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04080143 CITY OF CUPERTINO s +c%+ BUILDING DIVISION PERNIIT gCONTRAC3TQR INkYORMATION . BUIIDINGADDRFSS: WESTERN ROOFING COMPANY PERMITNO. OWNER'S NAME: PERMITLSUEDATE ONE: SANITARY iftOL N0. I CHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LO LICENSEDOatIam licensed dM IngiCLARATION ���® Z1 ido.7 affirm Nat 1 am licensed under provisions of Chapter 9 fro I feting Job Descriptio < th Sou T )af Division Sof Use Busi cMalofrssiuns Code.and myliccnsc is nneumm a A 2� REROOF W/ASHALT SHINGLES p License a. �7 ^-7 Dam cmaraorAUG ZG SS7W ARCHf1ECTS DECL ION 2ool. i K undcrvand my plans shall he mse as, m r.cmds T J-u m Licensed Professional airs l B� tt 11] ® ,¢� OWNER-BUILDER DECLARATION gNfOdtltJ ley � � 1 hmaxo o(Rrm on 1 am exemptfroms an the ContraLectin Carm's License c ty o for the ix O O following¢ossa Permian]113 consumer,Bolter. and ve d vote Code:Any tiny or county s m� which mquims a Pmmit m tri=fle, akar,improv.,h Permit t or e a Mi any ummure u prior miumaued issuance.also uantto n trovoioonmor wchpermiuoiciense Lnedsua:mem L'r< LmWishccnsed Pursuant to On of Division NC Camsinessnd Pref Lions Core)or Sq.Ft. Floor Area ValuatlOn QFC tha he is erg with Section 70 And of Division r of 0.Mla,inv¢wd Professions inion of thin io is 31.5 b any ap li and IW basis far be alleged exemption.as Any violation of not on 7031.5 five ury red doll fora permit subjects the applicant m a civil penalty of 3 B��P 7ti1 bgr0 0 Occupancy Type not more Nan Eve hundrtd dollar($300). P Y YP El I,Mo-=oftMprapwy,mmyemploycvwithwgvuthe wlecompensedon, will da tW work end Ne awctuu is not immnded or offered for sale(Sec.]004,Business and Professims Code:The Ca nnumnea License law dors Out apply As an owner of Required Inspections pmpeny who buildsorimproves themon,and who docs such work himself orthmugh his awn employees,provided Out such improvements ort not inmMed araRned her sale.If. however,the Wilding or improvement is sold within one year of completion,the owrcr. builder will have Le burden of proving Wil he did non Wild an Improve far purpose of sal..). ❑I,as awrcr of da:prepcny,am exclusively Miam ing with licensed canawrors no construct the pmjem(Sec.7(W,Business and Professions Cade:)The ConuactaYs Li cove law does oat apply m an owner of property who builds or impmses IMman,And who convects for such projects with a contractor(s)licensed pursunm an Use Chroniclers License law. O lam exempt under Sec. ,BkPCfor Oismmon Owner Dam WORKER'S COMPENSATION DECLARATION 40 I herby aRrnder penalty of perjury one of the fallowing declarations: un I haveand will maintain a CertiGcam of Consent to self-insure for Worker's Compete , nation,v provided for by mart 37W of the labor Code,for be Performance of the .,it for which this permit is issued. ❑1 have and will mainuin Worker's Compensation Insunn¢,u acquired by Sccuon 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Wmke/s Compensation Insurance carrier and Polity number vc: OC PaliEcysNo.: C IF'j ATEOF EKEMPaROBPROMW KERS' COMPENSATIlC114ka1NNSURANCE (TT6scetion need not W completed if the Permit Is forom hundred dollam(SIM) lea) I certify Nat in the Performance of the work for which this Permit is issued.I shall not employ any person in any manner w As m become wbjacuo the Workeri Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:IL after making this Ccm1IMUa of Exemption.you should hecome subject m the Worker's ComPcvation pmvisio m of the Labor Code,you MUM .J O forthwith comply with such provisions or this Pcrmin shall be deemed revoked. Z Vy CONSTRUCTION LENDING AGENCY Ibcmhy affirm that ft.iso couuuaimn lending army for the Pcrfwmaracuf fY rte-. dm week fm which Lia Permit is issued(Scc.3097,Civ.C.) 1 Q Isnder's Name . Z Lender's Add. U Q 1«rdfy Lan I have rad Lis application and sum that the W.adma auun W Hcorrect.l agree no comply with all tiny and county ordinances and same laws minting to 0U building conawnion,and herebyautharis mpvsenutivv of Lis city to enter upon me yahovomemidgm propertyset for inspection Purposes ( 1 (We)agree m save,indemnify and keep harmless the City of Cupertino against t.1z liabiliucs,judgmcnts,cosuoand g.1 thisvmit. may inany way eccvc against said City con covequ c of the 6ruting of this permit. ^ APP LICA NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ' SOURCE E LATIO S. V 1� Re-roofs in o of ApplinnVC isms Dam HA ARDO S MATERIALS DISCLOSURE Type of Roof ill ft applican orfigure Wilding oecupam vote or handle lotoor smaterial A s le ncd by On,Cupertino Muni Pal Code Chapter 9.13,and IW Health and Safety Cale.Section 33512(1)? All roofs shall be inspected prior to an roofing material beim ❑Yea a P P Y g g installed. Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove Mit havardov air contaminants u de0ned by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes �Nui I have read the hvardousvmaterials requirements under Chapter 6,95 of me Califon niaHwlth SafetyCodc.Seeuov15505,35533 and 2553d.lunUcrsund thetifthe huilding 7 ,, //7 �/ �j_Q/ ' Joey not c road he.a mnanr,that it u my MA,Mwbility 0 noury the occupant of the .+1/ `-e '`� // Ny / X mgaimmc tswni nmaM emenpd miatuanec ora c.rtiReatc rasp apancy. gnature ofA buts ' Date Owner.rautho . a at AD,m - All roof coverings to be Class "B"or better Community Development iJ 10300 Torre Avenue 4Wry' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPE(�TINO Building Department JOB ADD'qSS• PERtar #0� 0 ?O/ OWNER'S N i / P O # T GENERAL CO CTOR: F # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 66 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 , Ce /Co act Signature fj- Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 �UPEQ_ INO 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 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: bA-L) I 'D Letoto fy r� Job Site Address: �� Q /5/4 V t Roofing Company Name: ( �°tZ lti. catlg: =r AIJ Aplicant's Signature: v��_ Date:� /7_p� Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOFCITY OF CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: S. b1 AJ XU� ea,.ti 9�oi Owner's Name: Phone#: .DA-ul'p L� N Contractor: Phone#: License#: 6,25 JQ We/a� 110W-9_q 77 Contact: � Phono� / `�� Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof t]-')�iphalt Shingles fa�sphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles o Other(Specify) ❑ Other(Specify) Nu r of existing coverings C3 Provide I.C.B.O.Report# C"°be Removed ❑ Provide Mfgr.Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: � 6 S D / U E Residential Commercial Fire Zone: Yes ❑ No ❑ Confirmed with PI e t. if there are an ctions: Cost of Project: Type of Construction: ,�� 3 Oc upanc Qty. if_` A abl 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 z,6 7 ! �