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05060196tar, CoC U'1 � =1ti33 J n� CX, JyU 03 C,KOK Kmt+ w�N X l- as CITY OF CUPERTINO Oforthwith N Qlender's z Q t" U n, Ig z BUILDING DIVISION PERMIT CONTR4CT0 INFORMATION s Af Bu ILDINGADDRESS: INTEGRITY ROOFING PERMIT N005060196 20637 CRAIG CT OW NER'S NAME: PERMIT 15.5(JE DATE JOHN HAVILAND 1537 CASA DE PON 2005 NE: SANITARY NO, CONTROL NO. (408)225-9263 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH T TORS DECLARATION LICENSED CONTRACTOR'S DECLARATION '1 ii � _ ` tt rl"-a' JobLDe� I Wrtby affirm that I am licensedCONTRACTOR'S of CTupwr Y (commencing Section 7W)) Division 3 Ne Busiscu Professions Code. and my licene is �)p on� [GEIS IpLr'a-y—.-'. sA with of of and meun mwe once effeeL - REROOF W/SHINGLES Licenu Class �Conuuwr Da /t A/ �� 7 Y 2005 ARCNITECI'S DECLARATION I understand my plan.shall he tied as public ¢cords �q p p q Licensed Pmfcssional OWNER -BUILDER DECLARATION DS}d�r" '7 Ijl� 1 hereby affirm that 1 sic exempt from the Contncmfs License Law for the VfA following mason. (Section 703 1.5, Business and Prorexsions Cotte: Any city or county which requires a permit Ra construct, alter, improve, demolish. m repot, any structure $15193 prior. un its issmnce, also requires the applicant for such permit w file a signed sulemcnt that he is licensed punuanuo the provisions of the Contractor's Licenu Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 71)(a)) of Division 3 of 1110 Business and Professions Coal or a that he u exempt th'mfrom and the basis for the alleged exemption. Any violation of per Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mom than five hundred dollen ❑ 1, u ower of the pmpeny, or my employem with wages u Nab sale compcnution, Required Inspections will do the work and the swcwm isnot intended or offered forage (See. 7044, Business and Prefessimu Code: The Convsctor, License law dose as apply m an owner of property who Wilds or improves themon, and whodas suchwork himself orthrough his own employees, pmvided that such improvements are not intended proffered forsale. If. however, the building or improvement is Sold within one year of completion, the owner. builder will have the Wrden of proving that he did not Wild or improve for purpose of Sale I. O h as ower of the property, am exclusively contracting with licensed contractors w Construct the pmjett (Sec. 9044, Business and professions Code) The Conuachies Li. - u Law does not apply to an owner of property who Wilds or improves themon, and who contracts for such projects with a contractor(s) licensed pursuant w the Contractor's License Law. ❑ 1 am exempt under Sec. . B k P C for this rtuon Owner Dale WORKERS COMPENSATION DECLARATION 1 hereby urian under penalty of perj my one of the following declanmtom: I have and will maintain a Cenificam of Consent w self-insum fa Worker's Compcn- ution, as provided for by Scction 3700 of the Labor Code, for the Performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Imuran¢, u required by Section 3700 of the labor Code, for the performance of She work for which this Permit is issued. My Worker's CompeuaGon Insurance Cartier and Palic number aa: Cartier SYS 7-L- FVA fi Policy Nbs��79-LOOS ' - CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This Scmhan need not W completed inbo permit is formic hundred dollars tg100) orless.) 1 anify that in Ne performance of ons work for which this permit u issued, I shall not employ any lichen in any manor an u w become Subject to th Workers' Comp'aotion Laws of C.1ifi m .. Dam Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject w the Worker's Compensation previsions of the Labnr Code. you mum comply with such Provisions or this Permit Shall W deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby aRRm that Vert it. cortsoucainn lending agency for the perforentuce of the work for which this permit is issued (So,. 3097, Civ. C.) Nam' lander'a Address . I certify that I have mad this application aM sum that the above information u comem I agree w comply with all city and county ordimncea and sou laws relating w Wilding conswelion. and hereby Sunburst, representatives of this city w coma upon the above-mention'A property for inspection purposes. (We) agree to save, indemnify and keep h mpLem the City of Cupcnina against Iimilitimjidgmems, costs and expenses which may in any way accrue against said City incoCofustregrantingafthUNDERSTANDS APPLICANT ArND WILL COMPLY WITH ALL NON -POINT Issued by: Date URCE CATIONS. / Re -roofs Type Of ROOF 6/Z9�oS nator of APpl' mracmr Date AZARDOUS MATERIALS DISCLOSURE Will the applicant or (Muni building aeupanutow or handle hvardousdSafrmaterial defined the Cupertino Municipal Cade. Chapter 9.12. and do Health and Safety i1surict? io tic. Section zss3z(a)? All roofs shall be inspected prior to an roofing material beim installed. P� Y ❑Yes - ❑Nu � P g g If a roof is installed without first obtaining an inspection, I agree to remove i Will the applicant or tbtnro btrilding acnpam tre'yolpm'm o, tlevias which it havallous air contaminants an dcfned by the Bay Area Air Quality Management all new materials for inspection. ❑Yes ❑Nu I have road the hazardous materials requirements under Chapter 6.95 of the Cali for nice Health ASafcty Codc,S'cdou25575.25533.d25534.1undcrsundthazirt Nilding � do not curently have a wnant, Nal It is my reg niihil't m notify RM owispant nr th' myuirtmc wn hmust mnpniorSo of rtificamoroccupancy. Signatuplicant Dale All roof coverings to be Class "B" or better o ` agcm r or amho Dawes alzo CITY of �UPEkTINO 0 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: �-Q& l r a; Cour+ PERMIT # d S6 6m/ F 0", OWNER'S NAME: ; j PHONE# d -ZZS Z GENERAL CONTRACTOR: — FAX # I am not using any subcontractors: �the ignatDate Please check applicable subcontract -and complete following information: er/Contractor Signature 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 z o5 Date er/Contractor Signature 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 z o5 Date • t Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 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. 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: Sn3 k n HU, u i la rJ Job Site Address: Roofing Company Name: Applicant's Signature: Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper Date: _,; �Z29%s ,m` CIN OF CUPEI�TINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM os- (9 APN # Bldg Permit Fees Date: BENERGY Energy BUILDING Building Address: 1 BUILDING BSEISMICOM Owner's Name: BUILDING Phone #: Plan Check Fee u; r� Z55 Contractor: Phone #: License #: Contact: Phone #: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ,E Asphalt Shingles � Asphalt Shingles )' 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. Ins ]anon Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: 2 ✓e I Residential—f Commercial ❑ _ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LI Cost of Pro'ect: Type of Construction: Occupancy group: �-5 Qty. if Applicable Fee ID J Fee Descrintion Fee Groun 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 n �je_