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03080185 CITY OF CUPERTINO '^ s az.->u BUILDING DIVISION PERMIT CONTRACTOR INFORMATION. ou LDING ADDRESS: WILLIAMS ROOFING PERMIT N003080185 69e CTRO OWNER'S NAME: 4921 CABRILLOPOINT PERMIT ISSUE DATE NE: (408) 252-5120 SANITARY N0. 9 2 CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH � ❑ O O l� +o ZO LICENSED CONTRACTOR'S DECLARATION Job Descri tion u�Ll © pp r� 1 Wrchy,affrm that 1 am licensed un r provisions of Chapter 9(commencing P cel vL� wiNS on 1pgl)of Division3af the Bu' and Profcssinm Code,and my license is S� icer l rte and cntt E z Lie e I 63 � ---Cic.a 74 79 REROOF SEP 0 2003 g- Dau f 9 Cu (' ARCHf1ECT5 RATION derstend my plans shall be used as public records pff,T tt�/1 yyw0 vv✓✓✓✓// tB l4dB�,®�L 19 V1 a In Licensed Professional 7a S OWNER-BUILDER DECLARATION 2<Y I herebynaso .(Siem Not 1 a.1. exempt from the Cmion Co License Law for the pO followingnaan.(Section IIDI.;B,ainess and ve.fdcroli Crede:Any city nr county 3$ which requiresan permit re construct,alter.improve,h ermit t or repair any aoucmm 000 i y prior m is caned e,also pursuant to the the vpionct or for the Contractor', Permit tofile aicansc signed(Cha mem 2 (Commat he eeccgWiLhSection7")ofvivkhm3oftheBwness ndProfssio(Code)or Sq. Fl. Floor Area Valua[Ion Z $ (Commencing he is anent, Section 1tand Wask;on 3 of the ra end Pr.A.,ns Code)or Nat be u eampt any applicant p li and the beer for bj ctsthalleged caicant t.Any violation of 36231001 . 00 Section IDSLive any delta,orepemth subjects the applicanuoacivil penalty of APN Number Occupancy Type_ not mon Nm Ove hundred dolbrs(5500). '- - -- "—' ❑I,as owner of the pmpeny,or my employer with wages as their sole compensation. will do the work,and the structure is not intended or offered for sale(Sec.7W.Business and Profevioa Cade:The Communes Licenses Law does not apply to an owner of Reqyuired Inspections property who buildsorimprom thereon,and who does such work himselfor through his 307 - INSULATI-ON own employees,provided that such improvements are not intended or offend for Ole,11. 601 - ROOF TEAR OFF however,Ne building or improvement Is said within ane year o(completlon,the owner. Wilder will have the burden of proving that he did not build or improve for pu pam of 602 - ROOF PLYWOOD NAIL "1c')' 603 - ROOF BATTENS ❑I,construct owner o(Ne property,am culusiv nd contracting with:) no Cconvacon i. - --- romLatheproject(Sec.oan wnerofproerty who or Improves es thecton, red 604 - ROOF IN-PROGRESS cense law dart not applytoan owner of property who tad p or improve Norton,and who ronmcu for projects with s cantrxcmr(q liceved pursuant to du Contractor's Licence law. ❑1 em exempt under Sec. .B&P C for Ihla neon Owner Date WORKER'S COMPENSATION DECLARATION I hereby affmm under penalty or Perjury one of the following declarations: I have and will maintain•Cenilicete of Consent o self-insure for Work s's Campion. 137(WI on,as provided fm by Section 3700 of Ne labor Code,for On,performvnce of the rk for which Nis permit is issued. 1 Marc and will maintain Worker's Compensation laurace,as required by Section of the labor Cade,for the performance of rise work for which this permit is Issued, Works, I CC�sm�pens�ation Insrurance artierand Policy numberam: rtier.TlPai las^' Policy No.: 00- 089 CERTIFICATE OFEKEMPfION FROM WORKERS' COMPENSATION INSURANCE [This section need not W completed If the Permit is furore hundred dallm(SIM) or In$,.) 1 certify that in the performance of the work for which this Permit is issued.I shall nut employ any person In any manner so as to become Subject o the Worheri Compensation laws of Cal ifomia.Data Applicant NOTICE TO APPLICANT:IL after making this Cerificata of Exemption,you should become abject o the Workeri Compcesation provisions of the labor Code,you mura =O (anhwith comply with such provisions or this Permit shall be deemed revalue. z= CONSTRUCTION LENDING AGENCY 1 hereby affirm that then its connotation lending agency for Ne performance of Y. ? the work(ter which this parfait Is issued(Sec.3091.Civ.C.) L0 lender's Name 3.z Landers Address j Q 1 sentry that I have read this application and state than Ne above information is !' comm.I ague to comply with all city and county oninances and state laws relating to SVS building construction,and Wnby authorise reptuemuivas of this city to enter upon One G 'lave-mentioned property for inapection purposes. (We)agree to on.indemnify and keep hanrlcss the City of Cupertino against r h Iiabihnes.Judgmenu.cosu and expenses which may in any way&come against aid City of the granting Of his Numb. J r. tncPLICANTeUNDERSTANDStAND WILL COMPLY WITH ALL NON-POINT Issued by: Date OURCE REG LATIONS. °3 Re-roofs igrature of ApplieanUComnetor Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will One applicant or future Wilding occupant sora or handle hanNous material as defined by Ne Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section pr 25532(a)? �rfNa All roofs shall be inspected prior to any roofing material being installed. Will the applicam or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove R haardaus air contaminants as dcbncd by the Bay Arca Air Quality Maagcmcm all new materials for inspection. resin? ❑Yes /�N0 I have read the has nfdusmaterials mquinments under Chapter 6.95 of Nc Ca I' IZ /O�Ithd'<gNctyutic,Su:dms25505.25533 and 25534.1 unonsund the iron,buildingQr_�L_:Z_ res not eurtendy h.ce a anent.Nu it r my napmsibithy in notify the occupant of the quner-Os"Ith on Mm at prior to issuance ofit Cenifien,�f Oce seer. Signature of Applicant Date U/;ISO 03 All roof coverings to be Class "B" or better Owner or authomntl&gena — Date Community Development Department Building Division g City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E RT I N O 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 withtheabove stated policy on re-roofing. Homeowner's Name: AI AIC 00'`JlLt e, Job Site Address: Zb(e& P C SD D2 Roofing Company Name: W t U- 1 R c A plicant s Signature: c.&� —� Date: '13 \il/�SIhLD�Xi Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper 1 • CITY OF CUPERTINOD REROOF CUPEI�TINO PERMIT APPLICATION FORM APN# ZDate: Building Address: 20(o4too Ct_F-o DrL. Owner's Name: Phone M. Contractor: - Phone#: License#: 4l 4 �9R Wtt, tmrit ' � 2sz—Srz� Contact: Phone#: t-t %,a Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof "tom Asphalt Shingles r Asphalt Shingles ❑ Wood Shakes Cl Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# 4 ,�C To be Removed ❑ Provide Mfgr.Installation.Buz 5 s 6 P I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: Residential Commercial ❑ Fire Zone: Yes ❑ NO Confirmed with Planning Dept. if there are anyPtricti s: LJ Cost of Project: ;l D� / Type of C ction: Occupanc up: _e.I2M QtY• . A is le 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 f Z / � r2 � -7