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04070142CITY OF CUPERTINO R BUILDING DIVISION PERMIT CONTRAC`TQIt INFORMATION BUILDING ADDRESS: R —M YOUNG PERMIT N0040 %01.42 OWNER'S NAME: PERMIT ISSUE DATE HAUSER JOAN TRUSTEE 14c;49 q RAqrOM AUR, 02 /,22 /�)nnd ONE: SANITARY NO. CONTROL NO. (408)358-6977 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION licensed Chapter 9 Job Description 1 hereby affirm that 1 am under provisions of (commencing with VDIIB)of Division 3of the Bust wProfession&Code.andmylicense is olio 75a Liccl I d ' 'c., - 796R,*? REROOF W/ PLYWOOD / COMP. to -7/0.4 /nU Co racwr ARCHITECTS D ON - � AUK I undersand my plans shall W uscd a tc records 2 2004 Licensed professional OWNER - BUILDER DECLARATION p I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Professions Code: Any city or county which att ices a Permit to emomonct. alter, improve, demolish, or repair any swcturt prior m its issuance, also requires the applicant forsuch Pewit to file a signed statement that he is licemed Mearmuo the omissions of the Contractor's liceao Law (Chapter 9 Sq. Ft. Floor Area Valuation (commanding with Section 7000) of Division 3 of the Busincvs and Professions Chat) Or that he as exempt therefrom and the thou for the alleged exemption. Any violation of Section ]031.5 by any applicant for a pewit subjects the applicant to a civil penalty of 3 2�N4�]ulnber0 0 Occupancy e P y TyP not tome Nan Jove hundred dollars ($500). 1. u owner of has property, m my employees with wages as their sole compensation, will do the work, and the swcturt is not intended oraRered! areal. (Sec. 7044. Busiow and Professions Code: The Contractor's Lieena law doss not apply to an owner of Required Inspections property who bu it ds or improves therean, and who docs such wmk himalf or through his own employes, provided not such improvements are not intended aroffered Forsake. IL however, the building or improvement is sold within one year of completion. the owner- builder will have the burden of proving that he did not Wild or improve for Pori of a1eJ. ❑ 1, as Owner of the property, am exclusively contracting with liecnad contractors to construct the project (Sec. 7D44, Business and Professions Code:) The Conuactoh U nse Law dots not apply to an owner of property who Wilds or improves thereon, a0 who contracts for such projects with a contracmKs) licensed pursuant in the Conmctols License Law. © Iw exempt under Sec B k P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under pa ally of perjury one of the following declarations: 1 room and will maintain a CentEate of Consent to self -insure for WorkeYeCompen- aadon, a provided for by Section 3700 of the Labor Code. for the performance of IW work for which this permit is issued. 1 have and will maintain Wofkces Compensation Insurance, a5 required by Section 17W of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Inannce carrier and Polity number art: Cartier. Policy No.: , CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (rossnetion tend not hccompleud if the permit is for one hundred dollars ($IM) , or less.) 1 certify that in the performance of the work for which Nis Permit is issued. I shall nut employ any person in any ma9ppry,�s tgJ)CCprole sobjecOO NC Workers' Compensation laws of Calif mIq 'a. Date _ 17�}�Ld li p linnt � TO APPLICANT: If, after making this Cenifcato of Exemption, you should Wco subject to the Worker's Compensation previsions of the Labor Code, you must C fo th comply with such provisians or this permit shall W deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm Nn Vert u a constmctinn Icnding agetaq for tee peof.. of the work for which this permit is issued (S.C. 3099, Ch, C.) Undch Name Lcndces Addmas 1 certify Nat 1 have read this application and sure that the above information is cmmCCL I agree to comply with all city and county ordinances and state laws relaxing to building construction. and hereby authon p rtosses. tatiss of this city mtour upon the (WC) agree to am, indemnify and keep harmless the City of Cupertino against aconsecntiOlted prop ertyforImphi40nunit. ei liabilities, judgments, costs and cxpcans which may in any way aceroc against said City �\ m consequence of the granting of this Pewit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: D ( SOURCE REGU T NS e Re -roofs D St i.dre ofAMIuMn VCdn nr /7��t3�e�/ / HA A OUS MAIMS DISCLOSURE' Type of Roof Will the applicant Or future Wilding accupanx mart or handle haraNOus material u defined by the Cupertino Municipal Code, Captor 9.13, and the Health and Safely one ScNon33532(e)? r7YCS ®.No All roofs shall be inspected prior to any roofing material being installed. Will de applicant or future building occupant use equipment or devices which L, If a roof is installed without first obtaining n inspection, I agree to remove g P hazardous air contaminants a dcftncd by the Bay Area Air Quably Management all new materials for inspection. fishier? ❑Yes S�Nu I ham mad the hazardous materials eltruemcnu tin @r Chapter 6.95 of the Calirm- nit di Health Safcry Cwe,Sations 25505, 25533 and 25534.1 understand that ifore Wilding does not c ly ham ochres, it n a that is my responsibility 10 mmily de oacupaut of the require hie usl d -or toissuanccofaCortificateofQ cy. (/ Signature o plc nt D to O A f coverings to be Class "B" or better Owner oaath anzed ascot If Ci bme CITY OF �UPEkTINO 4 • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax(408)777 -3333 Building Department JOB ADDRES%�10353 PE # 0 q0 -?0 / vZ OWNER'S NAW. PHO 46 5 _6 GENERAL CONTRALTO • FAX # I am not using any subcontractors: U Signature Date Please check applicable subcontractors and complete the following information: 17/ ntra Signature 23 Q Date SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering Plumbing Roofing �n Septic Tank Sheet Metal Sheet Rock Tile 17/ ntra Signature 23 Q Date Community Development Department Building Division I City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408) 777 -3228 SUPEkTINO 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 pondin& 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and wi comply with the above stated policy on re- roofing. Homeowner's Name: Job Site Address: 1 .��/J� i/2 �r Roofing Company Nan A plicent's Signature: Date: Vi 2 3 D � ' Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper U i J an of CUPERTINO CITY OF CUPERTINO REROOF O a % ° t Z PERMIT APPLICATION FORM APN #/,.� D Date: Building Address: /0353 Owner's Name: P Phone #: Contractor: I^n P Phone #: L Ltcense #: 7 7 6 J /6 Q QO Floou 3 O O Contact: P Phone #: C Cupertino Business License #: Type of Roof Covering: Existing: P Proposed: • Built -Up Roof ❑ ❑ Built -Up roof • Asphalt Shingles 4 41P 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 # is To be Removed ❑ ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: e Y 6 C CV-A Z Residential ® C Commercial ❑ Fire ne: Yes ❑ No ❑ C Confirmed with Plan if rZ� t there are an re tction o PF� c_.,y � T T ns c Occupancy ou . Qty' if ADDlir. ie Fee ID Fee l7escrintinn Fee rrn,m 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 a� ti a� ti