03050008 CITY OF CUPERTINO '�""��' *�°-
Buu.mNc DivlsloN PERMIT CONT'R'ACTOR INFORMA'fION�;
CJ.: . , .�>at.:l•? r c se's-s•,*ae.,r.
eu1LDINGADDRESS: LOS GATOS ROOFING PERMIT"G03050008
OWNER'S NAME: — -1771 SMITH AVE. PeRMrr bTn2/2003
LFRED BRAD
ONE: (408) 298-9399 SANITARY NO. CONTROL NO.
ARCHTIECT/ENGINEER: BUILDING PERMIT INFO
B� O PLT rn
alpp LICENSED CONTRACTOR'S DECLARATION lob Description
FF 1 hereby affirm tont 1 iso licensed under provWons of Chapter 9(commencing C ,'
n� wish Seedon7000)of Division3of OMBusirussand PmfcWOMCode.endmylieenwis r'lIY A ��i®
in forceICIA eRecL`31 Lm.Is E00707 REROOF r /'�
LlccnAu Clus I
"�— °'M `anDECL MAY 12 2003
ARCHITECTS DECLARATION
I understand my Pbna shall he used As public rtcerds
3 a Licensed Professl
iona
O OWNER-BUILDER DECLARATION BUILDING
<0 1 hereby affirm dint I am exempt farm We Convectors License Law ror the
G o following mason.(Section 7031.5.Business and Professions Cade:Any city or county
$ which requires a Permit to construct.glut.improve,demolish.an repair any structure
poor in its issuance,also requires the applianr for such Permit to file a signed skument
that M is licensed pursuant m Ne previsions of dmontr
Cactor's 11 ..LA.(Chapter 9 Sq.Ft. Floor Area 6�0`A tion _
is (commencing with Section 71110)of Division 3 of the Buten.and Professions Code)or
Nat he is exempt theMfrom and the bust for she alleged exemption.Any violation of
Seedon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 9LYNaa3"uO O Occupancy Type
oat more than five hundred dollars(SSMk
❑I.is owner of the property,army employ.with wages As Heb rule compevadon,
will do the work,•ed shestructure isnot intended or offered far sale 7044,Busivn —
and Professions Code:The Committees Licvve Law dears not apply to an owner of 307 - INSULATION
gInspections
property who builds or im proves themon,and who d.such work himsel f or through his
own employ.,provided that such improvements are oat intended proffered for sale.If. 601 — ROOF TEAR OFF
however,the building or impmvement is sold within one year of comphuon,she owner.
builder will have the burden of proving the,he did rot Nim or Improve for purpose of 602 — ROOF PLYWOOD NAIL
Ai , 603 - ROOF BATTENS
I]I,as owner of du property,am exclusively commuting with licensed rononutom to 604 - ROOF IN-PROGRESS
conawnt div project(Sec.7044,Business and Profesalons Code:)The Contnetser's Li-
cenew law does net apply to an owner of property who wilds or improves theuan,Md.
who canonical for such projects with a conusotoris)licensed pursuant in the Camncters
License Law.
❑lemuemptunba Sx .BAPCfartin. n
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby allure under peri ty of Perjury ow of Iso following declarations:
I
his and will normal aCtnrimmof Coventtoself-insumfor Wob 2Compen-
ution,u prnvmed for by Section 3700 of she labor Code,for Use performance of she
woo for which this permit is luted,
I have and will maintain Worker's Compensation Inweanu,u required by Section
700 of the labor Code,far Ne penfonnence of the work forwhich this Permit is issued.
My Worker.CamPensauon Insunnee eemiv end Polley numwr tie:
Carver. `y Polity No.: ZZ77—ZO113
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thus Auction rued not he completed if the permit u retain hundenddollan(g1(1()
M MSt)
1 certify that In the performance of die work for which this permit is issued,1 shall not
employ any person in any mannan so as to herome subject to the Workers'Compensation
Lawaof California.Due
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to Iso Worker's Compemauan provisions of the labor Code,you in=
,J O foMwith comply wish such provision in this permit Nll be deemed mwkcd. .
,z,► CONSTRUCTION LENDING AGENCY
'[ti I hereby affirm that them is a construction lending agency for the Performance of
a? the work for which this permit Is issued(Sec.3097,Civ.C.)
94 Landers Name
z Landers Address
U C 1 Mary Nat 1 haw read this application and sou that the have information is
careens.1 agree to comply with all city and county eminences end sou laws elating to
building Construction,and hereby amhorive repmunutives of this city m enter upon the
Izl shave-mentioned Property for IvNClum PLmFML
(We)agree to taw,indemnify and keep harmless she City of Cupertino against
liabilities,judgments.ensu and experti which may in any way accrue gaiut said City
U 7 in consequence of the granting of this permit.
F7 APPLICANT UNDERSTANDS AN ILL COMPLY WITH ALL NON-POINT Issued by: s Date
SOURCE REGULyTro� l
�� �� T;A Re-roofs
Signartre of AyplicanUComr ecmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the spplicant or future building occupant store or handle huudous material
az de0ned by the Cap nice;Municipal Code.Chapur 9.12.and the Health and Safety
Cock,
Secde2s53z(a)?
❑Ye. (�Na All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant tAu egtipmenl ar devl.which If a roof is installed without first obtaining an inspection,I agree to remove
it examines air cenuminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Disonict?
❑Yes �{1s
I haw read she huamirmsmuerialsrtquimments underChepur 695 of she Califon / / ) 7/
nia Huius B SafetyCodc,Sections 25505,25533 and 25534.IundcrsruM Nu if the wilding
does not currently new a Meant,that it is my responsibility in notify the occupant of she
rcquincmcnuwh �` ` _,,a, usual¢ all0mifiesuofOccup ey. Signature of Applicant Date
«—'— ����3
Owner or wthorireJ.gem All roof coverings to be Class"B"or better
Date
a Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
_ • �
� ��O
INO Pax: (408)777-3333
wilding Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing is
completed.
3. All roofs shall be inspected prior to any roofing installation
4. To receive a frml sign off from the City the following steps are required.
1) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of'Vi"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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: it
Address: __ 2 t� Q Lceh 1 Ova
Ijeroofmg Company Name: JQ S' o i n
Applicants Signature: Date: aLb
Joe Antonucci
(Chief Building Official)
6MI01
CITY OF CUPERTINO
REROOF 6 3
CUPERTINO PERMIT APPLICATION FORM
APN# 35 Date:
DBa �S 3c� a
Building Address:
102-30 ee 2la 9/v ////
Owner's Name: / 2d Phone#: z//,5
26S- q1&
Contractor: /0S k 0 �n Phone 0J98--D9?
9 g 99 License#. 300707
: 300707
Contact: Phone#: Cupertino Business License#:
Tina )a12 i e 2 9- U9 9 ep,3 41g/
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles X Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Cl Provide I.C.B.O. Report#
To be Removed ] Provide Mfgr.Installation Specs. S s P
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 30 clp�t/�
Aft4�4 Ay=
Residential Commerci 1 ❑ O
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Proje t: Type ofonstruction: Occupancy roup:
(08040. o
Qty. if
Applj6able Fee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
# zl 7� 6
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