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05070034ani 0O0CC ?toW J p n�td oG �ppo Kmlr y�N �6 FFG 0z z C Ct BUILDING DIVISION PERMIT *-GOANZ'RACTOR�INFURMATIO,N BUILDING ADDRESS: PERMIT NOO 5070034 OWNER'S NAME: PERMIT ISSUE DATE ANN DIEP n 2 ONE: SANITARY NO. CONTROL N0. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDOO ELECT PLUMB MECH O. dna O O LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Clupmr 9 (comm acing Job Description with Section ]OCU) of Division 3 of me Business and Prommions Codomd my license is imfull force anaerctt. � LicenseClazs Lic.17 XS fel REROOF W/SHINGLES } DaM ammamr ARCHITECTS DELLA ATION CONTRACTOR: K H ROOFING - I undcmanJ my plans shall be used az public lecora Li..d Professional OWNER -BUILDER DECLARATION lCV I hereby .(firm that 1 a.1. exempt faro the Contractors License Law for the Q, following miner. (Schon B13sr Businessand ve dcroli Code: Any city or county Impfnsu, hrorrepaira any Permit tel CnnSIr11CL aftapplicant requiresissuance, Permit Citl prion n e, sig ammom priortoslcense C p•LSUnt tot mi pro inion o for Such on'Inice License coed (Chapter the escegwithSrstion7 Sq. FL Floor Area Val ua .rg'aOO )ofDiviaaznf of Division3 oftheBusinmsandPrxssmasCode)or (comm encingwith Section the Business and Professions Code) or (comthat mencing and she that he u exempt therefrom and Ile baso for the alleged exemption. Any violation of ' APN Number Oeeu e T P Y YP penal(y Of Section ]031.5 by airy applicant for a permit subjects the ppliant to a civilane not mom than five handled dollars asoo). 37505001.00 1,nownerof Nepmpcny,Ormyemployeewithwagesu Noirsoleeompem dDn. Required Inspections will do the work. and the swcturt is not in¢nded or orfc,ad for sale (Sec. 1044, Business and Profusions Code: The Cmusemr's License Law docs not apply to an all of property who builds or improver thereon, and who does such work himself or through his own employees, provided that such improvements arc not intended or o@red formic. IL however, the building or improvement it mid within one year of completion, the owner, builder will have de burden of proving that he did not build or improve for purpose of min.). O h as owner of the pmpeny am exclusively contracting with licensed contractors m consumer the project (Sec. 7044, Business and Professions Cade:) The Conmcmr's Li ccom law docs not apply to an owner of property who Wilds or improves themon, and who comuacts for such pmjeca with a conaactor(a) licensed punctual la the Ommommrs License Law. ❑ 1 am exemptan&, Sec. B & P C Tar this rcawn owne, Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of to following dalalationm 1 have and will maintain a CcrOfam of Consent a self -insure for Workers COmpen- andmi, as provided for by Section 3700 of me labor Code, for the perfolmance of the work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Imuran . u required by Sectun 3100 of me labor Cade, for the performance of me work for which this permit is issued. My Worker, Compensation Insurance artier and Polity number arc: Carrier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu x in. mend at W c.plcmd if the permit is fm one handled dollars ($100) or lea) I artily, that in dic gerfonnanee of the work far which this permit u issued, I shall out employ any person in any in x as u became subject in the Workcli COmpcuation Laws of Califomia. Data - Applicant NOTICE TO APPLICANT: if. after m king this Certificate of Exemption, you should become subjeer m the Worker's Compensation provisions of the labor Code, you muss foMwim comply wile such provisions or this permit shall be deemed Mvoked. CONSTRUCTION LENDING AGENCY I hereby affirm that them is a construction lending agency for the performance of me .,it for which this permit is issued (Sec. 3097, Civ. C.) Under's Namc Lender's Address I ecrlify that 1 have read this application and sac e that me above information is coned I Ripme to comply with all city and county ardinanas and role laws totaling ar building construction. and hereby authorine leprnsentxtives of this city in enter open the , ahove-mcndoncd property for inspection Purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabihims,judgments.cosu and expenses which may in any way menum against said City in consequence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. - 'Re -roofs Type of Roof G� (91-0'("o Signmm. of Ay icant/Conoaclor Dam HAZARDOUS MATERIALS DISCLOSURE Will the, applicant or future Wilding Occupant store or handle humdous material u defined by be Cupertino Municipal Code. Chapter 9.12. and me Health and Salary de, 5eetion 255", [D Y. t�Nd All roofs shall be inspected prior to an roofing material beim P P Y g g installed. If a roof is installed without first obtaining an inspection, I agree to remove Will Ute applicant or future building occupant use equipment or devices which it hazardous air contaminants m dcfned by the Bay Area Air Quality Management all new materials for inspection. hieO �[[ El Yea C Nu Its I have mad the haaardnus materials uquimmems under Cu par 6.95 of 0th Calif., Health& Safety Code Sections 255)5, 25533 and 25534.1 undersand con iflhe Wilding ' es not currently have a Moroi, that It Is my MmOncibility m and I the occupant of the uirement%which rSLW=1 o WdammeofaCertificateoraeupancy. Signature of Applicant Date All roof coverings to be Class "B" or better Owrer or aummb�ts Dam k —61 CITY 0, �UPEI�TINO i JOB ADDRESS: OWNER'S NAME: 4VA, GENERAL CONTRACTOR: Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department PERMIT # D%o0 PHONE # Qqoa ) FAX # I am not using any subcontractors: ��J w�- Signature Please check applicable subcontractors and complete the following information Z -321 Date 4--v— Owner/Contractor Signature (�7•06•0� 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 Septic Tank Sheet Metal Sheet Rock Tile 4--v— Owner/Contractor Signature (�7•06•0� Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Subject: Re -roofing policy for the City of Cupertino Telephone: (408) 777-3228 Fax: (408) 777-3333 1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards 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: A A) N 0 / E' -p Job Site Address: �� _/� Q f l (��/ 40 irv, Roofing Company Name: Applicant's Signature: C-, Date: �o'd� Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper 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: A A) N 0 / E' -p Job Site Address: �� _/� Q f l (��/ 40 irv, Roofing Company Name: Applicant's Signature: C-, Date: �o'd� Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM D -S' -b 7 U a_ APN # 3 7 cr n Bldg Permit Fees Date: 07. oE.o I— Building Address: �g4lea C'gll c% �,c cVlo,741 Owner's Name: AI ,(l _P/z-F Phone #: Contractor:K )�11 Phone #:�4vr� d J_el License Contact: i/ ` Phone #: p -r2 Cupertino Business License #: F �7 BUILDING BUSLIC Business License Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Asphalt Shingles ❑ Built -Up roof J� ;9C Asphalt Shingles of- Wood Shakes �I-e;S> ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report # Cl To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job � Description, S / 2'n`l sues./_ reaov �t Residential . Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: 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