03100174CITY OF CUPERTINO777
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INFORMATION.;
BUILDING DIVISION PERMIT
kCONTRACTOR
BUILDING ADDRESS:
SIGNATURE ROOFING INC
PERMIT SOO 3100174
11 4 SCOTLAND
OWNER'S NAME:
SSS OINEILL AVE, #16
PERMITISSUEDATE '
LEVITE RICHARD.J AND CARMEN
E
10/23/2003
ONE:
(800) 644-7410
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
LICENSED CONTRACTOR'S DECLARATION
IOU Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
P
de lse is
with Section 7") of Division JmNC Business and Professimw Co rad my icen
in full force and of q -
a REROOF
License Class r Lic.
e
PINALED
Date 117
ARCHITE SDECLARATION t p
d 6 O
I understand my plans shall he used ax public ebmds
,1 'g IJ �% �]
NO V 1 1 2003
Licensed Professional
DECLARATION
OWNER-BUILDERreptfrom
1 hereby affirm thus I exempt from the Contractors License Law for the
_
following re son. (Section 7101.5. Business and Profeaxiens Code: Any city or county
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which requires a Permit to construct. sort, improve, demolish. or repair any structure
®IIY 6 0 6 6
Prior to its issuance, also rcyvires the applicant for such permit to rile a signed surment.
Ft. Floor Area
that he is licensed pursuant to Ne provisions of the Contractor's License Law (Chapter 9
Sq.
Valuation
(commencing with Section 7")of Division 3 of the Business and Profcasions Code)or
36228009.00
-
Nat he is exempt flaefrom and We basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
P Y YP
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil Penalty of
.at more Nan Eve hundred dollars (5500).
❑ I, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do Be Work, and the slNClam is not Intended interfered rur sale (Sec. 70,14. Business
and Professions Cade: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who doessuch work himself 9rthrough his
own employees, provided Nat such improvements are not intended eroRered torsade. If.
however, Ne building or improvement is sold within one year ofcomplelion. Ne owner.
,
builder will have Ne burden of proving Nat he did not Wild or improve for purpose of
mm.)
❑ 1. as owner of the properly. am exclusively contracting with licensed contractors to
construct the project (Sec. 70", Business and Professions Code:)The Contractor's Li.
cense law does not apply to an owner of property who builds or improves Merton, and
who contracts for such projects with a contractor(s) licensed purseanno Ne Contractor's
,
License Law.
❑ 1 am exempt antler Sec. . B k P C for Nis re am.
DarWORKER'$
ECLARwner
COMPENSATION ATION
I hereby of on under penalty of pe jury m¢ of the following declarations:
i'd
1 have and will maintain aCeni icate of Consent to self-insum fmWorker's Camper.
ion, as, provided for by Section 37011 of the labor Code, for Ne performance of the
work for which this permit is locoed,
have and will maintain Worker's Compensation insurance, as required by Section
00 of the Labor Code, for Ne performance of On work for.linh this permit is issued.
My Worker��''s'''Com nsetion 1 sumnce artier and Policy number aa:
'� -'010
Cartier. Policy No:
;EXEMPTION
WO
C RTIFICATE MOM WORKERS'
COMPENSATION INSURANCE
(This section need not M completed fiber permit is for one hundred dollars ($10(B
or less.)
1 certify Nat in the scruntrome of the work for which this Permit is issued, 1 shall not
employ any person in any manner so ss to hecome mbjecuo the Workers'Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Ccndicatc of Exemption, you should
become subject to the Worker'9 Cam penaalion provisions of the labor Code, you must
forthwith comply with such provisions at this Permit shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
Out work for which this permit is issued (Sm. 3097. Civ. C.)
Lender's Name
Lender's Addreda
1 that 1 have read this application and duan Nat the above information is
builgree
dr e1 agree m comply with city and ceumy ordinances and sur laws relating to
�.
and hearty aenhon Of
y representatives utives of this city to enter upon the
shove-mentioned property for inspection purposes.
above-mentionedro p
(We) amen to save, indemnify and kith harmless thew City Cupainsts against
and expenses which may in any way accmc against City
is
incobics. once of the
n canuyucncc of the greening of this L
APPLICANT ERSTA S i�y^Wn�ILLCj}IPLY IVITH ALL NON-POINT
Issued by: Date
SOURCER LATI
\/
/9
Re-roofs
Type of Roof
SignawrcofApplicaoat
HAZARDOUS MATERIALS DISCLOSURE
Will Ne applicant or future building apt store or handle havNuus martial
as defined by be Cofounded Municipal Code,Chapter 9.12, and the Health and Safely
,
de. Section zss3z(a).n
All roofs shall be inspected prior to an roofing material being installed.
]Yid ❑No
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or dcvima which
it hazardous air contaminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
mic'?
lrcyuircmcnu
❑Yes C] No
1 have read the hanorhas materials requiements under Chapter 6.95 of the Califon
nice HralNdr SafctyCcdc, Semen, 25505.25533 it 255Jd.lundcrsmntl met i(Nc Wilding
dos not currently halm a tenant that it is my mar ommility to nodty the occupant of the
whi user rex tnety [y/�f�anbeora niEbamoraef 1p
Signature of Applica Date
!G
All roof coverings to be Class "B" or better
Owner or mT.e a tot 7 Dale
T
1
CITY OF'
CUPERTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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.
Homeowner's Name: �` &L' - .
Job Site Address:
Roofing Company Name:,
1A phcanYsSignature: / Dater 3/U_3
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
G
t
✓9
CUPERTINO
CITY OF CUPERTINO O 3 �,, 174
REROOF
PERMIT APPLICATION FORM
APN #
Bldg Permit Fees
ate: /0 /X /03
Building Address: S
_ . r, /1 10
-ChIJ
Owner's Name: / _
Y�l
n
CPhon"e -'#"%J4
Phone #: SS _7 2 G �.
Contractor: C �
Sl�o)S 4$-SY4+
License #: G 8 (0 G 6 g
Contact:
Phone #:
Cupertino Business License #:
BUILDING
BUSLIC
Business License
BUILDING
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
)d Asphalt Shingles
V Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
,X To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job escription:
�o�
? �� 3
/ 3
Residential t3�'
Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Det. if
there are any restrictions: E
Cost of Project:
Type of Construction: Occupancy group:
'606 (0-6t)
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
�1'27-��_ 70