03040103 CITY OF CUPERTINO '"�
BUILDING DIVISION PERMIT 'COT NTRAC�TOlR INF,,OR, 'IATIQN '.�
BY'UitF°tMACE DR ANTHONY ROOF SERVICE PERMITNo.03040103
t ' CHERIE F 199 RYLAND ST PERMIT ISSUEa/ 21/2003
(408) 265-5147
ONE: SANITARY NO, / L CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
3Gp LICENSED CONTRACTOR'S DECLARATION
�uI lureby.ffrm that lam lieeosdcunder provi.m...lChepmr 9(cammcacing Job Description
s withSmLkm]DB()afDlviAAA3afOcBoamessandPrufcssonsCale.mdmyliccnub FilliALED
,pN in full fome.ndc _
License us Lk.N REROOF
CHITECTS ECIAft oN CONTRACTOR: ANTHONY ROOF SEVICEIIYrI'hAtY $ 2003
e a I understand my plans Nall be Sauu d Public menrds
e�U
N
Licensed Professional
-XI
OWNER-BUILDER DE CeCOoLMON BUILDING
:0 0 I hereby.(fim Sect on 1 ). .Bumps from the fcaacom orsCoU :Any c Law for the
p O (allowing toms a.(Section]1131.5,Business and are,durnll Code:Any Cary of county
5$ which rcyuscsae,rahalso Fe cures the alter.improve,for suhfremih,nrmash signed sny tatement Prionnits iensedprsumtto the theapplicantof for such mienseIA a Law(stammcnt
0 (m.nacing licensed pursuant 7 )of Division 3 the Connector'ssinessnd PrIclaw(C oule)9 Sq. Ft. Floor Area Valuation
I
{E B that he
exempth Section And
of but&ofr the
theegal essandon.Anynvi CMC)or
L��
that he i exempt therefrom and Ne buffs far the dlcgcd exemption.Any violation of $12300
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
net more than B.hundred doll..(5300). P y yp
01,As owner of the property,or my employees with wag$u Ocif Sale eomPens.11on, 3261.3082 . OO
will do the work,and Ne swcmm is not intended or offered for ale(See.7094,Business
and Profession,Code:The Contractor's License Law does net apply te an owner of Required Inspections
property who builds orimprovesHereon,andwho doeseuch work himselfor through his 305 - FRAME
own employees.provided ON such Improvements ase not intended unaltered for Axis.If. 307 — INSULATION
however,Lie Wilding or improvement is mid within am year of completion,Ne owner.
builder will have the burden of proving that he did not Wild or improve for purpose of 601 - ROOF TEAR OFF
sale.).
❑I,as owner of she propeny,am exclusively contracting with lk$Ised contractors to 602 - ROOF PLYWOOD NAIL
construct the pmjcn(Sec.7014.Business and Professions Code:)The Conmcterb Li. 603 — ROOF BATTENS
came law does not apply u an owner of PmU,ny who Wilds or improves themon.and 604 - ROOF IN-PROGRESS
who contracts for such projects with a eonsracsor(s)licensed pursuant to the Contnuoh
Limnse Lew.
❑1 an exempt under Sec. .B A P C for this recon
Owner Data
WORKER'S COMPENSATION DECLARATION
I Mosby afRrm under Pendry of perjury arc of the fallowing declarations:
I have and will maintain a CeniOeam of Consent to salt-insure far Workers Compen.
tion,u provided for by Section 3]00 of Ne Labor Code,for the Performance of the
work for which this Permit is issued
ISS I have and will maintain Workers Compensation Insurance,u required by Section
-3] of the labor Cash,for oe perfanmmce of the work far which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number Sae:
Carrier. 1C?72 XU id.d Polity No.: '0Z al
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thi section need not W completed If the Permit Is(mune hundmddulla.($101)
ar loss.)
I certify On,in she performance of dm work for which this Permit Is issad,I shall not
employ any person in any mannerSa as m become subject to lfmworkeri Compcnsasiun
Laws of California.Dem
Applicant
NOTICE TO APPLICANT.IL after making this CPltlfmme of Exemption,you should -
heeome subject to the Wolters Campcmation provisions of Ne Lothar CMC.you most
�z fuMwith comply withtach provisions or this permitshallW deemed mvolmd.
Z y CONSTRUCTION LENDING AGENCY
1 hereby affirm that One is a cormonian lending agency for Om performance of
the work(car which this permit is issued(Sec.3097,Civ.C.)
1 Q (Antler's Name
z Lender,Address
;J Q 1 cenify that 1 haw mad this application and sold that she above infom,a(ion is
A (✓ correct.I agme to comply with all city and county ordinances and sum laws misting to
�O building convection,and hereby auNodm reprcunmives of that city to enter upon the -
W above-mentioned property for inspection purposes.
pw (We-)agree m Love,indemnify and keep harmless the City of Cupertino Against
L,L Liabilities.judgmenm.costs And expenses which may in an,way acerae against aid City �s
J Z in consequence of the granting of this Permit. ,q
APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC G
/ Re-roofs
nature olApplicaV actor ate
HAZ RDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building OccopmL Store or handle hazardous material
u defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Scctinn 25532.)7 (((yyy������ All roofs shall be inspected prior to any roofing material being installed.
E]Yet tp.Nu
Will 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
1 h.randous air contaminants u dc0ncd by one Bay Area Air Quality Management all new materials for inspection.
a"
❑Yes .14 No
Ihave reW the hvSamoa.amrid25533Amc5534.under CMPter and.93 OIL it
the hddirg
rias net
cma fes CMc,Sccdut. IL I,i my rearm 25539.1 understand O mewl.Wild in
dors not eurrcnlly have a moat Nas It u my rtapansihility m mdfy NO Ocsupat of the
trim n�Aw c m - pnormissummcnfaccnificau, cupartay. Signature pplicant Date
mr m.mnon s=rat Date All roof coverings to be Class"B" or better
Community Development Department
Building Division
44 � City of Cupertino
,., 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
^U P E kT]N Q 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 i/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.
Homeowner's Name:
lob Site Address: /D Sir C/41 e"(f-e
Roofing Company Name: LzTh u��G G/` 5-72
A plicant's Signature:
Date: l�vo7� D
\it/r61ADCXt
Greg eel
Building Official
Revised 1/30/03
' CITY OF CUPERTINO
REROOF
CUPEII;TINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
C L
Owner's Name: Phone#:
e' ,f h)A IJOYI ,Z_ —
Co tract r: Phone#: License#:
s
Cont ct: Phone #: Cupertino Business License #:
qc
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )9, 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 Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions:
CpAlf Project Type of Construction: Occupancy group:
Qty. if
Appli ab 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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