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05090051 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION - BUILDING ADDRESS: SIMON SAYS ROOFING PERMITNO05090051 OWNER'S NAME: PERMIT LSSUE DATE Ah MARY KAWAGUCHI 3866 REXW00 09/08/2005 .ONE: SANITARY NO. CONTROL NO. (408) 531-9700 ARCHITECrIENGINEFR: BUILDING PERMRINFO BLDG ELECT PLUMB MECH D O O O uOp .LICENSED CONIRd under DECLARATION Job Description w❑ I hereby affirm that 1 am licensed under provisions of Chapter Y(commencing P <W mfulif tion rude o(Divizimnlof Ne Bu Qpr�c}jinns Cole and myliccnsc is - n ^� inranrarc aderr 3y / Y f •REROOF-T/O SHINGLES, INSTAID COMP S�HaINGLES j�z Liaaa.c ase fr+ d� �J / , �f, �1-o Dam O fl 1/—Q L�-, ARCHDE C RATION Jm I understand my plans shall he used at public mcmN U n0 H Licensed Professorial 2005 3 OWNER-BUILDER DECLARATION E a 0 1 hereby arRrm that 1 1. exempt from tPr Contractors License Law for the pQ$171921 ///area po (allowing n]onstr Business and Professions Code:Any oily Or County �t{l 1,1 D 16� V ,I m which requires a Permit m construct,altar,improv,demolish,or repair any ulrwmR If�II II'I " j' tl`\�" 11 9 2 1 prior m its batione..also mquims Neapplieam potlatch permirm flea signed suscroma a� u that he is licensed punumn,to the provisions of the Component's License Law(Charter 9 Sq.Ft. Floor Area u�i sew Valuatibn K1- (camommiag with Section 7")of Division 3 of N.Businessland Profesliaas Codd or Nat he is exempt Ncmfrom and the basis for Use alleged exemption.Any violation of Section 703 1.5 by any applicant for a permit subjects be applicanuo a civil penalty of oC araC QGGU not more Nan fin hundred dollars(s500). Occupancy Type ❑L as owner of the property,army employees with wages u their salt compensation, will do be work and be mountain at not intended oroffcnd for sal.(Sec.71364,Business and Professions Code:The Conuacmrs License Law docs not apply to in owner of Required Inspections property who builds or improve b ureon,and who does such work himselfor through his own=play=.provided that such improvements are not intended Or offered for sale.If, however.be building or improvement is sold within one year of completion,be owner- builder will have the burden or proving Nat he did tat Wild or improve for purpose of sale I ❑1,as owner of be progeny,am exclusively contracting with licensed contractors to construct the project(Sec.71364.Business and Professions Code:)The Contractor's U. cram law docs not apply m an owner of property who builds ar improves themon,and. who contracts for such projects with a ewtvcmr(s)liaised pursuant o dm Contractors License La . ❑I am exempt under Sec. .B A P C for Nis mason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under proalry of perjury arc of be following declaration: ammI haw provided ro will maintain Section 37W of Cansem r Code.for far Performance of tax f u pro h phi for by Section 1]00 0(be,labor Code.for Nc pcnformamx of tM work for which this permit is issued. Mw and will maintain Workets Compensation Insurance,as mqumed by Section 37W or be tabor Code,for be performance of be work for which Nis peropi,is issued. My Worker's Compensation Insurance cannot and Policy number are: Cartier. Policy _ CERTIFICATE OP EXEMPTION MOM WORKERS' COMPENSATION INSURANCE , Thus section wed not beeampleted RNe permit is forone hundred dollars(SIM) or less.) 1 cmOfv Nat in the perf....of be weak par which this permit 0 issued.l shall wt employ anyperson in any manwr as as In bacome subject to be Worlmos Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL arm,making N6 Car irmate of Exemption.you should become subject in the Worker's Compensation provisions of be Labor Com.you masa .J O forthwith comply with such pmvisiou or this peinch mall bme Ito deed ranked. Z'" CONSTRUCTION LENDING AGENCY [-.N+ Ihereby arfrm Nat drove is a construction lending agency for the,performance or W 7 be work fur which this permit is issued(Sec.7097,Civ,C.) fA Q Leader's Namc =,z Undce.Add. J 0 1 certify that 1 have read this application and sum that be about information is , canes.I agree to comply with all city and county ordinances and sole laws relating to DU building construction,and hereby authorise«presentatives of this city to enter upon be N W about-mentioned property for inspection pummes. (We)agree to save,indemnify and kelt harmles the City of Cupertino against pFy Iimilities,)udgatents,costs and expenses which may is any way see=against said City ' U Z in conmqusenec of the grammil a 's permit. ^ APPLICA UNDERS N ND WI OMP1Y_WITH ALL VON-,RgINT Issued by: Date J— SOURC GU S q / // //'f'Y//�5 Re-roofs Signlrure of Applicamam or D HAZAR HAZARDOUS MATERIALS pSLOM or URE Type of Roof Will be due Cupertino fume:Municipal CgOccupant startor handle Heallousmaterial as defined by Nc Cupertino Municipal Code.Chapter 9.12.and be Health and Safety Calc,Sec tion 23512(x)? All roofs shall be inspected prior to an roofing material beim ❑Yea �g� P P Y g g installed. Will the applicant or future building occupant use equipment Or device.which If a roof is installed without first obtaining an inspection,I agree to remove nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. iaria1 ❑Yes Idsvo I have mal the hvardeuem 5505. 533 indents under Chapter6.95that lithe the Glifoo- .I.Health not marmot haw 355(15,2351)and 25514.1undCrslaldn am.scbuilding dos not cuncndy haw a mnan4 Nati my repo hility m noufy the wcupant of On mgmrcmcnts muatx�at itcaaance �cerdr amorotsugG S Signature of Applicant Date I 6/ All roof coverings to be Class"B"or better Owner` auNam<d aFcm g Dam am Community Development CuTorre Avenue peOrtino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Buildin Department JOB ADDRESS: y S ,� n� C)L, PERMIT#0 ,5 U S 00 5 OWNER'S NAME: �'{I I PHONE# LI V 6 -2 7/ GENERAL CONTRACTOR ' o FAX# n I am not using any subcontractors: 2^vo - 05 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§ignature Date Community Development Department ' Building Division z City of Cupertino .: ' 10300 Torre Avenue CITY l l Y OF Fax: (408)777-3228 . Fax: (408) 777-3333 L U P E IST I N O Building Department Subject: Re-roofing policy for the City of Cupertino -1- Prior to permit issuance;you must agree to comply with 1997 UBGStandards- - 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 1.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. C Homeowner's Name: /� Job Site Address: �p— Roofing Company Name: 7 Applicant's Signature: - �+ Dater OS Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO DSS atr�%Ibow!, REROOF I SCUPEkTINO PERMIT APPLICATION FORM FAPN # Date:lding Address: 4fIner's Nam *siness Contractor, -- - -- Phone#: — - .-31--57-00Contact: Phone #: License#: L _ 2— 305-7> 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) ❑ 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 Com 1 With Cupertino's Tear Off Policy: Job Description: T��' y/� � "d (: � f (� Residential Commercial ❑ Fire Zone: Yes ❑ No F-1 Confirmed with Planning Det. if there are any restrictions: LJ Cost of Pro ect: Type of Construction: Occupancy group: ji 2z� Qty. if Fee Description Fee Grou A licable Fee ID BPERMFEE Bld Permit Fees BUILDING BENERGY Ener y BUILDING f BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING (