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04010148 CI'CY OF CUPERTINO •"° �z ' ? BUILDING DIVISION PERMIT CONTRACTOR INFORMATION.: xz,. �„tat. ✓.* ';oz.s vx1�5�ii'' &t� ,��:c_`?..Y?�, '_. BUILDING ADDRESS: PETERSEN-DEAN INC """"04010148490 A4�4 ARBOR AME OWNER'S NAME: PERMIT ISSUE DATE ONE: SANITARY NO. CONTROL NO. IITECIENGINEER: BUILDING PERMIT INFO BLDC ELECT PLUMB MECH a00 LICENSED CONTRACTOR'S DECLARATION m FF 1 hereby affirm that 1 am licorice undo provisions or Chapter 9(commencing Job Description zw with Section?0W)of DiviArm3of NC Biaiocss Professiona Code.mr!my licensers �'� A ��� in full forte and of qa��oe� ;'p= LicenxCl 39 , 5�68/l REROOF ZF' DOW ��nlr tar ro ” ° FEB 1 1 2004 UI urWcrsunJ my Plato rt ;I, Licensed Prubsuianal OWNER-BUILDER DECLARATION �U�L®Iiv�� .�a y 1 hereby affirm that 1 am cacmpf from the Conlymor's License Law or the v p o following reason.(Section?W I.S.Business and Pro@ssiom Cole:Any city or county E m which requires a Permit to construct.alter,improve,demolish,or repair any structure Prior o its issuance.also ruImics the applicant for such Permit o file a signed stmemem ££ < that he is licensed pursuant In the provisions of the Contractor's LicnuLaw(Chapter 9 Sq. Ft. Floor Area Valuation YS (commencing with Section?0Ub of Division 3 or the Business and limitations Code)or that he is eacmpt Ncmfrom and Ue hues for the alleged cumpdon.Any violation of Section 7031.3 by any applicant for a permit subjects the applicant to a civil Penalty of .�,p�si�I.r ,,v1�er Occupancy Type not mos than five hundred dollars($500). 3 G©CO I1fl0. 0 0 El 1,ss owner of she pmpeny,in my employees with wages IS their sale compensation, will do the work,and the sfmeture is not intended or offered for sale(See 7W,Business and Pmpossioris Code:The Contractors License Law does Out apply Or an owner of Required Inspections property who builds or imprmms thermn.and who docs such work himself or through his Own employ=.provided that such improvements are not intended oroffemd formic.IL however,the building or improvement is mid within one your of completion,the owner. builder will have fire burden of proving that he did not Wild or improve for purpose of , salt.). ❑1,as owner of Ne propeny,am exclusively contracting with licensed contractors to common she project(Sec.7044,Business and Professions Cadc:)The Comruturi U. cense Law doe not pply to an owner of property,who Wilda or improve themon,and who mmracts for such pmjeca with o CONOelnr(f)licensed punuun to the Contractors Limpae Law. I sat eaempf under Sec. ,B&P C far Nis moron Ower Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: . I have and will maintain a Certificate of Consent o ul6im ume for Worker'sCompen- .u provided for by Section 3100 of the IaWr Cade,rat the performmee of Ne for which Nis permit is issued. 1 have and will maintain Worker's u cr's CCmpcmation irance, required by Schon ?00 or oc labor Code.for de Performance of the work for which this Permit is issued. My-orker's Commnaad//oo//aa��Insunn��a tamer and Policyu b7 Q7_/3�iW ,aricG Policy NC.:�3 _ CERTIFICATE OF EX EM MON FROM WORKERS' COMPENSATION INSURANCE (Thu lection need nm irco mpleted if the permit is forone hundred dollars(Sip)) or less) 1 Codify that in the performance of the work for which this Permit is issued,1 shall or employ any person US,manner en as an become subjecO.f W Workcri CCmpermtho Laws of California.Date Applicant _ NOTICE TO APPUCANT:IL after making this Cenificae of Eaemption,you should , become subject in the Worker's Compcmadon provisions of Ne labor Crede,you must .J z foMwith comply with such Provisions or this peomit shall be deemed revoked. zCONSTRUCTION LENDING AGENCY [-+ I hCpOY effum that dem is a comtmctin.]Coding agency for to perrsmmance of E the work fur which Nis permit is issued(See.3097,Civ.C.) Q Landers Name lr z der'%Address V Q 1 minty that 1 ban mad this application add shote that de Show infoomafiun is Caron.I agree to comply with all city and county ordinances and sue laws relating to C V building conshosoon,and hereby zuthOme fePrcacmatives of Nis city to enter upon the CL1011160. 01116 .judndr PmPcny for inspection.hu mus (We)agate to saw,indemnify and keep harmless the City or Cupertino against \ fn incomantijudgmc do euats. expenses which may in any way accrue against said City V z A PLICA nccot Nc ranting Cf Nis permi ^ APPLICANT UN STANDS N L COMF'�/y WITji ALL ON�pppOINT Issued by: Date SOURCE REG ION]. � / N Re-roofs Signature of ApplreanUCommat r Dale HAZARDOUS MATERIALS DISCLOSURE - Type of Roof Will the applicant or future building Occupant store or handle hamrdous malenal u defined by the Cupertino Municipal Code,Chains,9.12,and IM Health and Safay Cale. Dyes 35512(a)? All roofs shall be inspected prior to an roofing material beim pYes ❑I.r' p p � y g g installed. Will the applicant or ru um Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove 11,7!; hauardous air momminan s as dchncd by the Bay Arca Air Quality Management all new materials for inspection. io? C]Yes l have read the.havadousma trials requirements under Chapterii.95 of the Califor. calth&Safcty CCM,Simmons 25505,25533 add 35534.1 undsmand thddNc Wilding / e , ly W nanr that' u m pomibility m nrrtiry de Occup f of the norralwhic atnen t a «once cateorpctan�x Signature of Appli ant Date pet orSimm;adagenf - ,e All roof coverings to be Class "B"or better +1 Community Development Department \> Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 • CITY OF Fax:. (408) 777-3333 IPPEkTINO 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 three above stated policy on re-roofing. Homeowner's Name: JQ',r,. Job Site Address: /O q s>p 12 Roofing Company Name: �o � A plicant's Signature: A?) . Date: 36 Greg tee] . Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF " ( � CUPEkTINO PERMIT APPLICATION FORM APN# --- n � D Date: /� (7 Salo 5� Building Address: n Owner's Names Phone#S S --U � 77 -7 Contract Phone#: License#: Contact: Phone#� Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ., ❑{ Asphalt Shingles ,)6, Asphalt Shingles )K 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. rr' I H=Understandom ] With Cu ertino's Tear Off PolicJob� �"CResommercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are an restrictions: LJ Cost c�Project: Type of Construction: Occupancy group: b z--�6K. O U Qty. if A licable Fee ID Fee Description Fee Grou BPERMFEE BldgPermit Fees BUII DING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING z 217 , 719 :