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05080133 CITY OF CUPER'1'INO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ; BUILDING ADDRESS: WOODS ROOFING PERMIT NO.05080133 10749 BROCKWELL DR OWNER'S NAME: PERMIT ISSUE DATE GENE MCGHIE 2179 STONE AVENUE STE 22 08/16/2005 HE SANITARY N0, CONTROL NO. (831) 637-5576 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BL ELECT PLUMB MECH 0 0 0 _oo LICENSED CONIRACOR'S DECLARATION c C I Mmby affirm that I am licensed under provisions of Chapter 9 commencing Job Description tzU with section 7")of Division 3 of0m Business mllesio o my lice ns tr;a, n n ® n<n, in full form and �tij . kEROOF-T/O 2 ROOFS, . RESHEET�\A',I.f!OSB,, �: Licenwcl L ADD 50 YR. COMP. SHINGfESlU " �P -Fp Dam Cu Imwr ARCHITECTS DECLARATION 5 z I undersand my plans shall be used ss public¢cords s G y Licensed Pmfcssional 2005 u,3 OWNER-BUILDER DECLARATION 'yx P I hereby.(firm Out 1 am eacmpl from dre Conuacmr'a License Law for the ((((f��pppaaa.�� pp n 00 following moan.(Section 7(1]1.5,Business and Professions Code:Any city on county II �9 II!ja i$Fi which mimics a permit to construct.alter.impravc,demolish.or repair an stm sum [( S r ii %(t Lis prior in its iwuanm.also soyuires the applicant for such pemnil to rile a signed statement -- .. .`.,,u.. < that lc is licensed pursuant to bepronmiomofth.Cim ichriLicenselaw(Chapter9 Sq. Ft. Floor Area As ta Valu I1d.680 YFC (commencing with Section 7000)of Division 3 of the Business and Professions Cdne)or i $ that he is escmpt therefrom and the basis for the alleged cmmption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of APN Number Occupancy Type out mare in..Ova hundred Collars($500). 36921007 . 00 . 0 1,as owner of the property,or my employees with wages a their sole compensation. will cia the weak,and the swaure is not intended or offered for ala(Sec.7014,Business and Pmlesdons Cade:The Contractors License Law does not apply to an owner of - Required Inspections property who builds or imprams themon,and who docs such work himself or through his awn employers.provided that such improvements art not intended or offered for sale.If, howmi,the building or improvement is sold within one year of completion,Ne owner- builder will have the burden of proving that he did not Wild or impmm for Purpose of Sane.). 0 1,as owner of the propanr,am exclusively contracting with licensed convectors to convect the project(Sec.7044.Business and Professions Code:)The Contractor's Li- mm c Law docs not apply to in owner of property who builds or improves themon,and, who contracts for such projecs5 with.conuacmr(s)licensed pursuant to the Contactors License law. ❑I Am emmpt under Sec. ,B&P C for this Owner Date WORKER'S COMPENSATION DECLARATION - " 1 hereby aRrre under penalty of perjury one of the following declarations: I how and will maintain A Ccnifmm of Consent to self-insum fur Worker's Compete omi.a,ns provided far by Section 3700 of Ne Labor Code,far On performance of the W ork for which this Permit is Issued. I have and will maintain Worker's Compensation Insurance,az squired by Section 700 of the Labor Cade for the performance of the work for which this permit is issued. My Workers Compensation lost c carticr and Policy numbera : Martie � � — Parer No.: .t CERTIFICATE OF EKEMPLTON FROM WORKERS' COMPENSATION INSURANCE (Dissection need not be completed Bthe Permit is farone hundred dollars(SIM) nr lCSi) , I ecvlfv Nat in the perromeanm of Nc work for which this Permit is issued.l shall not employ any permit in any manner w As w become subject o do Workers'Com,ammon Laws of California Date Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should became subject to the Worker's Compensation provisions;of On Labor Code,you most .JO foMwith comply with such provision;or this Permit shall be deemed ranked. Z CONSBUCTION LENDING AGENCY 'ra I hereby affirm that them is A remanded..lending agency I.,the performanm of x� Oc work for which this Permit is issued(See.3097,Civ.C.) W� Q Lender's D.z Lender's Aoil. U C I mr6fy Nat 1 have read this application And state that Ne above information Is ry, P corms 1 agree to comply with all city and county ordinances and state laws relating to CU building construction.and hereby Adrienne mpmaenmites of this city to enter upon the above-mentioned pmperly for inspection purposes. (We)agree to save,indemnify and keep teumlrss the City of Cupertino against F' rq liabilities judgments,costs no expenses which may in any way crane against acid City U z ivied seguenc the gams of r c c/ ^ APPLICA NDfi A D WILL MPLY WITH ALL N-POINT Issued by: Date o /G sOU OLlf Re-roofs Signature of ApplicaDate HAZARDOUS S MATERIALS DISCLOSURE Type of Roof Will the applicant or future building acupanumrc or handle hazardous material AALaz defined M1y Oc Cupertino Municipal Code.Chapter 9.13,and the Health and Safety ode sec tion 25532 Ali All roofs shall be inspected prior to an roofing material being❑Yes ❑Ntr P P Y g g installed. Will the applicant or futom building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it havardam air contaminants As defned by the Bay Arca Air Quality Management all new materials for inspection. 7iaH smer? 0Yes 0N Ihave&Safr thchanodslus de.Secumna25materials 25533 nd 53 der.1u Chapwrdentanb.95oflhc Califon ealth gr Salic Codc,Sccdws25${M7255JJ and 5}4.1 undcrsmnd thatifd¢huilding ��/- ✓/a�-'� /� S` ns nor a ham m t(3ph7St r my resp hility a nndly the me t of @c di ` mer«w Signature of Applic t Date r�I G/D3 Owner tar authorir.eJ agate Dam All roof coverings to be Class"B"or better .l Community Development 10300 Torre Avenue /^ Cupertino CA 95014 Telephone(408) 777-3228 � CITY OF Fax(408)777-3333 UPEI�TINO Building De artment JOB ADDRESS: PERMIT # etca�� pi. (D-5-0 Y/ ,s OWNER'S NAME: ;;!;VC IPHONE # 25'Z _ GENERAL CONTRACTOR: S FAX # IV 11 I am not using any subcontractors: L22,J,s W4 • SigrrMre 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 QTile �� Owner/Con actor Signature Date Community Development Department Building Division 4 City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 SUPEkTINO CITY OF 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 fust 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: n Job Site Address: /07 �/ 5' ��5 Q /0111_ LOA Roofing Company Name: Z6 9y Is /fir rS4 4 Applicant's Signature: vr� v_ _ftt=_ ' Date: s Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO REROOF OCITFOF S��'t' OCUPERTINO PERMIT APPLICATION FORM APN # Date: 3 '21 � v /o s Building Address: Owner's Name: Phone#: 25z -494 Contractor: Phone#: License #: �G vzP -S e1U woo -3 Contact: L Phone# Cupertino Business License #: Zoe'/v Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles )t Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes V, 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 Comply With Cu ertino's Tear Off Policy: Job Description: Vo da SD y� Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are any restrictions: Cost of Project: oo Type of Construction: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group J' 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