03050010 i CITY OF CUPERTINO '' '
BUILDING DIVISION PERMIT CON RAC"TORI�NF,ORMATION, � .
BUILDING ADDRESS: CAL-PAC ROOFING SAN MATEO PERMIT"b3050010
20076 PF.ArI4TRF.TP. LA
OWNER'S NAME: 2515 S EL CAMINO PEL`I`fITLrSD�T�2/2003
idhiILLIAMS WILLIAM J TRUSTEE
01"E: (650) 286-0450 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
i0o LICENSED CONTRACTOR'S DECLARATION JobDescription—
with
escrip[i
C I hereby affirm that 1 am Reeved under provisions or Chapter 9(commencing �B B� tie
ty with Section 70(10)of Divislon 3 Mine BuGnev and professions de,n mylic 'u FF YR e�y ® E®
. or'n in fun fa me and"1" 3 REROOF �n
jqz
C. Chun Chu Lica
Y�� Dale RCHf1ECTS DECLA 1 MAY 2 7 2003
Y I on heard my plans shall be used as publi rods
3yu
3 u.03 cense
Lid BUILDING
OWNER-BUILDE0.DECLARATION
I I hereby from that I am exempt from the Canuacwfs License Law for the
a.p O following moron.(Section 7031.5.Business and Profc,tions Code:Any city ah county
which requires a Permit to ennslrucL titer,improve,demolish,or repairanystructure
prior in its icaus..shun inquires the applicant forsuch Permit w rile a signed statement
that heis licensed pursuant tothe provisions fdlConmcwr,License Law(Chapter 9 Sq. Ft. Floor Area $16Vl;�ir tion
fir$ (commencing with Section 7")of Division 3 Of the Business and Professions Core)or
that he is exempt therefrom and the basis for the alleged exmpdoo.My violation or
Section 7031.5 by arty applicant for a permit xbjecu the applicator in a Civil Penalty of 3 1Pfl13aQ Eae10 0 Occupancy Type
not mart Nan five hundred dollars(55001.
❑i,ot owner of the pmpcny.m my employees w o wage u their(Sec.
camper sines
will do prof awork.and Ne he Con is em's Lic ed nee,La dens,ed s1 apply ]WC,Barites — jgjd IDS BCt10nS
and property
h W code:The eonuacror's I.iecnse law eau tort apply lf an rough of 307 — I NSLJLAT l VN p
pwperywho builds oimprovesthereon,and who docssuchworkhimxhredAwugh his
however,dr,
ns,ping or ithat such vementprowmentsartne can ed or fcomplrtemd roe owner. 601 — ROOF TEAR OFF
Wilder.Ne Wildingorimprovementishat withinaneyetiorcompletion,theowner-
Wuwwiuhawti¢Wmenufprovingwthte die Out build erimprove for purpose or 602 - ROOF PLYWOOD NAIL
sale.). 603 - ROOF BATTENS
❑1,as owner of the property.am exclusively contracting with licensed common to 604 - ROOF IN-PROGRESS
encounter ft pmjm(Sec.7061.Business and Professions Code:)The Conaacwrs Li-
rue law dans net apply W an awno of property who Wilds Or improve thereon,and
who commas for such projects with a conuacrer(s)licenced pursuant to the Contractors
License Law.
I am exempt undo Sec .B&P C for this recon
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under Penally of perjury arc of the following declarations:
I have and will maintain a Cenificaa of Conant to self-insure for Workin sCompcn-
7C33700
ion,as provided for by Section 3700 of the IaWr Code.for Ne peRmmancc of the
rt for which this Permit is issued.
I ban and will maintain Wmker s Compensation Insurancq as required by Scotian
of the Labor Cade,for site performance of the work for which this permit is issued.
y Workers ti s carrier and Policynuartier. F Polity No.:
C IF TEOF EXEMPTION FROMW KERS'
COMPENSATION INSURANCE '
fma sectim reed not be complewd dsix l march u foranc hundred dhilans(SIM)
or Mss)
1 certify that in the performance of the work for which this permit is issued.I cull not
employ any pecan in any co morrx as or ream-subject re the Warkmt'Compensafiaa
Laws of California.DAM
Applicant
NOTICE TO APPLICANT:If,after mating this CcniOcate of Exemption,you should
become subject he the Wohus Compensation previsions of the Lahr,Code,you muss
0Z foodwidt comply with such provisions or this permit shall be decreed ro
neco.
ZO
CONMUCr10N LENDING AGENCY
E4 I Miley affirm Nat there iso cia.ro r lendingagexy for thc per(omarax tar
7 site work(m which Nis permit is issued(Sec.3097.Civ.C.)
W�; Lenders Name
G Lendcra Address
U0 I=Mfy that I haw read this application and sura that the show information is
W— correct 1 agree w comply with all city and county aNinarun and total laws relating m
O U building constrction,and hereby sullied=represenutivss of this city to enter Open d¢
f1d ahove-mentioned property for inspection pmpoxa
y
(W as
agree to sec n mnify and tr p leu the City of Cupertino against
N liabilities,judgmcnts sex dcxpcauswhic to any way accrue against said City
V z m consequence o c in,of this per
^ APPLICA N STANDS AN LL COMPLY WITH ALL NON-POINT Issued by: Date -
SOUR TIONS. 2� .
V Re-roofs
nature ofApplicuOCan r Date of Roof
HAZAR US MATERIALS DISCLOSURE Type
Will the applicant or future Wilding omupach store or handle Wardens material
U defined by the Cupenina Municipal Code.Chapter 9.13,and the Health and Safety
cmk,Stionus3z(a)7 ONO All roofs shall be inspected prior to any roofing material being installed.
Ye
Will the :'1iwm or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
In mh hazardous air contaminants u defined by the Bay Area Air Quality Management all new material I'nspection.
District?
❑Yes
I have read hs, ommaterialireq ' cuts under chapter 6.95 of dm Calif.,.
ria Hearer&Saf C 6.25305.25 arWM36.1undcuwddmiftMWBding J (i
doe rat torte y Irenan,that it' ymspamibility re artily de occupant Or the
require enmarthmetprior xis earacelllncwu(occypacy.�, azure of Applicant Date
ar tWdee.gan, L All roof coverings to be Class 'B"or better
Date
Community Development Department
Building Division
U
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Telephone:
(408)777-3333
CUPS T1N0
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 fust 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 o re-roofing.
Homeowner's Name: ! I IL4A
Job Site Address: 0
Roofing Company Name:
A p'icanls Signature: Date:�'03
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO A o O
P REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 33 C�, Date: S-c77 -03
Building Address:
Owner's Nam Phone #: r,
Contrac 24 1W), Phone A: License 1
Conta Phone#: 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. r+
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Descri t• n:
Residential Commercial ❑ C.�
Fire Zone: Yes ❑ No ❑ Confirmed with Planni .DgWt. if
there are any res ' tons: LJ
Costhif ject: Type of o s c ' Occupancy g up:
Qty.if
AppljeQlFee 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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