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05090155 ., CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION' , Bu1LUNG ADDRESS: K REGEVIG ROOFING PERMITND05090155 10268 BANDLEY DR OW NER'S NAME: PERMIT ISSUE DATE BANDLEY CENTER 2600 MCCONE 09/22/2005 NH: SANITARY NO. CONTROL NO. (510) 782-8181 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH cjp LICENSED CONTRACTOR'SDECLARATION JobDescri [ion wF I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p �U, with Seeion70(lo)af Division3ofthe Busineuand Professions Cole,and my Licensers Bma R n' p <e in mu farm andeffeJ REROOF--T/O BUILT UP ROOF.IN6 INSTAL.'L1 5q= License Class ue.,r .7s7S 'O 4 PLY W/CAPSHEET SURFACING =da Dam Conlnnor ARCHITECTS DECLARATION Sa I undcri and my plain shall be used u public acids 7.005 g o 1 Licensed Pmfcssional S OWNER-BUILDER arCstafrom m Ce Contractors ON c<o 1 hereby ilTrm that I am aempt tram He Canuactoru LiAny C Law for Hy rte. fl res r � _ coo following rima..(Section Zfn L5.Business and Pmtde loin Calc:Any tiny or county I IU/O�I` AHI I ((//�7p $ , which¢yuires a Pcmtit m cnnaedm,alcor,improve.demolish.or repair any stmqum prior to its imuance.also requires the applicant for such permit to rile asigned statement < that he is licensed pursuant oINpmvisiomufone,Commerce's License Law(Chapter 9 Sq. Ft. Floor Area "Valu yFC (commencing with Section 70W)of Division 3 of NC Business and Professions Codes)or i $ Nat h is exempt H¢rtrrom and the more for He alleged exemption.Any violation of Section 7031.5 by aryapplicant fora Permit subjects the applicant to a civil penalty ofApN Ntgeif Occupancy Type not more Nan five hundred dollars($500). 3 22 66 33 30 y 7 . 00 ❑I.u owrcr k.and pmpeny,art my employes with wages u Heinle campewnon. will Pr Newark.and He manure re no's Lime d e a w do farm a(Sec.toad, weer o. and Pmressions Coot:The manhattans License Law aces not apply m an owner is Required Inspections Own emwhos.provided that Hereon,and who doessuchwork M1imulfor ed fermi his ownemplaycr aping or pr vein improvements artnot inmrwcdunpoercd formic however.Ne Wilding or den of pment is old a didn one year of completion,thepurpose aie.) Owner- builder will have Jus burden of proving Het h did not Wild or improve for puryou of rlc.l. O 1,as owner of the property.am inclusively contracting with licensed contractors nes consomt He pmjen(See.7004.Basinev and Pmf.knes Code:)T7w.Contractors Li me Law does not pply to an owner of pmpcny who Wilds or improves Hemon,and who contracts for such projects wit a contractor(s)licensed pursuant to IW Contractor's License law. ❑1 am exempt under Sec. .B h P C for His reason Owner Dam WORKER'S COMPENSATION DECLARATION I hereby aRrm under penalty of perjury,one of Ih following declarations: 1 have and will maintain a Cenifcam of Commit to self-insure for WorkmesCompcn- scion,as pmviMd for by Station 37W of the labor Code,for the performance of He work for which His permit is issued. ❑1 have and will maintain Wmkcra Compensation Insurance,az required by Section 37W of the labor Code,for the moarmancm of the work for which this permit is hermit. My Worker's Com mutation Insurance artier and Policy number is Carrier.. Policy Policy No�7�e d✓D ERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This union need not heomplemd lithe permit Is(mane hundred milars(Slip) or less.) I anifv that in the performance of the work for which this Permit is issucd.I shall not employ any person in any manner an,as in Wcome subject to Ih Workers'Comprnsation Laws of California.Dam Applicant NOTICE TO APPLICANT:If.after making this Cenifcam or Eatontown.you should become suhjcn to the Worker's Compcmation previsions of the labor Codc,you mug .J vZ forthwith comply with such provision or this Permit shill bb dremcd revoked. Z'O CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a constructinn lending agency IOfthe performance of a the work for which this permit is issued(Sec.3097,Ci,C.) U.)Q Lenders Name =,z Lender's Address V Q I certify Nen I have read this application and sate that the above information is correct.I agree to comply with all city and county ordinances and sum laws mlaling to V Wilding construction.and hereby authoria mpreunmisrs of this city to enter upon me W above-mentioned pmpcny for inspccnon pur,mme H gy (We).,me no save,indemnify and keep harmless the City of Cupertino against N liabilities.judgments.costs and aspenus which may in any way accede Ignorer mid City U income,mmic of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 60 Date SOURCE REGULATIONS. valAt Re-roofs ..J Signmum of Applic HAZARRDDOUS MATERIALS DISCLOSURE Da Type of Roof Will the applicant or fumes building Occupant atom r or handle haadterial ous ma az dcft.ed by tW Cupertino Municipal Cods,Chapter 9.11.and the Health and Safety cede.pr.zss3xar ,4nm Na All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant mo equipment or deices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. iminTath 0yea esu N9 1 have read He he ohnismamrods mquirommus under Chapmr 6.95oftheCalifor- niaaH@ SafetyCodc,Secuau73505.15533 and x5534.1 undcrsla,W ung if de Wilding does not currently haw a mnanu mi a Hat it my mapohility to oddly He Occupant or the requirements which mug he met poor to issuance ofs Certificate of Occupancy. Signature of Applicant Date Owner or autharivcdagent Dam All roof coverings to be Class"B"or better .� Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 � CITY OF Fax(408)777-3333 UPEkTINO Building De artment JOB ADDRESS: PERMIT # z p/ o OWNER'S NAME: 0qAj&Lp C I cAV7&' p,_Zjje,. PHONE # GENERAL CONTRACTOR: ITFAX # I am not using any subcontractors: A4jmzool AAZAae Signature Date Please check applicable subcontractors and complete the following information: 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 Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino El 10300 Torre Avenue ®®CIO ' EkT �.O8 A Telephone: (408)777-3228 U PCI 11 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. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. 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: AAH 4�L e v fJ�vT e � c . Job Site Address: /D.Z48 jdW,0VJeW1LG. $e Dry v� Roofing Company Name: 0-pe e—,eoPI O D /E/ IIS/ 9 Applicant's Signature: / _ Date: Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO Gtr -- REROOF C,COF CUPERTINO PERMIT APPLICATION FORM APN # ,3 . 6 .33 © y ? Dat Building Address: /do," Owner's Name: Phone#: moi- ,rrc B 78.Z 8 l / Contractor: Phone #: License#: Contact: Phone#: Cupertino Business License #: Type of Roof Covering: Existipg: Proposed: Built-Up Roof �Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) C30ther(Specify) /A44 I rZ C 00*08�� Number of existing coverings ❑ Provide I.C.B.O. Report# �[�s •r~'� � a--To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Ia Job Description: u;L m��.• yid wi � 7:Z�b �ip�val,sw�'ce ?- Residential ❑ Commercial Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Co to Project: Type of Construction: Occupancy group: Y6 ♦g.ef Qty. if Applicable 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 � �239S�