03030125 (2) CITYOFCUPERTINO # +wsR»�•� az -'� c'+-'S;t - -K":
UuamNC DIVISION - PERMIT =4CONTRAC�TOR`I1FUIiMA.TION - .
t ,
BUILDING ADDRESS: PERMR NO.
WILLIAMS ROOFING
1 OW NE ' ME: PERMIT LSS
4921. CABRILLOPOINT .
N GREEN GREGORY
SANITARY OL NO.
(408) 2527S120. .
ARCHITECTrENGINEER:. BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Sop LICENSED CONTRACTOR'S DECLARATION. O O O O
I Acmby affirm that 1 am licensed under pmvlsians of Chapter 9(commcncing - _ Job Description
with Sectlon'?")of Division J ofthe Business anSilmdessions
CunCode,and my license 1,
in full efn��GeaCa �Lle.R
REROOF
lowwrN
fT l ARCHMC"DECLARA T/O WOOD SHAKE, INSTALL- 1/2 CDX- PLYWOOD &
Iunderstand myplains aNllMused uPublic mcard 30 YR'. FELT 50 YR. ELK SHINGLF$�IAO A II tG
5� Licensed Professional . . 1�eF�
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt[mm the Communes License Law for the ' U 8 2003
p D following moon.(Secuon 703[.5,Business and Professions Cmle:Any city or county APR
$fvi which.,of=A pcwlt to consimi atm,,improve,demolish.A,repair any Amex..
So poor to its issuance,also requires the applicant for such permit to fie a signed naememt ��jj '
< that he is licensed pursuant to the provisions of the Contractor's Lune Law(Chapter 9 Sq.Ft. Floor Area {(yyT('.�',yy1�{tytJ EIQ n� p�
(commencing with Section 70010)of Division 3 of the Business and Profusions Code)or - YVr4�, LNG
..
that he is exempt Nemfrom and the baso for dm alleged eampdon.Any violation of
Section 7071.5 by any appliesnt for a permit subjects the applicantto to.civil penally of
not mom than five hundred dollen APN NUmberglpW
y Type
❑1,ea owner of the property,or my employees with wages u theinole compensation,
will do the work.and theawetum is not intended or offered for sale(Sm.70",Business 36919055 . 00 Required Inspections
and Professions Calc Tie Camasmes Limns Law does not apply to an owner of Q p
Property who builds or imporm themen,and who doeuuch work himself or thenugh his -
own employees,provided that such improvements are not Intended oroffered foraw.If.
however,the building or improvement is sold within one year ofcompletion,the owner- - 305 - FRAME -
builder will have the burden of proving that he did not build or improve for pu tine of 307 - INSULATION
ale J.
❑I,as owner of the propeny,am exclusively contracting with licensed contractor,to 601 — ROOF TEAR OFF -
construct the pmjeet(See.7W,Business and Professions Code:)The Contractors U. ,6OZ — ROOF PLYWOOD NAIL -
come law does not apply to in owner or property who Wflds or Impmvm Ihemon,and
who contacts for uch projects with a contramra)licensed pursuant to deContustm'a' 603 — ROOF BATTENS
Lien Law. 604 - ROOF IN-PROGRESS
0 I Am exempt under Sm. .B&P C for this season
lift: Policy
et - Data -
WORKER'SCOMPENSATIONDECLARATION
I hereby iffum under penalty of perjury A.of the following declssatinnc
have and will nwi alnACeNBesm ofCome..self-Imure for Worker's Compen. -
n•u provided for by Section 3700 of the labor Code.for the performance of the
for which this permit is issued.
has and will maintain Workers Cmopenudon insurance,ss required by Section
0 of the Labor Code,for the Mrfomanm ofthe work for which this permit Is issued.Worker's Compensation lnsunnm earicr and Policy number am:
Ffa.sa.L No.:0+L Ock'106,3
C 7l.
A ATEOPEXEM PnON FROM WORKERS'
COMPENSATION INSURANCE
(This ecllw need not hecompleedtithe Permit is(mow hundred dollars 151(11)
or less.) - -
f certify Nat' Nc perfowince of thc work for which this permit Is issacd,l shall not
employany mon in anymanmrau to becomesubject to the Worken'Compenuuon
Laws of Ce..
Applicant
NOTICE TO APPLICANT:If,after making this CcdlOcate of Exemption,you should
become subject to the Worker's Compensation provision of the Lahr Code.you most
xi forthwith comply with such provisions or this Permiuhsll he rimmed revoked -
'Z O CONSTRUCTION LENDING AGENCY
E+ la
I hereby arm that them is a wmtrucdon lending agency for the performance of -
C'7 the wmrk for which this permit is issued(San.301 Co.C.)
W A Lenders Name
=z Lcmwr'IAddmss
J O - 1 sanity that 1 have read this application and am that the above infotmalue is
U. coned 1agreeto comply with all city end countyymewivnma and sue bwrWontto
p buildingconstruction,Pro and forherImby ecimnp rposes. miwa of this city to enter upon the
W eM1ovc-mcnlioned properly forimnify and keep
gy (We)acme a ave,indemnify and kith harmless the y me of Cupertino atsimt
a new,a cc of th.casuand ex tenspe which may In aY waY accrue colon said City
U A PLICA T of UNDERSTANDS
of lists permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: . Date
SOURCE RE ULCy ATIONS. 3 � g
V --� Re-roofs
Signuurt of AppliesHice
HAZARDOAZARDO US MATERIALS DISCLOSURE Type of Roof
Will the applicant orwm bulldinodgacupamsmA u hand lc hsardo -material
As dcMed by the Cupertino void d Chapmr 9.12,and the Health and Safety
Code,Section 25532(.17 All roofs shall be inspected prior to any roofing material being installed.
❑Yee No
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applic t I future building accupanl use equipment or devima which P s g
h luaNnus Air contaminants ss defined by the Bay Area Air Quality Managcmcnl all n materials for inspection.
atricR '' '
❑Yes /QJN�u -
IhavemAdthe /,to
+e,YA us ..,aIs requirements under Chapter 5.9s or the Covet- �
At HcAIN&Sefmy Cotle,Secuwsl5sI13,335J3 anJ2SSJd.londcrslAnd thuifthe building
d not currently haw a tenant,that It is my responsibility to noth'y the occupant a the
mqut mcntsw hmu met Poor to sous cc of aCmariftteof'app 1 Signature of Applicant Date
owner ar aatho .<d Agem doo All roof coverings to be Class "B" or better
Community Development Department
f�§ Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228'
Fax: (408)777-3333
CUPEkTINO
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 ya"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: 1pR fQ oetcre A
Job Site Address: ci93 YJliue� �SG�o� I�eliryr+� inn.
Roofing Company Name: tui m*-1
A plicant' Date:
Greg eel
Building Official
Revised 1/30/03
Prinlad nn Panvn/nrl Pene.