03070126 a CITY OF CUPERTINOvis >.'• t '�
t BUILDING DIVISION PERMIT CON'"'OTORANFORMATION,
BUILDING ADDRESS: LOUIS AND REPARRETTI INC PERMIT NO 03070126
MAi-NAMEVICERGY. eT
2964 C SOQUEL AVE PBRmfrr Issue DAT)
N ONTROL
(831) 477-7270 SANITARY NO.
ARCHITECTIE'NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
Loo LICENSED CONTRACTOR'S DECLARATION Job Description
wF 1 herchy.af0rm Ihat I am licensctl un�dey provisions of Chapter 9(commencing
iu� with Sation lIXg))nfDiviaion3of theBd;inht and Pr fe inns GMe,endmylicen¢ia
^�B, in fullO defr ,/"
Rq=
Lie s Lica '�63 n REROOF
ng Oatc contorcurr
RCHITECT's D RATION
1 n sehall he uhlic.,Aid, cy'
3>_6
q�� License Pmf)asinnal
OWNER-BUILDER DECLARATION
d 0 I hereby mRso of oc Net 11. exempt from the fissions Co License law for the
OO followingmom..(Seddon W3str Business and Improve.
Professions Code:Any city or county
Pi which rcyvia a issuance.also re enres be ither,pplic;mpmve,demolish, fl repair any atructent
prior lu inensedpalso pursuant
to the the applicant for such Permit N)signed Statement
Ed
(commislicensed puuuam 70th)of Divinrmnf the cBusieessand Pnsclaw(Copmr9 Sq.Ft. Floor Area Valu non
�1-$ Old(cohe is exempt
Section7000)da Division r the al aged!exempt Profession,Cock)or
.. Net he is eacmpt therefrom and the buil for the atkgrA exemption.Any viohdon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan five hundred dolhe($500).
❑I,u owner of the property,or my employees with wages u their sold compenullon,
will do The work end the structure is not Intended or.1fim l fond.(See.JOCN,Business 305 - FRAME Required Inspections
and limitations Cade:The ConlnctoYa License Law docs not apply In an owner of P
property who builds or improve demon,and who doesiowll work himselformrough his 307 - INSULATION
own employees,provided that such;mprovements are not intended oroRaed for sale.IL
however,me building or improvement is mid within one year of completion,the owner. 601 - ROOF TEAR OFF
builder will hoe the burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
sale.).
E!*.
1,es owner of me properly,am exclusively contracting with licensed contractor{to 603 - ROOF BATTENS
E!*." meproject('in.70diBusinessandRotation,Code:)TheContnetoriLi. 604 - ROOF IN-PROGRESS
celiac law docs not apply to an owner of progeny who Wilds or improve Merton,and,
who comncu fonuch pmjecB with a Conmctor(Q lianwd punuanntu the ConlnctaM1 .
License Law.
I am Can ph
under Sec, ,B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one lir the following declarations
I have and will maintain a Cenifieata of Consent to self-insure for Wort Compere
cation,u provided fm by Section 3700 of me labor Code,for the performance of be
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,u required by Section
37W of me labor Code,for the p rformance of dre work for which this permit is Issued.
My Wor s m nsalinn Insurance camerind Poli[ u r
Gm Q tAx/ Policy N : Z
CGRTIPICATE OF iXEMPfION FR M WORKERS'
COMPENSATION INSURANCE
(nd.seclion raced not Ie C(SOACted If th permil Is fortune hundred dollars(SIM)
or Ices.)
1 cen;fy that in me Notormat¢e of the work rot which this permit is Issued.I shall not
employ any person many manner m as to become subjecnmhe Workeri Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Cen ricatc of Exemption,you should
become subject to the Worker's Compensation provisions of the Uhm Cnd),you must
.JO fonbivah comply with such provisions Or this permit shall M dcdm)d invoked.
Z 4 CONSTRUCTION LENDING AGENCY
'(ti r I hereby affirm that mere in,conswctinn lending agency tonne performance of
R$ > the work for which this permit is;imed(Sol,3097,Co.C.)
UjQ Lcndcr's Name
M' Lender's Address
;Dz
U 0 1 cenify that I have red thus application and state that me above information is
*Date ly f-' somal.l agree to comply with all city and county ordinances and state laws relating to
DU building construction,and hereby au@orluc efAcsenu Ivss of this city to enter upon thesove-(We)a reeto S w ro dcmnifdon keep ho.(We)egrtemcove,indemnifyandkeep hay in an the Cilyor luCupcnst id itlincnHaddlilia,jnee of theSunni ng of nning exthis Pemit. theyin enyway accrue againnaid CityZ APPLICANT)UNDERSTANDSIAND rWILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs
ign.h..of AppIiC.mVCrm for Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant lir future building occupant store or handle haardous material
u defined by the Cupertino Municipal Code.Chapter 9.13,and Nc Halm and Safety
Code,Section 25312(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes ANY
'I Will the�pplicautorfuturebuildingoccupantuseequipmentordeviceswhich Ifaro 's installed without firstobtaining aninspection,Iagree toremove.
,lilt ha srdous air contaminants defined by the Bay Arca Air Quality Management all n )rials f r inspection.
DisuictT
❑Yes No _7
1 have ad the haekres materiels reyvimments under .Chapter fi95 of the Cali(nr 6
nice Halm&Safoy seem. and 25534.1 und)mand Oat BOO Wilding _C
docs not curt I ve a unam,' t it is my responsibility In mi fy the Occup of thd
req.;rdmen , hurt,,is.xA..r.ct fl)ateofC y� ign urn of Applicant Dae
r or mthmivnd.,Cut All roof coverings to be Class "B"or better
Community Development Department
Building Division
amme,
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U w���'�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 com ly with t e above
-stated policy on re-roofing.
Homeowner's Name: 7Q ",- +- -E 1
Job Site Address [ �, ,�(20
Roofing Company Name: S( � Gw� f'.
/W CJo, 4 (' Z_N `i
Applicant's Signature: L Datel-L 3
1 Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
c1 CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 157— ate:
} I — D
_— IJ
Building Address:
to (�t`C ✓ 1~1 .
Owner's Name: o[� ?t�
Contractor } Phone#: (License#:
v.;S �� 2� e � ��f- -�2�� -� 6o G3�
Contac Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
O Asphalt Shingles ,E(,Asphalt Shingles
,91� Wood Shakes O Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Cl Other(Specify) ❑ Other(Specify)
Number of existing coverings O 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: ( J"V-SI..- C, /Z t
Residential 19 Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning D
.�-� there are anyrestriction .
Cos f Pr tqJ T}��_e of onstruct' n: ccu ancy group:
[ -
1 F�V�!i`-�'� �'"fJ'- M•.0.
i
Qty
A I' a le) 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