03030021 CITY OF CUPERTINO '°"'�e �
BUILDING DIVISION PERMIT CONTRACTORNFORMATION '
BDILDINGADDRESS: ABOVE ALL ROOFING PERMITNO,
OWNER'S NAME: 700 NORTHRUP ST PERMIT64UBDATE
v
JOHN NEIBEL
NE` (408) 292-4188 SANITARY N0. CONTROL NO.
ARCHITECT/BNOINEER: BUILDING PERMIT INFO
BLDG EIF.CT' PLUMB MECH
30o LICENSED CONTRACTOR'S DECLARATION Job DescriptionO O O O
z 1 hominy affirm that 1 am licensed under pmrialons of Chapter 9(cemmencing -
n<n with Sallon7 ) sin of the Budrcs,and Pro(e,alom CoN;aMmy licmmIs
in full forces q.1.1, REROOF
Llscnse to UO,N
Dae conmmr T/O BUILT UP TO WOOD DF( K INSTALL 4 PLY
HITECT9 Os. TON t lq(fypAII Eft p .
@ lundertunJ my plenastillwused DECLARATION
BUILT UP ROOF tt-1111 NN 11 ALED
d!
i ttt777
c Licensed Professional .
g OWNER-BUILDER DECLARATION JUL 14 2003
4 f 1 hemby affirm that 1 1. exempt from the ConlnstCo License Law co the
Y p o which re moon.(Suitt 71171.5,Busmen and improve,
de o demolish,
h,or Any city s county -
y$� WAICh rCgYIfG\pC1111It to WIINNLL aIIM,Imhmve,demllllSn,fir repair any structure _ _
prim m Its Issuance.also requim the applicant for such Permit to file a ig atimmmcm
{iFF<
that he isllcensedpursuant tothe provisionanfUmLicense Sq.Ft.Floor Area f Valuation
360 (commencing with Section 1")of Division S of the Business and Professiom CMB)or
$ But he la exempt thenefmm and the buts for Ne alleged exemption.Any violadan of �y�,
Section 7071.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number MB41ilfty Type
not mon than Oro hundmd dollen($5W).
0 1,as owner of Ne propeny,an my cmployw with"gas as theirRule ampensstim,
will do the workandtheawnurcIsnotNtended Oroncred forabl°(Sec.]ON,BURittusRe tired Inspections
and Pmfessiona Com:The Conuamm's Limme law does not apply m an Owner of q P
property who build,or improsm Butson,andwhodmuuch Work hlmselforthmugh his
Own employees,pmvlded that such Improvements are not Intended oroaered losable,If. 305 — FRAME
however.the building Or improvement I,sold within one year Of complsdon,the owner•
builder will have the wrda of proving that the did not wild or improve Oxer purpose of 307 — INSULATION
sal'.)' 601 — ROOF TEAR OFF
O 1,as Owner Of the property,am eaclmively contracting with licensed canvaerOr,in
construct the Project(Sec.7Da,Business and Professions Code:)The COnaacter's U. 602 — ROOF PLYWOOD NAIL
cam law does not apply in an owner Of propeny who Wild.or improves Bunion,anal, - 6O3 — ROOF BATTENS
who contracts for uch pmjecm with a conaacmgR)lian¢d pursuant to BU Conmctoes
License,Law. 604 - : ROOF IN-PROGRESS -
❑Iamexempt under Sm. .B B P C for this mato"
Owner Data
WORKER'S COMPENSATION DECLARATION -
1 hemby aifitm under Penally of perjury one of Ne following declarations:' -
1haw and will or
a Certificate ofComent to Reif-Insum for Worker's Compcn-
cation,as provimd for by Section 7700 of the labor Cede,for the performance of the
wick for which this permit Is Issued.
Qave and will maintain Workers Compensnl°n Iuunme,as required by Section .
.1 the Labor Cede,for the performance Of Ne work for which this Permit is Issued.
My Wnfket'R "�roN$RUonI unnw`�mm and Policy number am::,)
Grner:/�j{([y[L lKiyK/ Policy No.: �/i VJ raNSp�
�''
CEM[FICACA Lr OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Or last.))(Thissemlon Deed not hecompieud if the pernll Is owon hundred dollen 151 W)
1 aNfy that in the perfnmune of the work for which this Permit Is issued,I shall not
employ any peon in any manners°as W became subject to(he Worker'Compensation
Lawn of Callfomla,Data
Applicant
NOTICE TO APPLICANT:If,after making this Cenifteate of Exemption.you shnuW
become subject to the Worker,Compensation provision,of the labor Cade,you mum
.JO
Nforthwith amply with such provisions m this permm
lt shall be deemed wred.
CONSTRUCTION LENDING AGENCY
I hereby affirm that thea is a eomanction lending agency for the Mforonmm of
BM work for which this permit Is Issued(Sec.3097,CO.C.)
Q Larder's Name
Z)z Lander's Addms,
V Q 1 aNfy that 1 have read this application and mu that Bu above Information is
2 correct.I agree to comply with all city and county on ineras and state Ism muting to
C) building construction.and hereby authorize mpmabmatives ofthis city to Omer upon thO
IS] above-memioned property for Inspection purpose.
Ly,CI.
We)agree to caw,indemnify and kap harmless the City of Cupertino against
Lyy IIebIIWn,judgments,costs and expense,which may In my Way came against mid City
V In consrguencc Ne granting of this lurmit.
^+ APPLICA NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: - Date
SOURC ULATIONS./ , , /
/s/d Re-roofs
SignatureSignatureOf ApPllcm umucor Gate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will IhO applicant or future Wilding occupam ROm or handle hazardous material '
u mftned by Bte Cupemno Municipal Code.Chapter 9.12,and the Health and Safety ,
ede.sem°n 25532(an All roofs shall be inspected prior to an roofing material beim Installed.
❑t ���7n P P Y g g
will the applinnt m f m building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It ha'ramnm°lr contsminmts as&road by the Bay Arca Air Quality Management all new materials for Inspection.
❑Yet NJ�
I Its.mud the hexaWwrcq
s materialaulmmem under Chapter 6.95 ofthe Califor.
nia Bost ,�/• ����
°ice Health R
rcySmctyCMS o 25505,25533 Rod 3553a.1 ' d this
u If the Wilding ilding
dmanmendyhw.un.m4NatIt4mycaondwnoaiymouptofNe
I. hIchomuPC.CLMXmissuance, CanifeteorOcap
Signature of Applicant Date
e
Owner or authorized agent - DomAll roof coverings to be Class "B"or better
.Community Development Department . '.
Building Division
aCITY0
City of Cupertino
one:.Torre Avenue Telephone:.(408)777-3228
Fix:"(408)777-3333
CUPEkTINO
Building Department
Subject: Re-roofing policy for the City of.Cupertino
1: Prior to permit issuance,you must agree to comply with 1992 UBC Standards
and manufacturers specifications on re-roofing,. .
2. New roof coveringsshall 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 LC.B.O. report is required to be,on the job site at the time on,mspection
I understand and will comply with the,above stated policy on re-roofing:
Homeowner's Name:
Job Site Address: 5C) /v • �C,/�(17.G �`V�
Roofing Company Name: ' v G ;.
AA12Phcanls Signature: ........ � w Date:
\/l/6tNOlXt
Greg eel
Building Official .
Revised 1/30/03..
Printed on Recycled Paper