03100105 CITY OF CUPERTINO . = :r
BUILDING DIVISION PERmrr "CsONTRkC"TOlkINFORMATION
BUIL DING ADDRESS;
yZ R E ROOFING & CONSTRUCTION TM"03100105
IUZ
ER'S NAME: 152.30 CLYDELLE AVENUE PERMIT MUEDATE
E'
(4108) 925-9995 SANITARY NO. CONTROL NO.
ARCH=11INGINEER; BUILDING PERL41TINFO
BLDG ELECT L MB MECI
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,op LICENSED CONTRACTOR'S DECLARATION O 5
I I hereby effrm that L am licensed under provixiuns of Chapter 9(commencing lob Description
wiLhSectitlM1 7f/JII)af Df 3ofihe0 airs... Professions Code,a ad my license is
_$ 1� Tq REMOVE EXISTING 1 LAYER
sg? License Clara Lk.
Data
0
CmltDmcmr OF WOOD SHAKE, INSTALL NEW 1/2 IN. CDX, 30#
t ELI A
v✓u lunderstand mypinasha neaxedaspahli x ASTM FELT & PRESIDENTIAL ASPHALT COMP .
RCHITECTS
r C Licensed Professianal
OWNER-BUILDER DECLARATION
1 e Y I hereby effrm that 1 am exempt from the Contracmr's License law for the
:00 fallowing mason.(Section 7031.5,Business and professions Code:Any city or county
5$ which requires a pcmtil to construct,alter,Improve,demolish,or repair any structure
priorhs its issmnce,alto requires lheapplicanl forsuch permitm Ate a signed statement
< that he is licensed proomm ,beprovisimm.ftheContractor's License law(ChapIrr9 Sq. Ft. Floor Area Valuation
j3 (commencing with Section 7")of Division)alone Busincasand Profusions Cods)or
J Net he is exempt therefrom and doe basis for the alleged exemption.Any violation of S13000
Section 7031.5 by any applicant far a permit subjects the applicant to a civil penalty of APN Number. Occupancy Type
not more than five hundred dollars($500).
❑I.ss owner of the property,or my employee with wages as their rale compensation, 35707020 . 00
Will do Ne work,and do muctum is cot intended or named for vale(See.7044.Business
and Profusions Ccde:'The Contractor's Licevrs e Law donot apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.It, 305 — FRAME
however.Ne building or improvement is sold within am:year of completion,Ne owner
builder will have the burden of proving that he did mat Wild or improve for purpoa of 307 - INSULATION
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
601 - ROOF TEAR OFF
convect the project(Sec.7W,Business and Professions CodeO The Contractors Li" 602 — ROOF PLYWOOD. NAIL
cause law docs not apply to an owner of property who Wi ids or improves thereon,and, 603 — ROOF BATTENS'
who coronets for such propursuant projects with a contractor(s)licensed pursuano the Contractors
License law. 604 - ROOF IN-PROGRESS
1 un exempt under Seo. .B&P C for meson
r Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury arse of the fallowing declamations:
I have and will maintain a Certificate of Consent to self-Insure for WorkedCompen-
mtion,as provided for by Section 37M of the Labor Code,for the performanee of the
work for which this permit is issued.
❑1 have and will maintain Worteri Compensation Tnsunna,as required by Section
3700 of Ne labor Code.for the performance of Ne work for which this permit is issued,
Mywor 'v Compensation nsumnceamaic, ad Policy Mark,am.
�olNo.: y 1 I_I U�aX
CERTIFICATE OF FROM WORKERS'
COMPEN ATION INSURANCE
('ITh section need not be completed Kline permit is for one hundred unit.($100)
or leas.)
I eenify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any mammran as to become subject to tive Workefl Cmartmadon
Laws of Celiramm Datc
Applicant
NOTICE TO APPLICANT:IL after making this Ccnifcate of Exemption,you should
become subject to the Worker's Campcnsition provisions of Ne labor Code,you must
�Q forthwith comply with such provisions or Nis permit hall he deemed reviled,
ti ► CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
Y, 7 the work fur which this permit Is issued(Sec.3097.Civ.Cd
J)0 Lender's Name
Y Lender's Address
Q1 certify that 1 hast mad this application and suit that the show information is
y tamed.I agree to comply with all city and county ordinances and slate laws relating to
V building construction,and hereby authorize repreuntadves of this city to enter upon the
ahovo-(We)
agree
to rany for iarnify an kmiphs. ^
(Wc)agree to saw,indemnify and kith harmku the City of Cupcnst against
h liabililiu,judgmenu,coming expenses which may in any way eccrve against said City
JT inean ante of the granting Of permit.
APPLICA q'Uly�€RSTANDS AND.SILL COMPLY WITH A4 NON"POINT Issued by: Date
SOURCE E IL / I ,)
I
( � IJ t Re-roofs
SigVhxof ApPieam ConuacIM/ `\ Data
HAZARDOUS MATERIALS DISCLO](Q1RE Type of Roof
Will the applicam in future boildiag aceupmt smrc lir I Rdlc hanrdmus mateud
Oiled by the Cupenina Munici t2oJe.Chapkr 9.13,and the Heellh end Sefcty
.oye3 zss3zla)7 No All roofs shall be inspected prior to any roofing material being installed.
Will he applicant r future building q aphm tau cyuipmcnt or Jcv faawemn a roof is installed without firs[obtaining an inspection,I agree to remove
7ni,Harrh
hazardous air contamiawn ss def ad by the Bay Arca Air Quality Management all w ma a for inspection.
ict?
r.
Dyes
�
I have rad thele Noon 2555, requirements 5534.1 under of the Calling
no, Safetyhave Sccsans255�5,2557]md25534.1unJcrsund thmifdtc Willing nota ntlyhovem anCthat itiaeponsiM1ililY tee nndl'y thesxcupmt of the0" 9 1mmc w4�ich nM Ipiurtuissu ole ertilreatcofQSI ature-of-Applicantner unmh rizcJ agent Data All roof coverings to be Class "B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
' Telephone: (408)777-3228
CITY OF Fax: (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 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.
s �(\' �� 1 t✓� c7171��
Homeowner's Name:
Job Site Address:
Roofing Company Name: '
A plicant's Si ature:
Date: 1 " k 4I U_3
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
. 311 Ol
CITY OF CUPERTINO O D
REROOF
�cUPE(,TINO PERMIT APPLICATION FORM
APN # O Date: F
Building Address: �-�UO
/ Z W1 `
'� O2Z SCh�IG ClR _
Owner's Name: I I Phone
MU�� ''
Contractor: Phone#:License#: 2 5
Contact: Phone#: Cupertino Business License#:
'�'oin Tio-&Tw.. 4A- x}21 -�`��
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:
Job Description: e>~ �_A LST I N K l Lie 0)(- W o`rV 5 HA_V-z t t N s-tA-Uk_
112 " GDX 3,0# Astl-k hf •T t' �PFeSlJll11 "hlk T (OW�
Residential Commercial ❑.
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: I�
Cost of j p .,Type of Cc Occupancy group:
Qty. if Fee Descri tion Fee Group
A lic b Fee ID
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