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05070048i CITY OF CUPERTINO BUILDING DIVISION PERMIT ,CONTRACTOR,�INFORMATI,ON BU ILDING ADDRESS: C & C ROOFING PERMIT Nib 5070048 1937 0 CALLE, DE BARCELONA OW NEWS NAME: PERMIT sSUE DATE DAVID DIKERSON 89 S 21 ST 5 PONE: SANITARY NO. CONTROL NO. (408)298-1868 ARCHITECTIENGINEER: PERMIT INFO jayBUILDING B EQ PLQ MECH Q LICENSED CONTRACTOR'S DECLARATIONtl licensed chapter 9 'r "-1 r Job Descriptioppn�'�) A. I Imrchy affirm that 1 am under pmvisione of (commencing Section 7)r10) Division 3 NC Businessd Proheraiana Code. and my license is with of of in full foe and e�1/Z�'Z rtLic. License Clara N ! 7 J-1 -fN REROOF W�COMP. 111�VVVaJJJ� '- "ca Contracr!• Dam —4-Y -fir to 120A ARCHITECTS DECLARATION `' y p ! IdiAGrstanJ m�l.��A SCJ uiCc�^hr-rG` ff Fy Q� —/. � Licensetf Pmressienel - -" - -- - - - - OWNER -BUILDER DECLARATION License Law for the I herchy .(Orin two I am exempt from me Csamess i o and Pe. decoona Code:Anydta or aunty whicfolloh reason. lettit to construct. after, which a to eonWlmt, alter, impmm, demolivlt, nr repair any structure ` 0 rtquiru permit Sq. Ft. Floor Area 'Valuation ! prior to its iimmecoalsu requires the applicant for such permit m Glc a signedsmemcm thin hr is licensed o the of the Contl*430 s License Law (Chapter 9 pursuant provisions s (commencing with Section 7000) of Division 3 of the Business and Professions Code)or than he IS exempt therefrom and On basis for Ne alleged exemption. Any violation of 0 Occupancy Type P Y YP Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty oferO not ream Than five hundred dollar (S500). ❑ I, as ownct of the preputy, ea in, employees it has as thch in compensation. Required Inspections will do the work. ad memorn a is not intended or offered far sale(Sec.]Osa, Businev and Pmrassiuns Code: The Committees License Law docs not appy m in owner of q P property who builds orimpreves thereon, and who doessuch work himself or through his own employers, pmvided that such improvcmenu am not intended orottered for sale. If. however, the building or Improvement is sold within one year of completion, the owner. builder will have me burden of proving that he did not Wild or improve for purpose of sal.j. 1. as owner of the propeny am excluz!vely contracting with licensed contractors to consumer me project (Sec. 7W, Business and Professions Code:) The Contractor's Li. ase Law docs not apply to an owner of pmpeny who builds or improves themon, and who contracts(or such projects with a contractor(s) licensed pure®nt to the Commichoes , License Law. ❑ 1 am esempt under Sec. . B & P C rte this reason Owner Data WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one or the fallowing decimations: I have and will maintain a Certificate of Conant to self-insum for Worlo iCompen- "umm, as provided for by Section 3]00 of me labor Code, for the perrormacce of me . weak for which this permit is issued. ❑ 1 have and will maintain Winter's Competwuon Insurance. as required by Secuon 3]00 of me labor Code, for the performance of me work for which this permit is issued My Worked C pensaIion Inzurvme Cartier and Polity number am: Cartier:��/ N li Policy No.: / ['/ o L� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This scetim need not be completed if the permit isforonc hundred dollars (5100) m It..) 1 cerody that in the performanm of the work for which this permit i5 issued. I shall not employ any person in any manner so as In become subject to the Workers Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the labor Code, you must ' foomwith comply with such provision or this Permit mail M dcemcd revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is lending agency forme Pcrfurmawc of auSec. ' Rework s 3 this permit is issued (Sec. ]09]. Civ. C.) Want, Lender's Name Lender's faMch Address j I certify, mal I have read this application and sum that the above information It _ • coned. I apse to comply with all city and county ordinances and mute laws relating to building construction. and hereby amhorim rtpmsenmuves of this city to enter upon one . above-mentioned property for milinction purposes. 1 (We) agree to save, indemnify and keep harmless me City of Cupenino against j liabilities.judgments. costs and c.,... which may in any way same against and City in eon"umme of the granting of this Permit. ' ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date �- , SOURf�j�EGULATIO 5. /�/G Re-roofs 'signature o(ApplicanUConmclor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the, applicant or future building occupant store or haMk harardous material as defined by the Cupertino Municipal Code, Chapter 9.1 i. and the Health and Safety «m. So bon 25532(a)? ❑Yens All roofs shall be inspected prior to an roofing material beim P P Y g g installed. 1 ' If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant inantra building occupant use equipment of deviant which it s air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. ict9 Wift? v�.a� ❑Yes �-"'V I have mad the harardummamrials requirements under Chapter 6.95 of the Califor- nia Health &SafmyCode, Socdom V5N15.25533 and35534. 1 mad land hot lithe Wilding � / (? ��/ Q does not..011y have a tenant that it is my responsibility to notify IM occupant or the i///r/t�L� C�f�CiC��'�� i7 {T mquircroems which most be met priorm issu re nr, Cerdnrate of Occupancy. Signature of Applicant Date a,,��tea-- i• -s-05 All roof coverings to be Class "B" or better owns or anmpn.acd.,at asrnt Dam w �CITY of UPEkTINO 9 �s Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: u-,5 G- cL-L lA PERMIT # OS07bo <-c ,30-- OWNER'S NAME: Dj4jlP6 PHONE # GENERAL CONTRACTOR: p ;v FAX # p I am not using any subcontractors: dga.,�/ 619-7-G13� Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature 6-Y_04' Date 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 C (G 1200 perj r✓G y Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature 6-Y_04' Date Community Development Department /i Building Division City of Cupertino ( 10300 Torre Avenue CITY OF Telephone: (408) 777-3228 U ^l � ��' � � 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. 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. Homeowners Name: Do d/'/> C) I K 9_2 5 G /� Job Site Address: / D (f,,411-4:5 b C J3v4eZC EGG h/ .4 Roofing Company Name: ��©O pc�,/ N G - Applicant 's Signature:` Date: Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper r-. � CITY OF CUPERTINO CITY OF CUPERTINO RE ROO F PERMIT APPLICATION FORM -S-v7�Y� APN # Bldg Permit Fees Date: 0 a Energy 6-�-GS Building Address: Seismic Fee Res L c G C 'GG Owner's Name: BUILDING Phone #: r 1C15rzs0.V Z - ;z s Contractor: Phone #: License #: F peg- - - 6� Z Contact: Phone #: Cupertino Business License #: �- Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles 4? Asphalt Shingles ,,F< 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 Comply With Cu ertino's Tear Off Policy: ❑ Job Description: 4cs i '7LG G 'dpi C'OnV\ ►� Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: 66G•Uti C✓C60h� Qty. if Applicablp 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 G 3�2-61