03110094 (2) CITY OF CUPERTINO e s »'
BUILDING DIVISION PERMIT CONTRACTnR INFORMATION �
,.:.iKk ?T T V..y 2F:
BUILDING ADDRESS: APACHE ROOFING PERMIT NO03110094
OWNER' IT ISSUES NAME: PERMIT DATE
LLAN DANIEL N 5829 EL DORI DR 11/18/2003
NE: SANITARY NO. CONTROL NO.
(408) 363-0205
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+00 LICENSED CONTRACTOR'S DECLARATION
w 1 hereby )of that 1 am lichened under yaoy foss of%Code. 9(commencing Job D og A ��®
�ZW
with Section]ql )fofDivisionlof thc0usinaaSnUProfcssione COJc,and myliccnuis ee��/'�
a<c in full fnrtc In c
#o o I�Connartur REROOF n 3
J ARCf11TECTS DE ATl DEC 2 ZOOS
f c U 1 understand my plana shall Mused as public records o��■ ga�InlpA.
epG LiccnuJPmfcssional - BUILDING
,g OWNER-BUILDER DECLARATION
<S I hereby.(Sero on I am exempt from the Contractor's License Law for Inc
<p p following manna etch 1 ]B3L5,Business and nn,de iso CMC:Any city sr county
m whim myvims a permit re esrowcl,alley,imforsu demolish.fi repair any structure
plitnn iecensed c.also pursuant
the applicantwitiosof for Contractch or
Licensle ae ned Law
That me licensed urstion70o)of
of eBusin ss Liortotilaw(Cha ¢r9 S Ft. Floor Area
�o p p p q� Valuation
(cat he
(commencing therefrom
and ti basissn3nf theegedecaand Professions COde)Ur
that io is 31.5 b Inerefmm and Ur bale fm ube alleged exemption.Any=of
not
than by any red doll forapermiuubjceutheepplieamtoacivil Penalty of 3APRMi22IHer00
not mom than film wmrta aomrs(ssoB). Occupancy Type
D 1,o IlM.A.thepm.rime, hemycmployeea m cfergaazth,(S.C.compensation, -
will ds the work,and the he Concis not intended or Law
do for salepply to an Business
end Pmfessions Code:The Contractor fid who Law data not apply to an rough of Required Inspections
property who builds m ed drascsch improvements
and who sin does such work or
onhmugM1 It.
tun employees the ipmvidcd that such improvementsarenalintended
mpledon.for owner-
builder!,Nc Wilding or improvement is solthat
a di in 011e Wild
of comm for the use of
We owner-
builder will have the burden Of Proving Net M1c did not Miltl or improry for purpose of
We I.
D 1,as owner of the property,am exclusively connecting with licensed convectors to
carouser the project(Sec.7034.Business and Pmfessions Codc:)The Contractors Li.
cense Law docs not apply to an owner of property who builds or improves IM1meon,and
who contracts for such projects with a contractor(s)licensed pueuanuo the Comvacrors
License Law.
D l am exempt under Sec. ,B A,P C for this meson
Owner Dare
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury om of the following declarations:
I nave and will maintain a Certificate of Continuo self-insure for Workers Compere
1cm
on,a pmvidcd for by Section 37M of the Labor Codc,for the performance of the
rk for which this permit m issued.
I have and will maintain Worker's Compensation houranu,a squired by Section
0 of the labor Codc,for the pcfformance of the work for which this permit is issued.
Work _C mpcnsalion lnsuencc eerier end Policy number arert' e�-�Rl�G �+.-.I Poli a. I O
CERTIFICATE OFEXEMPI'ION F$ 1WORKERS'
COMPENSATION IN ANCE
(This section need not lecompleted if nM Permit is for one hundred dollars(SIM)
fir Icss.)
1 certify that in Inc performance of the work for which this Permit is ismed.I shall not
employ any person in any manner an az to Mcume subject to Workers Compcaarion
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should
Mcume subject to the Worker's Compensation previsions of the Labor Codc,you must
,Z forthwith comply with such provisions in this Permit shall M deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a Com uction lending agency lot she Performance of
Y Ne work for which this permit is issued(Sec.3W7,Ci,C.)
Q lender's Name
=z Leaden Address
J Q I certify that 1 have read this application and sem thin the above information is
ILCorrect.1 agree to comply with all tiny and county on inanecc and sum laws elating is
0U bidding corowmion,and hereby aithorim mpresematises of this City to enter U,mrhe
.hon ormlioned property for inspection purpoxs. I/h1// 1py/�,� 1
H y (We)deme he nese,indemnify and it. harmless the City of Cupertino against ( V L I V
rp
liabilities,judgments,costs and expenses which may in any way aeeme against said City
Jz
in consequence of the grand ng of this permit.
APPLICANT
UUNDELATIORSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
s
anteesu Re-roof
nature ofApplig
Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant store or handle haerdous material
az defined by the Cupertino Municipal Code.Chapter 9,12.and the Hcalth and Safety
Codc.Section 25532(a)?
71 Yes No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant Use cquipmenl or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hvutlous air emai minanu a echoed by Be Bay Arca Air Quality Management all new materials for inspection.
cl?
❑Yes ONO
1 have read the hexamnus materials requiemenu under Chapterh.95 of the Califor-
nix Hcaltn6SafetyCuedSahmas255(15.25533 and 25534.l understand thatifthe IvOlding /
does net eumently haw:a lemium,that it is my ms,nobibly to entry ar cecapal Of the
;Gm,
e ¢wnicn mus M prior m issuance of a Ceruf me Qcupancy. /
/g uU0 Signature of cant Date
ownerm,ihmi,Cdag Date All roo coverings tobe Class"B"or better
t
Community Development Department
Building Division
City of Cupertino
t 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
OUPEkTINO
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 i6quired.
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: \ rr,e1 C C
Job Site Address: '? C' 2 7
Roofing Company Name:
A plicant's Signature: Date: / A/u o 3
Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 0 3
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
/7 ov 03
Building Address:
Owner's Name: Phone#:
'DrA -7.?s o2 9 Ys
Contractor: Phone#: 1/o P License#:
r��t koo-Q.,J Fs ir- Y/YS 98
Contact: Phone#: s'o r Cupertino Business License#:
�3/3- O I 0 3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles A' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O.Report#
/ef To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy:
Job Description: __.---.--_—.
Residential P6mmercial
Fire Zone: es EJ No ❑ Confirmed with PI ing—Det. if
ost
there are anr rictioris:
o Project: Type of Co t i n: Occupancy g u
0o2S. vu r.
Qty. if
A lic 1 Fee ID Fee Description Fee Grou
i
RMFEE BldgPermit Fees BUILDING
RGY Ener BUILDING
ISMICRE Seismic Fee Res BUILDING
ISMICOM Seismic Commercial BUR DING
LANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
I d T Ste.