03070141 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 90ONT=RAOTORANFORMATION .
OUILDING ADDRESS: DAVE SMITH ROOFING PERMIT NO 03070141
1
OWNER'S NAME: 1052 KELLY DR PERMIT ISSUE DATE
TAMES MEN 17 AND 71ITTA III TR IST nq
ONE: SANITARY NO. CONTROL NO.
(408) 973-9427
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a 0 0 0
40z LICENSED CONTRACTOR'S DECLARATION
26- 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
ii wilM1 Scni9n]ax»11 Divimm of the Busincxsjnd Pmfcssinm Codc,and mylicense 4 �n n
a=y in full Fpll'e and eff ..j( 11�sJ 9
j�? Licen l n T Lica S✓, REROOF �`� �
Contnr r JULy
A Cibectr'SDEC T N JZ8T 2003
Ni 1 understand my plena atoll M used u pts m rtcIGN
Licensed Professional
OWNER-exempt R DECLARATION BUILDING
<f 1 henry sect on 11. exempt from tho Com Col License Lew for Nr BUILDING
y pe D whichalloNg reason.Permit
t IIonstr t,.1teab and Poroo.demolish.
Code:Any ally m LOVmy ,
c which its ire s a pans t re correct,a@c impmsu h Permit t fie a sig any statement
2Z8
poor to tensed e,ommainithe proviPns,ofant fm Contrarmiuoicese Lawdnammem
tt < that menccenwitpuntion7 )pmviioasofthe e0usi (Chapter 9 Sq. Ft.Floor Area Valuation
a=-D (commencing is exempt section and the
Divisionafor of lila alleged
exe real on.An Inas Cd an or
that he is exempt therefrom and tM buts for the alleged eumption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type
not more than Eve hundred dollen(SSW).
D 1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the fracture is not intended or offend for sale(Sec.7514,Business 305 - FRAME Required Inspections
and Professions Code:The Conuacmfs License Law docs not apply m an owner of p
Property who builds or impravta therarmand who doeuich work himselforthrough his 307 - INSULATION
own empmyata.provided lial such Improvements an not intended or offend forum.If. 601 - ROOF TEAR OFF
however,lie building or improvement is sold within ane year of completion,the owner
huildeb will have the burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
tile.).
D 1,as owner of the property.am exclusively contracting with licensed conuactors to - 603 — ROOF BATTENS
consumer the project(See.7W,Business and Partisans Code:)The Contractor's Li. 604 - ROOF IN-PROGRESS
cease Law data not apply to an owner of property who Wilds or improves thereon.and,
who contracts for such projects with a contncloos)licensed pursuant to Ne ComactaM1
License La-
0 1 vac exempt under See .B 6 P C far this reason
Owner Dan
WORKER'S COMPENSATION DECLARATION
1 hereby alfmm under Penalty of perjury one of the following decimations:
1 have and will maintain a Cenlfinle of Consent to self-insure for Worker's Compen-
ation,as provided for by Section 37W of un Labor Coale,for the Performance of the
work for which this p.I,is issued. - -
1 have and will maintain Worker's Compensation Insurance,as acquired by Section
3700 of the Labor Code,forthe performance of Ne work for which this permit is issued.
Ca�k�s�CnmPcnuti nlLnsunntt caPol' PaW,mc: R
2 Y PSV S -O -I�—
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he complend if the Terrell is for one hundred dollars(OW)
less.)
1 cti ify dint in Ne performance of the work for which this Permit is iuucd,1 shall not
employ any person finny manner so a to become subject o the Worker!Compensation -
Laws of Calif varm.Dan
Applicant'
NOTICE TO APPLICANT:IL efill making this Ccnif¢ete of Exemption.you should
become subject to the Worker's Compensation provisions of the Labor Code,ynu must
�Z forthwith comply with such provisinneorthis permit shall all deemed mould.
z O CONSTRUCTION LENDING AGENCY
I hereby affirm that Nen its construction[ending agency for the Performance of
f1S 9 the work for which this permit is issued(Sec.3097,ON.C.)
ps7 Q Lender's Name
D' lender's Address
7 Z
U Q 1 comfy Nat 1 ban rad this application and sum that the above information is
�^ Conan.l ague to comply with all city and county ordinances and sum laws brisling to
C)
building construction,and hereby authorize representadveS of this city m enter u,mohe
r U above-meminned properly for inspection purposes.
(We)agree to saw,indemnify and keep hamOrss the City of Cupertino against
liabilities,judgments.costs and expenses which may in any way iccmc against eid City
U mnsequcnee of the granting of this Permit.
AP NT UNDERSTAN S 617
AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU E q H.ATIONS
�1- Re-roofs
HAZARDOUS 5' re of AppiiaHAZA DO Be
US MATERIALS DISCLOSURE Type of Roof
ill the applicant or future building occupant non or handle hazardous material
d told by the Cupeninn Municipal Code.Chapter 9.12,and the Health and Safety
Co c,Section 25532u)7
_oyes ,�- No All roofs shall be inspected prior to any roofing material being installed.
Will Ire applicant or future building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
it nonrdous air contaminants as defined by till Bay Area Air Quality Management al materials for inspection.
inrict7
Dyes No
ehuurdtws mamrials rcyvimments under Chapmrb95 offal Califng
nieliubhhe SarryColo Secunns755115.15533 end 25534.1 undcrsund thaifNc huildir r /)
dr ally haw a teaml,Not it is my rcspmxiM1iliry In nattily tic nxuPent of the
rof man w 'h sIR'mof mu'issuanccnfsCcm5cm, ffbcupanc. Sig nature of Applicant Date
-�7cJ All roof coverings to be Class "B" or better
D teamed agcm Dam
Community Development Department
,
MBuilding Division
I
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408) 777-3333
UPEI�TINO
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 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.
Homeowner's Name: D 1
Job Site Address:
Roofing Comp e: °O
A plicant's Signature: Date: —11 — O3
• Greg tel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
a REROOF
�CUPEI�TINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
L► nn� L_qm-4z-
Owner'sName: Phone#:
vhn 3av�e s 0
Contractor: s e� Phone#: Q ,3 _C License #:5-` �� 3 ^
10 1
Contact: Phone#: I,*\— Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ 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:----I!]
Job Description•
�Pa.< --"—h S+q t S-0 — aR
Resident Commercial ❑
Fire Zone: - Confirmed with Plaept. if
there are any r ctions: fJ
Cost of rojec9� / T e of Co struction. Occupancy ou .
Wil_ 00 Q ca
Qty. .
A is e 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