03090141 (2) t CITY OF CUPEWFINO
Euu.Drnc DIVISION - 'MIT a CONTRACTOR, ANFORM, ION
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BUI LONG ADDRESS: WM H FRY CONSTRUCTION COMP TNO03090141
OWNER'S NAME: 10351 SAN FERNANDO AVE PERMIT MUE DATE
MERALA MARK n '11B/2003
NE: (408) 996-8173 SANITARY N0, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� I� 0 Q
+oo LICENSED CONTRACTOR'S DECLARATION
i V� I hereby affirm that I am Ecensed under previsions of Chapter 9(commencing Job D¢SCrIpIIOn
s� willMaccljan7000)Of Division 3 or NC Business and Professions Code,and my license is
mraugMFeanderreet. JQ �Zo-7f'T REROOF FINALE®
-nvsom Liccmcf�Ius C."o�
eF Date 'f-f fFy
ARCHITECTS DATION NOV ']
Is ndN
m loos h I u public records O 1 O 2003
5yU
c o G Licensed Professional
3
OWNER-BUILD/("DECLARATION
I 1 hereby affirm that 1 oro exempt from the Comnanr's Liccnx Law for the
OWNER BUILD DECLARATION BUILDING
OO fallowing mason.(Section 7031.5,Business and Professions Code:Any city ar munty
Z w Fi. which requires a permit to construct,ahcr,improve,demolish,or repair any structure
�¢i
Her to its iasmec,.1m.quires lheapPlicml forxch permiut fleasigned snmment
es< the,he is licensed pursuanuothe previsions critic Conwctor&License Law(Chapter9 Sq.Ft. Floor Area Valuation
I I-$ (commencing with Section 7")of Division 3 of the Business and Prafessions Code)or
—
that he is exempt therefrom and the Was for the alleged exemption.Any violation of 35913062 . 00
_ Smion7031.5byanyapplicantforaPermitsubjecumeapplicantto!civilPenaltyof APN Number - Occupancy Type
not more than five hundred dollars ISSOW. --- I '-- '- -' -'-- -
I,uownu of the pnpeny,mmy employeu with wagu uNelr sole compensation.
will do the work and 0aamnuatre is nut intended or offend for sale(Sec.7044.Businam 305 —
and Professions Code:The Conuanofs License law dors not apply to an owner or 307 - INSULATION Required Inspections
progeny,who builds orimproves Ihenun.and who does such work himself or through his
own employees,provided that such improvements are not intended or offered rot sale.If. 601 — ROOF TEAR OFF
howavcn the building or improvement is sold within one year of complexion,the ve duowner- _
builder will ban burden of proving duet he did not build or improve far purpose of 602 - ROOF PLYWOOD NAIL
603 - ROOF BATTENS
I,a tweet of the progeny,,Business siv nd contracting with Iiceneed mmichoon to
came uct Law it nonpplyto1 nOweofand who
Ca def The msivi ma.Li 604 — ROOF IN-PROGRESS
cense Law dog not apply to an owner of property who builds or ant to
Charas and,who contracts or such projects with aconlncmr(s)licenced punuannothe Conlnnar's
License Law.
❑tmor exempt under Su. ,B hPCfor this mazon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of due following decimations:
I Aave.nd will maintain a Certificate orconsent n self-insure for Wari eb Campen-
mion,As provided for by Section 37M of the Labor Code,for the performance of the
work for which this perm is is iscced.
0 1 have and will maintain Weaken Compensadon huunnce,As required by Section
3700 of the labor Code,rot the performance of the work for which this school is luted.
My Wmkafa Ci mPensad lnsunna artier end�Poli�ry/ numbest:
Ca :nr%o cam, .p.A...... Patbyatgd.: 519irzuz_
CERTIF�Pr1ON FROMWORKERS' _
COMPENSATION INSURANCE
(This ucsion aced not be complcnd if the Icrmit isfor one hundred dN1an($1(111
or lam.)
1 centfy,that in be performance of the work for which this Permit is issued.l shell not _
employ any person in any manner anaz at become subject to IM Wcalaci Compensation
Laws of Calif.m..Dau
Appliunl
NOTICE TO APPLICANT:If,after making this Cenificau of Exemption,you should
become subject to the Worker's Compensation pmvisiou of the Labor Coca,you must
Ofodhwi th comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
1 herchy affirm that there is a mostruninn lending agency fnr the Performance of
Ys > the work for which this permit is iaxed(Sec.3097,Ctv,C.)
YQ Lender's Name
z Lcnderi Address
Q I chnify that 1 have read this application and slow that the above information is
1. comet.1 agree to comply with all city and county oNiamem and mule laws Misting to
U building construction,and hereby aathonM representatives of this city to enter upon the
G ahaw'memioned progeny for 1 repeetton Pmmasm.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City Q
J 7 to conuqueacc of the granting alibis permit. �,Vl
r=1 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N POINT Issued by: Date
SOURCE RE LATI�"S.
/ 9 A"o Re-roofs
Ygnatum of ApplicentuCamrxmr Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant to future Wilding occup.maoure or handle hazardous melenal
As defined by the Cupertino Municipal,Code,Chapter 9.13,and the Health and Safety
Code,Section 35533(.)? All roofs shall be inspected prior to an roofing material being
❑Y P P Y g g installed.
wlu Ina apVncanl or Bslura building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
iI hmuNnm air contaminants az derned by the Bay Area Air Quality Management all new materials for inspection.
A
tria?
❑Yes Nn
Ihavereai Ncha:'Shear 25505,2553ll 3semenu34.I a ChePur 6.93 Dobe Califon
me hoth.45htlyy Coda..S¢wm ter at
myhmd2533s.1.amitnt that ifthe Wilding
Jnea not v'urtanlly has a lemn4 that it ii my resptmihility m notify the amupenl of the
Mquin�enuawhfb mus don SyyleeOIs CRliEeaN tjo fey. Signature of Applicant Date
//IJP `7 SEs 0q
Owner or aulhmiaed Alamo pact All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
E. 10300 Torre Avenue
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: 104-1-K Am--XALL
Job Site Address: 20 88/ T✓4 t c�
Roofing Company Name: 91ZI04�.a'17/ )ea r-l-e e a w'14r2"
A• plicant's(Si�g�nature: �i/l/ Dater o�
\�1/r61HD�.X�Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
f /
CITY OF CUPERTINO v 3 `�
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# ) 3 _Q / Date:
Building Address:
Owner's Name: Phone#:
/fJM/L ///L7Gt4� Yvk z5-7- 626o
Contractor: Phone#: License#:
4,W-S7-cv 996 IPS 7 ? sw-7 glS
Contact: Phone#: Cupertino Business License#:
rR`' 9oF (ros ffzoo
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
aS1`Wood Shakes ❑ Wood Shakes
❑ Wood Shingles O Wood Shingles
❑ Other(Specify) Ik- Other(Specify) 7741F_
Number of existing coverings ❑ Provide I.C.B.O.Report#
O To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: QE7ifv✓� SL +,rCr , IA .rrifc
4 1&- t- sr4-
Residential 5�K Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: i5
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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