air c.imimmis a dcrn by the Bay Ara Air Que isy Managem�mall-n materials for inspection.
istrmn
❑Yes E]No /
1 have mad the Weardous masrials requirements womrChapter 6.95 of We Glifon
IW&Safcsy Code.Sections 25N)5,25573 and 25534. untlentsnd Wolf the wilding
dams no commit haw a inapt,the it is my responsibility m noufy We omupui of m`
re ' what, t m_ct ' usnccafaCcnamm,ofoe �r�. -..SignatveofApplicant Date
o«•� uWridaedagm ram All roof coverings to be Class"B" or better
Community Development Department
Building Division
al� City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C i 'PE kT]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 t/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.
Homeowners Name: I GCS�� t `S
Job Site Address: 712 3 t/'1 U 0910QI5 LA�t�
Roofing Co ame: UZJ�t N k� s N SifZu eft l N C
Aic isSigna re: �___ _ Date:�C)9
eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
v CITY OF CUPERTINO o 3 f W-v3
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# � � „ /' _ Date:
Building Addres ; L�b
q�� '1
Owner's Name: Phone#:
Contractor, ' Iry Phone#: S License #:
Contact: Phone#:� Cupertino Business License #:'auk- x}21-�y12
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof O Built-Up roof
Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 2 ❑ Provide I.C.B.O.Report#
J� To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Job Description:ICNmn EXlbr ti4 2 LA'1�:� dF Corm t NSTArLL-
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with ning Dt. if
there are an estrictio
Cost of Project Type of Constru Occupancy gp�;p
l�,uU.
r(J
Qty. if
A 'kable 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
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