03060136 (2) CITY OF CUPEWFINO
BUILDING DIVISION PERMIT XON , 'CTORjNFORMATI�ON
BUILDING ADDRESS: P & R ROOFING PERMITNO03060136
OWNER'S NAME: 265 WREN WAY PERMIT ISSUE DATE
ONE: r SANITARY NO. CONTROL NO.
(408) 374-7421
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 o ct
C O Q
�<< inraurorceannLem.3 O CONTRACTORS
'S DECLARATION
tu 1hereby affirmthat
I.maunder pcProfcnamet
9(commencing
Job Description
� wcmion]IXpofDivxl.farcBusilwuandimc on and
myliccnx is
.� REROOF FUN,A LE•15
j�jZ Licens Clos Lie.N
tip DaN &_ h Z Calllfaetor
ARCHITECTS DEC 9 p{
10 1 undmimnd my plum shall he used as public ammda U U I. O N `p/0 J
5O Licensed Professional
5OWNER-BUILDER DECLARATION
gs 1 hereby affirm Net I am exempt from the Contractors License Law for the BUILDING
00 following meson.(Seetiun 7031.5,Be incss and Professions Calc:Any city or county - 'mss'
which requires&permtl ,,construct,alter,improve,demolish,or repair any aructum
�Zj, prior m its issuance.2150requiro the applicant for such permit to file a signed aaamcnl
that M is licensed paOasat to the M,ialaN of the CamrmWh Ll m.LA.(Clepler9 Sq. Ft. Floor Area Valuation
FCu (commencing wi N Section 7")et Division 3 of the Business and Professions Cmle)or
3$
that he Is emmpt Nemfmon and the basis far the alleged mtroptlon.Any violation of 35623004 . 00
Section 7031,5 by any applicant for a permit subjects she applicant to a civil penalty of APN Number Occupancy Type
not more Nan Ow limited donor(5500). P Y YP
o I,u owner of the prPeny,m my employee with wgo u fair sale oampensalon,
will do the work,and due wcture is not imeuded.,offered fonalc(Sm.7014,Business 30b — Re wired Ins eCt10HS
and Profession&Cade:The Contractor's License Law does not apply W an owner or P
property who buildsor impmvm nm theon,and whodosuch work himsel/mrthrough his 307 — INSULAT ON
own employees,provided that such improvements are not intended oroffered forule.If, 6O1 — ROOF TEAR OFF
however,the building or improvement is sold within one year of compinion.the owner-
- builder will have the burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL
rat`')' 603 - ROOF BATTENS
El I,as owner of the property,am exclusively convecting with licensed connectors to
construct the p.jcc,(Sm.7044,Basin. ad Pr.rwi...Code:)The C.ntrml.r2 u. 604 — ROOF IN—PROGRESS
come Law does not apply to an owner of property who Wilds or improves Income,and
who contracts for such projects with a contrumr(U licensed pursuant to the Contractor's
Limme La
❑lame ^Oder See. ,B&PCor this moan ,
0 n / \ Date
WOR(ER'S COMPED NSATION DECLARATIO
1 hemby Nitro under penalty of perjury,one of the following declarations:
I have and will maintain a Certificate of Consent to se161nsum for Worims Campers
nation,be provided for by Section 3700 of Ne Labor Code,for Ne performance of the
work for which this permit is issued.
0 I him and 11 mainpitn Workers Compensalinn Insurance.ss ItyuioJ by Section
"Noor Ne Code,for the performance of Ne work for which Nis permit isissmJ.
M1GyWsy�yr/kmpenullon Imunme arti!er�Pan�d,{}Palley num am:
CERTIFICATE OF EXEMP170N FROM'WORKERS'
COMPENSATION INSURANCE
Goes seclim need not bo meoplemd if Ibo Iemtil is forum hundo idollus($100)
a less.)
I certify domain the pc formaoce of .work for which N a 9C 1.t Is issued,l shall nor
maPI4 byp ubrmi mmncr t� �m oc�gob' miK Wmkcn'CampcwJon
Lawes or c.brorn{Doc
Appjice
NO IC PLICANT:If,after making this Ccnificaa of E&(rptinn.you should
become mI to the Worker's Compensation provisiam of IW Labor Code,you must
.J O r."wil comply with such provisions or Nis permit shall bo deemed revoked.
'Z "' CONSTRUCTION LENDING AGENCY
H FN-c I herehy affirm that there its cmmtrmlion lending agency for the performance of
CG
the work for which this permit Is issued(Sec.3097,Civ,C.)
W 0 Lenders Name
0. lenders Address
� z
fJ Q 1 mnify that 1 new read this application and state that the above info,mAdun is
F coned.1 agme to comply with all city and county ordinances and spite laws misting to
QV building ronatrmtion.and hereby mlh.riR apmsenlalimS of this city to enter upon the
U above-memicamd propcny impaction
far pubucs. -
0.
(We)agree to save,indemnify and Imp harmless the City of Cupertino against
Ir h Imbilifiesjudgments.costs and minimum which mayin anyway accrueagainslmid City
U la incoAURIDERSTINDS
aidof Nispermit.
APPAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUONS.
ore ofApplicandConrnctor a-rOOfs
-HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupant entre or handle haoudous material
As defined by the Cupertino Municipal Code.Chapter 9.17,end the Health and Safety
code,Sor an53z(o7 — All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding om.imal use eaaipment or devices whim If a roof is installed without first obtaining an inspection,I agree to remove
it harardnm air c.nmminants u defined by Nc Bey Area Air Quality Management all new ere for inspection.
it ha
❑Yes 11j"O
I have mail the humbihues materials requirements under Chapter 6.95 of the Collier. ^ ^ D 2
niaHealth&S ety Colo.Scctiou 25505,25537 and 25534.1 un@nurul lhet if e,building /
Jam not c Ily haw a wrianl Nal II is my respamibility 0 nudity Ila Occupant or the
require which must be met poor WissuanccofaCcniOcamof c anc0^U nater of Applicant \, �cf1 Date a
er or aushmmrcd agent Dae All roof coverings to be Class"8"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF
Telephone: (408) 777-3228
4UPEDTINO 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
2stated/policy on re-roofing.
Homeowner's Name: N�IIGGj e 4 / / �)1/ l�
Job Site Address:
Roofing Company Name:
Aplicant's Signature: Date:"
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINOOo /3
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 0,cfr Q Date
Bu�djn ress:
B07
O
)VersPhonel.3 61G/�,
r
C n Eto Pho #� 37 / N, / Licens :/
vl � 2 5
Cont t: I Pho e#• ��/^C Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
A Wood Shakes Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / ❑ 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: �
ea✓ a S'� i,z r t, i4 dS3 3o� � -[Y'ts
Residential Commercial ❑
Fire Zone: Yes ❑ ..No ❑ Confirmed with Planning De
there are any restrictions•
Cos(of Project. T Type of nstru�tion: Occupancy group:
CJ V a={� 4 2
Qt
A lic e 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