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03080034 :I CITY OF CUPF O - - � - --- -- -. - ]BUILDING DIVISION ISION PERMIT �:CONTRACTORINFORMATION:`� 1BUILDING ADDRESS PERMIT N00 3 0 8 0 0 3 4 20725 ACADTA CT V OWNER'S NAME PERMIT MUE DATE 'IU MELODY S AND JOEY C _Q8/08/2003 _ ,.JE: SANITARY NO. CONTROL NO .CHmL ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH X00 firm that of CON ti❑ I hereby affirm thou 1 am ftheBu anger ndprof ssofsCode, 9 my license is Job Description ps wore Section 7000)of Dwimon3of thc¢usinc.s and P,hrea.nnnseadc,and my license 1. m full foo' dclfc � 9Z/�i �Z REROOF h,o Date —V cantracm,App,q�Ia3F'Z—e21£oAr CONTRACTOR: MARTINEZ-OJEDA CO L15T, g8 ARCHITECT'S DECLARAcords ALED rc< I understand my plans shall M recd as public records IyU o l- Licensed Pndc.monet a3 OWNER-BUILDER DECLARATION JAN 2 0 2004 Y 1 hereby affirm that I am exempt from the Contractor's License Law Tor the 0 o following nacho.(Section 7031.5.Busmen and Pmfccamts Code'Any city a,county Sm which requires a permit to construct,alter,improve,demolish.or repair any structure ze pnor to its Issuance.also,resinous the appheanl for Such permn to file a signed sutement . g — - < that he is lice nscd pursuant to the provisions of the Commi.mr's Litton Low(Chapter 9 Sq.Ft. Floor Area p 0 121-0 (core meriting with Section 700tB of Division 3 of the Business and Professions CWe)or `t that he is exempt therefrom and the basis for she alleged exemption Any violation of Section 703IS by any ,,imam for.pe.it aubjecu the applicant o a civil penalty of 3�51�tvGlid�erOO Occu ana Type not more than¢ve hundred dollars(5500) Occupancy YP ❑1,u owner of the poppers,or my employee with wages as their sole compensation. : will do the work,and the structure Is not Intended or offered for sale(Sec 7W,Busnne¢a ,and Pro(nnona Code.The Conmcmr's License law dots not apply to an owner of 305 - FRAME Required Inspections property who builds or Improves thereon,and who doessuch work himself or through his own employees.provided that uch lmprovemenu are nounseaded or offered for Sale,If. 307 — INSULATION however.the building or improvement Is sold within one year of completion,the owner. builder will have the burden of proving over he did not Wild or Improve for purpose of 601 - ROOF TEAR OFF 'ale')' 602 - ROOF PLYWOOD NAIL ❑ 1.as owner of the property.am exclusively contrecung with licensed contractors to - 603 - ROOF BATTENS construct the project(Sec 704x,Busmcss and Profcssmns Code-)The Canbaztor's LI- cruise Law doea not apply toin owner of property who Wamorimpraveathemon.ana . 604 - ROOF IN-PROGRESS who contracts for such projects with a contractor(s)becnsed pursuant to the Contractors License Law. ❑ I w exempt unit,See .B&P C to,this reason ' Owner Is. WORKER'S COMPENSATION DECL.ARS.f10N _ 1 hereby affirm under penaty of per dry one of the following declarations 1 hest and will ntatnum a Ceni"-to of Consent to self-insure for Worker's ComPch- a�pro v,the for by Scmmn 3700 of the labor Code,for Ban performance of the nfo,which this Iris is Issued 1 have and w ff mamlam Worse, Compensation huunncc,as roswmd by Section 37W of the Labor Code,for the perfmmancc of the work far which this permit Is issued. My Worker's Compensation Inxunnre cart¢,and Policy number art: Comer. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE frhia semmn need nut W completed If the permit is for one hundred dollars(Sim) or less) - 1 comfy that m the performance of the work for which this permit a issued,l shall not employ any person In any memos,sit se to become subject m He Workers'COmpensauhn I Lawsof Cah a.Dm^ Applicant 1 anc— Qya NOTICE TO APP ANT IL after m mg this Ccni�e OI EACmptihti,you should t become subject to the Workers Compwtsation previsions of Be,Labor Cade,you must O forthwith comply with such provisions or this permit.hall be deemed revoked 'Z uj CONSTRUCTION LENDING AGENCY 't— the reby affirm that there is a construction lending agency for the performance of a the work for which thus pemlit is Issued(Scc.3097,Cn.C.) W Lender's Name lL Lenders Add,- U O 1 certify that I have read this application and suit that Bic about Information u ry F correct.I agree to comply wish all city and county ordinances and sit¢laws relating to 0 t building comtmctlon,and hereby authmire represemahwx of this city to enter upon the alwvcm consequence properly for o f this Permit. mit. F y We)agree to save,Indemnify and keep harmless the Cary of Cuperuaa against N lubdmes.judgments,costs and exp nxrs which may In any way see=against said City U Z in eonscyucncc of she granting of this permit. ^ APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date SOU ULATIONS. gnai Re-roofs gppllcaHAZARDOUS MATERIALS DISCLOSURE Date Type of Roof Will the applicant or future building occupant store or handle ha s,dous masmal as defined by the Cupedvno Mumapal Code.Chaper 9.12.and the Health and Safety oJC.Section 35512(e)+ UYa All roofs shall be inspected prior to any roofing material being installed. �I No Will the applicant or fumrc building equipment If a roof is installed without first obtaining an inspection, I agree to remove pp s by the B ova a 10,acne.:winch g P Sur c'iarmms atr cnmamtnants as defined by the Bay Arca Av Quality Managcmcnt all new materials for inspection. 1­1 Yes y/_ {Iy(/,I(//�� //� ,a, ' I haw &Safet thehmaedhons materials .25533 it requirements 341 u Chapter 695 if the Wilding /I�/ // `" `V l/ /L/L%C�N/U�h ma Health o Safety Code,wittio,that I15a my r snd25534 1 to nouI sat thudthc t of c �f l' ` gam'_ O J of cuncntly base a¢pant.that n u my responsibility m sanely 1W ac<upant of Inc Z) d rem Treks whmh must Be met poor to Issuance of a Ccmricate of Oscupancy. Slgnatllre,�f Applicant U Date 11 owne, Suthomed....I /YNr —�f�� Data All roof coverings to be Class "B" or better CITY OF CUPERTINO 03 0 8 0 6 3 REROOF CITY CUPEf�TINO PERMIT APPLICATION FORM APN # :�'c--f7 _ S_� — 0 2—/ I Date: Building Address: — 010 -7 2S__ t19 A? Owner's Name: I Phone M Contractor: Phone#: License#: MA2:TI ti Or, - oases ca OSz - I -794/ 9 / 2 Contact: Phone#: Cupertino Business License#: I ALT-- (9 NS1) M4P-Vt g3S923z I Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) /�' 1ST'�G ❑ 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 Cupertino's Tear Off Policy: I I Job Description:tt II ` 1 ` 1 I /1 ./ q_Tvlbge e.Y.1S -k n tk LI . �Q � ...5��\ �J\`I W©O C p,✓vA` f 1 �n/ r-i Z`� K,,_0 Residential V Commercial ❑ `} Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ 1 Cost of Project: Type of Construction: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group I / BPERMFEE I Bldg Permit Fees I BUILDING I BENERGY Energy BUILDIN G BSEISMICRE Seismic Fee Res BUILDING_ I BSEISMICOM I Seismic Commercial BUILDING I I BPLANCHK i Plan Check Fee BUILDING I / BUSLIC I Business License BUILDING I I I I I I I I I aa73 � �a 7. 70