03120052 CITY OF CUPERTINO '''
BUILDING DIVISION PERMIT � �';0 `I 'M�'T
BUILDING ADDRESS: PERMIT N0.
.,
JIM KRAUSE ROOFING 03120052
OWNER'S NAME: PERNUTMUEDATE
ONE:
SANITARY OL NO.
ARCHITECTMNGINEER: - BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Y00 LICENSED CONTRACTOR'S DECLARATION JobDescri tion
1 hmeby affirm that 1 am licensed umkr provisions of Chapter 9(commencing P
with Suction7=)uf Division 3ofthe Busineasend Profrssirsu Codc,and my license is �r ,,//��
�S'�z uceosarorceyesna dcL3 I Lk.R 5.�3 ,REROOF PIIS ALE®
Dem 9! a�Cont r
ARCHI ff
�i l understand my plans shall o'N JAN 2 12004
3 tail Licensed Professional
3 OWNER-BUILDER DECLARATION
I Mmby affirm that 1 am exempt from the Contractor's License Law for the BUILDING
S O O following mason.(Section IID 1.5,Business and Professor.Code:Any city or county
$9 which requites a permit to m newt.alter,nature.,demnitsh,or mpair my namare
prior to its issuance,also requires the applicant for such permit to file a signed statement
FF < that he is licensed pursuant m the provul...Of the Conlrscmrs License Law(Chapter 9 Sq.Ft.Floor Area VaIU tort
Y $ (commencing with Section 7000)dDivision 3 clue Busineasand Professions;Cam)or
that he is exempt therefrom and the basis for tate alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of 3�Iggtpelp 0 Occupancy Type
not mom Nan Ove hundred dollen(SSW).
0 I,as owner of the property,in my employees with wages as their sale compensation,
will do the work,and the,mmu a is sat intended ora@sed for sale(Sec.70th,Business
and Professlom Cade:The Contractor's License Law docs not apply to an owner of Required Inspections
Property who builds ar improves Neem.end who does s tach work himsel f or through his
awn employers,provided that such improvements are not intended oroQered forsam.if,
however,the building orimprovement is cold within one year of completion,the owner-
builder will have the Wooden of proving Nat he did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7014,Business and Pmlaetions Cade:)The Connecut's U.
came law does not apply in an Owner of property who builds or improv daemon.and
who contracts for such projects with a conacmr(s)licensed pursuant to the Contnetor's
License Lew. _
0 l am exempt under Sec. ,B&PC for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby amrm under Finally of perjury one of the following declensions:
1 have and will maintain a Certificate of Consent m self-insure for WorkeesCompen-
7031."M
hn.,us provided far by Sealant 3700 of the Labor Code,for the performance of the
rk for which this permit is issued.
1 have and will maintain Worker's Compensation Insumec.,as required by Section
of Ne Labor Code,for Ne perfmmenee of the work fur which this permit is issued.
y Worker's Compensation Insurance carrier and Policy number am:
rtier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nutty completed if the Permit is home hundred dollars(SI00)
or Icss.)
I certify that In the performance of the work for which this Permit is issued,I shall not
employ any person in any mannerse,as m become object o the Workers'Compensadon
Lava of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject in the Wofker's Compensation previsions of the Labor Code,you must
0z forthwith comply with such provisions or this permit shall be doomed invoked.
Z O CONSTRUCTION LENDING AGENCY
(~i I bcinby affirm that there is a coroWctinn lending agency for the perforromec of
{Y. > the work for which this permit is issued(Sec.3097,Civ.C.)
W�Q Lender's Nam.
a z Lender's Adders -
U 0 1 certify that 1 Nva read this application and sum that the above informallun is
G.F correct.I agree to comply with all city and county ordinances and sum laws mating to
DU building construction,and hereby authorise representatives of this city to enter upon the
abovmmentimmil property for inspaim purposes.
(We)agree t.save,indemnify and keep harmless the City of Colman.against
nFi h liabilities,pcipu m.costs it capenses which may in any way accrue eg.1mataid City
V Z in consequence of the granting of this mit.
ti APPLICANT ERSTAN S ILL C PLY WITH ALL NON-POINT Issued by: Date
SOURCE RE ATI® ///m
HAZARDOUS
61,3
Re-roofs
Signature ofofAppliceARDDam
HAZARDOOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant tar future buildinge,Chaptsomoranndle HeaMousmateriel
u defined by the Copenino Municipal Cade.Chapter 9.12.and the Health and Safety
,daLCmIn.Scalon 35532(a)? All roofs shall be inspected prior to an roofing material beim Installed.
puce nom— P P Y g $
Will the applicant at future building ocmpant use equipmmd Of devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit N>ardoes air conemim us as dcrined by the Bay Area Air Quality Management all new materials for inspection.
District?
Oyes
Ihave m LYCOiSca s2SM5lsmquimmcnts underChapter and6.95 thaofthc Califon
naHcalth&SafctyCodc,SccNns 355f15,35517 and 85J4.1undcmund thsifum building
tlacs nowurrendy have a tartest,that it u my responsibility m artily the cecupant of the !!!
mquiremenuwhiehm tbemerp.02 ttofeC ficaea(Occppan SignamreofApphcant Date
073
Owner or a cam All roof coverings to be Class"B"or better
Community Development Department
Building Division
r r. City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U����I�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 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.
Homeowner0-4-1/s Name: D / G/z24, /n
tea/
job Site Address: ;111�7 �LJ
Roofing Company Name: ��.tA- /7i i c/-��
A plicanYs Signature: Date: /�l
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
J CITY OF CUPERTINO 312-
�S Z
REROOF
CUciao
ERTINO PERMIT APPLICATION FORM
APN# � ('/ o 2- Date:
Building Addl s: r �A /� L
rJ�G 5 ,/ a�
Owner's Name: Phone#:
�O . 351
Cctor, Phone#: License#:
dial u�,: ((Y�'J)776-076 f Y-5-V351
Cont ct: � Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles `Ji Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Cl 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 Dept. if
there are anrestrictions: LJ
Cost of Project: 4-1-2 Type of Construction: Occupancy group:
/0 Ddv
Qty. if
Applicable 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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