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03070167 CITY OF CUPERTINO BUILDING DIVISION PERMIT h CIONT.%i ORINNFORMATIQNS'', . BUILDING ADDRESS: PERMIT NO03070167 3O7O167 5!630 WATRRIMRD OWNER'S NAME: PERMIT ISS(fe DATE NE: SANITARY N0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 u00 LICENSED COSURACIOR'S DECLARATION fL wF I Mreby affirm that 1 em licensed un provisions or Chapter 9(commencing Job Description <Z" with Smd.r'(INg)of Division 3n�e Bus and Professions Cmde,andm license is ((�� t�� /J� �® vdWi in full force.RWfecV // y U"• n�J(+°•exa>a q� Linnaeclaa IJe.a �- - U 7 EROOF Date Ce�Rnw{- CONTRACTOR: RIDOUT ROOFING RCH CTSD601.ARAT AUG 2 B 2003 � nand my plane[hall M used a public records �yU 0 Lisp tttl Pnrfessinnal OWNER-BUILDER DECLARATION . BUILDING<� 1 hereby affirm that I em exempt from the Contractors License Law for the v g V(� O O follnwing moon.(Section 703 I.S.Business and Profession Code:Any city or county K m which below.a pumit tit convect,alcor,improve,mro,uh.or.,I,any stmctum pnminitsissuancc.elm requires theapplicant for such permiuo file asigned,Mumomt Nat he is licensed punuant 1.the provisions of the Conotoon's Lice.U.(Chapmr 9 Sq. Ft. Floor Area Valu t ¢�$ (commencing with S.tion][I[p)nf Division 3nftM Businessand PmfnsimMCMe)or 814225 that heis exempt Nemfrom and the buss for rite alleged exemplion.Any virl.dum of Section 7031.5 by anyapplicam for a permitsubjeeta the applicant to&civil penalty of not mom Nan five hundred kAla36+�Ii18`l➢�IitbeI00 Occupancy Type n 15500). ❑I,.owner ofthe propen,or my employees with wag.as Ocirsole compenution, will do On work and On structure is not intended or offered for ale(Sec.701,1,Businw and Professions Code:The Contactors Licercz Law doss not apply to an owner of Required Inspections pmpeny who builds or improves thereon,and who does such work himmlfor through Ms 305 - FRAME own employees,provided Nat such improwmenu are not intended morseled for ale.If. 307 - INSULATION however.the building or improvement is mid within one year of completion,the owner- builder .will hoe the burden of proving that M did not build or improve for purpose.of 601 - ROOF TEAR OFF ale.). ❑I,a owner of the pmpeny,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL constrict the pmjcct(Sec.]Baa,Business and Profusions Cade:)The Contactors U. 603 — ROOF BATTENS. cc me Law does not apply be in owner of property who Wilds or impnives tharcon,and 604 - ROOF IN-PROGRESS who contracts for such projects with a eontnctur(s)licensed Pursuantto the Cmdosctora Limmic Uw. ❑I un exempt under See. ,B&PC for this..on Owner Date Alibis WORKER'S COMPENSATION DECLARATION 1 hereby air,_under pealty of perjury one of the following decimations: 1 hoe and will maintain a Cenifinmof Cnmm�uo lalf-insure for W9rkchCompcn- ution,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,u myriad by Section 3700 of the Labor Code,for the performance of NC-stork for which this patent is issued. GkWker's Pebastion Imm�nce[&Bier rad Pplky num i �O u ERTIFlCATEg�ON FROM WORKERS' COMPENSATION INSURANCE (This section need not M completed If the permit Is for nnc hundred dol0rs(SI01B or less.) 1 cenify that in the performance of the work for which this permit Is Issued,l shall not employ any person in any manner sec a to become subject to the Workers'Com,cosailon Uws of California.Date Applicant NOTICE TO APPLICANT:If,aricr making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions a(the Uhm Code,you must .J O forthwith comply with such provisions or this I,mmil shall M deemed¢voted. 'E `� CONSTRUCTION LENDING AGENCY F k for herebyaffirmNat there iss.cd(S .ion X97,nO, agency lnnhc perfurmancc of C' .moi the work for which this permit is issuctl(Sec.3lN7,Ci¢CJ Fi A Lenders Addr z Under',Atltlmu V Q 1 certify Nat I have read this application and MAID that the above infmroLkm is (~ correct,1 agree to amply with all city and county ordinances and state laws relating to pv building convection,and hereby authorin representmives of thisui ty to enter upon the Y'a above mentioned property for inspection por,mes. (We)agree rat law,indemnify and keep harml.s the City of Cupenino against iF"•t fq liabilitiesmen ,judgts,cash and DxKrocs which may in any way carve against laid City V z APPLICeof the grand ng of Ipermit. ANTUNDERSTANDS AND WILL COMPLY WITH A NON-POINT Issued by: Date S ERE L TION Re-roofs Si ebur[& App1inn0Con.,bu &le HAZARDOUS MATERIALS DISCLOSURE Type of Roof , Will the applicant or future building occupant store or handle huurduus materia u defined by the Cupertino Muriel I Cm! Chmtcr 9.12.end the Keith and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant r furore building occupant use equipment ordeviaa which If a roof is installed without first obtaining an inspection,I agree to remove it ho'arduIts air conaminanu u d ed by the Bay Arta Air Quality Maugement •all new materials for Inspection. uricB ❑Yes u I have mad the hamrdcws materials mquimments under Chapmr6.95of theCalifnr maHnith&SafetyCeM,Seetiuns25505,25533and25534,1 understand 011ifthc Milling dons t currently haw a tenant Nat it is my rcapmuibility to notify tM omupam of the req menu w s et prior tissf a CcniOca f u ey. d uance o ,Zy Signature of pplicant e Owner or autharisd apcm Dat All roof coverings to be Class"B" or better Community Development Department Tllr Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408) 777-3228 U P E kT I N 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 comply with the above stated policy on re-roofing. xHomeowner's Name: Da '`1 Ie C Job Site Address: CO Roofing Company Name: � Apliteelcant's Signature: � Date: Z Greg Building Official Revised 1/30/03 Printed on Recycled Paper , CITY OF CUPERTINO REROOF o3 v 7o / 67 CUPERTINO PERMIT APPLICATION FORM APN# 3('0& ' ^ 1 (p © �>s I Date: -7/ Z Z j 03 Building Address: r O er's Name: Phone#s Pe o e. C ntract r: Phone#: o License#: 0 1400 P3S I -i )�_ a o1 0 6 ct: Phone#: Cupertino Business License#: err U" S� 3S1 - i z Type of Roof Covering: Existing: Proposed: ❑ 'Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles CI—Asphalt Shingles _Z�Wood Shakes ❑ Wood Shakes –Cr-Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# „a<–To be Removed ❑ Provide Mfgr.Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: Aa K q.Kd- &A.SS T S �1a.�l.Q. S S Residential]" Commercial ❑ Fire no:—Yes❑"No,❑ Confirmed with P g I. if there are an trictions: Cost of Pro ect: S as Type of Constru 'on: Occupancy roup: O Qty. if A c ]e Fee ID Fee Description Fee Group BPERMFEE ldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING , 8