03070192 (2) CITY OF CUPERTINO
13UILDING DIVISION PERMIT ("O NTRACT�
, R`�I1VP'ORA"'IAT10ION
T� -
BUILDINGADDRESS: R E ROOFING & CONSTRUCTION PTttND03070192
i
NER'S NAME: 15230 CLYDELLE AVENUE PERMITL4UEDATE
rSTUART HAMILTON —..0-7124/2003
ONE (408) 925-9995 SANITARY NO. CONTROL NO.
CHITECnENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j 11 LICENSED CONTRACTOR'S DECLARATION IobDescri tion
�' 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing p
^?� with Section AXKOnf Dgiviqsiopn 3ofthe Business andpmryryfcasinna Gmmq,Md my license is
: „ Lic 11foree1Meff / ll/ LIc 1 L 7 1 REROOF
g? Licenre Clew lL
9 DemCaaffracior _ INSTALL 3/411 CDX, 3U .#ASTM FELT & IILIKETIMEII
ee RCIIITE LS DEC'AR
` 0 IundcrwnJ my phos ahallbeu rnrVa ASPHALT SHINGLE
6G Licensed Proona
fessil
OWNER-BUILDER DECLARATION
F I hereby affirm Nn I am exempt from she Contractor's License Law for the
$O�, following meson.(Section 7101.3,Business and Professions Code:Any city or county
which requires a permit In construct,eller,Improve,demolish,or repair any structure
_Zio Prior o its issuance,also moulner be applicant for such a nit m Rlc.ulpri Jsutemcm
qmm< that he is licensed Pursuant 10 the privisionsofsheCommune,Lieenalsw(Chapmr9 Sq. Ft. Floor Area Valuation
t I'$ (commencing with Section 7010)of Division 3 of the Business and Prefessions Crim)or
Nat he Is exempt therefrom and tits basis for the alleged camption.Any violation of $11000
SeNon 7031.5 by any applicant for permit objects the applicant o a civil penally of APN Number ,Occupancy Type
not more Nan five hundred dollen($500). 35701038 . 00
❑L as owner of the property,or my employma with wages a their compensation, II A
will On the work,and sheawnure is smimended or offered f...Ic(Sm.70".Business Required Inspections
and Pmfessioes Code:The Comncmres Am
s License Law does m e ns apply an owner of q p
property who builds or improves thenar,and who doessuch work himalror through his AUGown employees,providedare that such Improvements anot intended or offered for ale.If, 305 — FRAME AUG — 2003
howewq the building or improvement is old wind.one year of completion,the owns,•
builder will ban the burden of proving that he did not Wild or improve for purpose of 307 - INSULATION
sale')' 601 - ROOF TEAR OFF BUILDING
602
u owner of she property,am exclwivcly contracting with acma licensed contrto 602 - ROOF PLYWOOD NAIL
consumer the pmjccl(Sec.7014,Business and Profusions Code:)The Contractors Li
more law does not apply to an owner of property who Wilda or improves Bmmoe,and, 603 — ROOF BATTENS
who contractsfor such projects with a eommsetor(s)licensed pursuant to the Convector's
Lica"alaw• 604 - ROOF IN-PROGRESS
❑l am amorm uric,See. ,B&PC for ria rtaon _
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby AM.under penally of perjury,one of the following declarations:
1 haw and will maintain a Certificate of Consent to alhinsum Inc Worker's Crimper.
lion,As provided for by Section 3700 of the Liner Cole.for the performance of the
work for which this permit is issued.
I haw and will maintain Workcr's Compensation IMunnce.As required by Section
3 of the Labor Cade,for she performance of rte work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy nI ummberare:
Cartier. r µ Policy No.: Ui l - l0�10�
CEIMFICA F EXEMPTION FROM WORKERS'
CO PENSATION INSURANCE
(This action need not becompleud if the permit h(none hundreddollaa fila))
its less.)
1 cenify nal In the perroneaneo of the work for which this permit is Issued,I shall not
employ any person in any manner an As On become subject to be Worker'Compemation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making Ibis CeniOcam of Exemption,you should
become object to the Worker's Compensation f ovisions of the Labor Code,you mon
O Rcuwish comply with such pmvisiow ser this pesmit shall be deemed mnkcd. -
„z,i CONSTRUCTION LENDING AGENCY
I hereby affirm that Here its conswcrinn londingagency for she performance of
a the.,it for which this pmmis h issued(Sec.3097,Cie C.)
ALender's Name
D z Lender's Address
V Q 1 cenify that 1 haw read this application and mm that the above Information is
Fco.en.1 agree to comply with all city and county ordinances and sum levet misting to
0
D V building cotioned roert hereby
orimamhodmropreanutiws of Oil city 1.corer upon the
W ebovw(W)agree property for emnify an keep hs
C
(We)agree n sew,indemnify and keep hay in an the City or against
against
UN in consequence
me th,coauand.ties oexpenses
Permit. may in my wayacme agalnat aid City
V rZr s ICyA ncnUNDERhe g STANDS AND WILL COMPLY WITH A NON-POINT Issued by: Date � Z Y \
SO _
Z 0 Re-roofs
S our ApPI'c°Hdcimunnot AZAR S MATERIA OSURE Da Type of Roof
Will theopplicant o lure building ncupanutore anile havandous material
As tied by the Cu on
Muriel I Codc,CluPmr 9.17,aro the Health and Safety
Code. I.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes ❑Nu
Win the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It havardow air contaminants As dartnJ by the Bay Area Air Qeeiity Management a`l`l`,new materials for inspection.
iYlrlCl7 �V
❑Yes
I bout mW the havardimsmeudalsmquiremcnrt uodcr Chepmr6.95 oflhe Califor.
ales ct tlnu755113.75533 end 35534.10notif LIth VL%up Wilding ZL4
Joel nal curte were L at it i s wihilhy m notify IMpppeeeeeeupant of the �
require. oncoffice orggla y.lU Signature ofAppliefl Date
Owner mauthorh< ��-. I ntl All roof coverings to be Class"B" or better
Community Development Department
Building Division
SLUM
City of Cupertino
10300 Torre Avenue
4 CITY OF Telephone: (408)777-3228
U P E IST 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.
Homeowner's Name: 1/T^�cM
Job Site Address: I U I �k l l�A-'� 5
C� 5-L
Roofing Compan ame: T-, C �V U� �� s oW `
AA plian cs Signa ��- Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF 0 3 � 7 ° ( �Z--
CUPEf�TINO PERMIT APPLICATION FORM
APN# .3 — 6 -- 22 Date: - 12-1-tI 03
Building Address: /, I 5/ TLA-
Owner's Name: U l 'I Phone -
S11.1A'RT trAM I t.��•l �U8— l 0 3
Contractor: Ro01%Irvp Phone#: License#:
trw, IrdL- CK 2 `1�� �
Contact: Phone #: 40�_ 1{2 1 - Cupertino Business License#:
�w l� �Pl�tr�ra>L —I H 13
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof 'r U Tjl;I Nt� ❑ Built Up roof
❑ Asphalt Shingles ( �� B� Asphalt Shingles
❑ Wood Shakes l ❑ Wood Shakes y�
❑ Wood Shinglesl�j){�X(S ` ❑ Wood Shingles 1 h�1➢ ���I ��'
L3 Other(Specify) ❑ Other(Specify)
Number of existing cove 'ngs ❑ Provide I.C.B.O.Report#
L3 To be Removed O Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: jt45TA t, aI4 tt (ADX t 3u # AS?M eLIA- f}nNf "Ll Ve-r IMS
ASPFr f^ 1N
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Plannin De t. if
there are anrestri ' ns:
Cost of Project: tI 1 ,000-Vol Type of C ns 'o : Occupancy gro
Qty i
Appl'ca le Fee ID Fee Description Fee Group
22 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