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04060138 ' CITY OF CUPERTINO �* "� -'"'"�'"I'll - � ;'+-A BUILDING DIVISION PERMIT I CONTR'ACTR,OINE RMATION �r BUILDING ADDRESS: STATEWIDE ROOFING INC - PERMIT NC04060138 ' 110991 N A DE ANZA BLVD OW NEWS NAME: PERMIT ISSUE DATE SARATOGA MANAGEMENT 5542 MONTEREY RD 06/16/2004 ONE: SANITARY NO, CONTROL NO. (408) 288-8680 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH �oo LICENSED CONTRACTOR'S DECLARATION O O O O I ManRestated!by afn at I am Ikenunder provisions Or Chapter 9(commencing Job Description wish Sec1I 79M)of Divuian 3 often Busimu stns Profculons Code.and my mecnc is -- — n'�zppp lora oC�derr cn� G REROOF W/ (BUILT`U-P fit F an Caul he used �D ,RATION n� I understand my plana Nall he used u public record, c Licensed Professional u OWNER-BUILDER DECLARATION i I hereby a1Rrm that 1 am mmorpl from the Contractors License Law for the ---- 0 o following reason.(Section 7031.5,Business and Professions Code:Any city or county S which requires a permit to construct,eller,improve,demolish,or repair any structure yS`2 7 375 t-Z N„ n prios its issuance,alao requires the applicant(orsuch permit to file a signed statement g that W is licensed pursuant to the provisions of the Contractor',License Law(Chapter 9 Sq.Ft. Floor Area Valuation $ (commencing wish Section 7000)of Division 3 of the Business And Professions Cnde)or that het,exempt therefrom and den but,for the alleged eumption.Any violation of Section 7031.5 by any applicant for A Parmit subjects she apple.,to A civil penalty of 3 2/14;nmelu U Occupancy Type not mo¢than five hundred dollars($500). ❑I.uovmec of the PmpatY.or mY employees wish w{mulheit sole mmpensation, will dothewars.Caere: he Cmisures undedm Loath tomt.pply.]fist, wnma and Pty.h.W :The Conor ora ndwho Law dao m,apply lf an ovmar is Required Inspections mancenwho Wilxvided rat Nimon.andmUmnatimm�dkhim,elf for Weugh his ownemployees,pmvixd Natsuchemprowm withdraw t art not intendedmpletirn.Tor We.or. builder,Nc Wilding orimptowmenlissold edidoneyear orcompvfrsheowmr- .[A.).rwill have du burden of proving Nn W did ml Wild or Improve for purpor of ark.). ❑1,a owner of the property,am imitatively coursening with licensed contractors to construct the project(Sec.70",Business and Profauiom Code:)The Conmcmt's Li. cense law does not pply to an owner of property who Wilds or Improve thereon,and who contracts for such projects with a eontnctor(s)licensed pursuant o the Contractor's Lkensa Law. ❑1 am exempt under Sec. .B&P C for this noon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury oro of One following declarations: ' ❑I haw And will mainssin a Ceeificam of Comets to self-insun for Workers Compen. , urian,As provided for by Section 3700 of the labor Cox.for the performance of the work for which this permit is issued. ❑1 Mw and will maintain Workers Compensation Insurance.As Iequired by Section )]00 of the Labor Cox.for the performance of the work for which Nis permit is lured. - My Workers ore tion Ins a carrier and Policy num r Treryler. Poli > CERTIFIC OF EKEMPION M ORKERS' 0 PENSATION IN RANCE (This section deed not W completed if the Permit is Its,am hundred dollen(SIM) or Ina) 1 certify that in the performance of the work for which this Permit is Issued.l shall not employ any person in any manmran As to become subject to the Workeri Compemadan . Low of California.Data Applicant NOTICE TO APPLICANT:IL arm,making this Cenifrcam of Exemption,you should become subject to the Wohars Compensation provisions of the Labor Code.you must ,J O foMwith comply with such provisions or this permit shall bo deemed moked. '�y CONSTRUCTION LENDING AGENCY [+ I hereby Affirm that then is a construction lending gency fm the Performance of CYi > the work for which this permit is issued(Sec.3097,Civ.C.) QLenders Name Z)z Lender's Add. fJ Q 1 certify that I haw read this application and sum Net the above information is E' correct.I agme to empty with all city and county aWinances and amus laws Mining to 0 building construction,and hereby authorize represenutiwa of this city to enter upon the W above-mentione4 Property for inspection purposes IV) (We)dime to save,indemnify and hmempick hay in m w Glly m Cupertino against Z liabilin lac mofth,cmuand ofpcmu which may in my way aecme against said City fJZ in comegmna of she granting of this Permit APPLICANT UNDERSTANDS D W L CO LY WITH ALL NON-POINT Issued by: Date SOURC EGULATIONS, 6 L G U Re-roofs Si t or ApplicanUContnctor am HAZARDOUS MATERIALS DISCLOSURE Type of Roof WI1 sho applicant ur future building occupant store or handle hanrdom material u defined by the Cupertino Municipal Code,Chapter 9,17,and the Health and Safety coda,SCAtianYm Iyy Nu 35534007 All roofs shall be inspected prior to any roofing material being installed. � Will Ne applicant or future Wilding Occupant iso equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emh hamrdnu,Ai,mnumina ns u de0nad by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yee /yyNu / I have read Nua ehrdirramrials nquitcmcnuunxr Chmmr 05af Ne Califar nu Has"Safety Cox.Secdmu25505,25533 and 23534.1 understand thnif in Wilding docs sol Monctly how•. t,dot' ' my ponsihiliryano.. the aecupart fNe require Is hichmonIV ' ma araC, mnmafGecnpxtu G If Si atureofApplicant Date wne authmoecd agent Dam All roof coverings to be Class"B"or better Community Development Department f Building Division ,let j> City of Cupertino 10300 Torre Avenue OpC[ITY�F A Telephone: (408)777-3228 Ur C kT I l i 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 obtainingsn 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 with the above stated policy on re-roofing. Homeowner's \Name SC✓l ��� ��l t l _ Job Site Address':' /Q T Roofing Company Na*: f Applicant's Signature: Date: Greg Iteel Building Official Revised 1/30/03 Printed on Recycled Paper X'or- am CITY OF CUPERTINO , REROOF CUPEIkiINO PERMIT APPLICATION FORM APN# 3 2 6 Date: Building Address: (� Owner's Name: Phone#: S 0 Contract r• License Contact: Cupertino Business License #: Q" 02 Type of Roof Covering: Existing: Proposed: b( Built-Up Roof ,K Built-Up roof ❑ 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# Cl To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: -� Job Description: �X . Residential ❑ C6mmercial Fire Zone: Yes ❑ No ❑ Confinned with Planning Dept. if there are an restrictions: u Cost f Project: Type of Constructs n: Occupancy group- 7 roup: -z737S G Q . if1 A li b e 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