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05060056 CITY OF CUPERTINO s ate'-_'aa "T 2 , 'g'� BUILDING DIVISIONPERMIT CCIN,TRACTQR INFORMATION: BUILDING ADDRESS: CENTRAL COATING CO, INC PERMIT N005060056 OW NER'S NAME: PERMIT ISSUE DATE �nnPFR k mmPAATV '777 NOR ONE: - . 2 �&ITARY9,6/99/2. CNTROL NO. x .. ARCHITECT/ENGINEER: I� ay �, BUILDING PERMIT INFO (�fp/ BLDG ELECT PLUMBL MECH ' 100 LICENSED CONTRACTOR'S DECLARATION F I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description z6 with Section7")ofDivisionSoftheBusines,iodProfessionsCmde,andmylicenseis ggg� L enmmesna ry V5 t REROOF W�NEW SPF ROOF �l� F,yM p v�z License Lic.N Zip Date Contractor ! �} +n �tj' ARCHITECTS DECLARATION �� rI ft`-W N•k ?uU lundcrslanJ my plana shall he used as public records, ru{'•tel,' w t; Licensed Professional t+Cf \Vy a.0g OWNER-BUILDER DECLARATION a:5 M 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 731.5,Business and Professions Code:Any city or county K m 0� which requires a Permit to construct,alter,improve,demolish.or repair any nrucmm priorm its iunanee.also require lheapplicanl forsuch permilsu file a signedsummem mNat he is licensed PUrsnanllO the Pmvismnsofthe Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valkition pts—a (commencing with Section 70M)of Division 3 of NC Business and Professions Code)or .. Out he is exempt therefrom and the basis for Ne alleged eaemptipn.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty of 3 jtgl�l3etp p Occupancy Type not mare than five hundred dollars(5500). ❑1,as owner of the property,or my employees with wages IS their sole compensation, will do the work,and Ne swcture is not intended or offered for sale(Sec.7044,Business and Pm(essiors Cede:The COmmelPa License Law docs not apply to an owner of Required Inspections property who builds orimprovcs thereon,and who doessuch work himself ortheaugh his Own employees,provided that such improvements are notintended or olfercA Imitate.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1.as owner of She property,am exclusively contracting with licensed contractors to construct the project(Sec.7014.Business and Professions Code:)The Contractor's Li ream Law docs not apply to an owner of property who builds or improves thereon.and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑1 am exempt under See. .B&P C for this moon come, Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under Penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-imum for Worker's Compere sation,az provided for by Section 3700 of the labor Code.for the performance of the work for which this permit is issued.have and will maintain Worker's Compensation Insurance,az required by Section 11 of the labor Code,for Ne performance of On work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number art: correct: 5f'1177" FYA,St Policy No.:ZSt SoOOZ2Z CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This Section need not h,completed if the Permit is for one hundred dollars(Slip) or less) I ccodfy Nal In the performance of the work for which this Permit is issued,I shall not CmPloy any person in any manner an as to become subject to the Workers'ComPcnsalion - Laws of Califomia.Date Applicant NOTICE TO APPLICANT:If,efmr making this CrobScrim of Exemption,you should Become subject to the Worker's Compctsation provisions of the Ichor Code,you mus .J O forthwith comply with such provisions or this Permit shall he deemed¢vmked. z'""' CONSTRUCTION LENDING AGENCY [—a o-h. I hereby affirm Nal Ncre is a construction lending agency for NC Performance of a 7 the work for which this permit is issued(Sec.3(197,Civ.C.) V� Q lender's Name ] ,z Lenders Address O C) 1 certify Nat 1 have read this application and stat,that the above information is U. P correct.1 agree re comply with all city and county ordinances and sum laws miming to 0U building construction,and hereby authors OrPremntatives of Nis city to enter open the . D.1 ahom-mentioned pmNrty for inspection purpows. gy (We)agree to save,indemnify and keep harmieas the City of Cupertino against iF.t r/I Iiabi line,judgments,costs and expenses which may in any way acerae against said City U Z in consequence of the gratin ng of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCER N TI �!'r s � Re-roofs Sig'nawre of Applicam/Contractor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle hatardous material CC dfined by Ne Cupertino Municipal Cod,Chapter 9.12,and the Health and Safety Code.Section 25532(a)? Flyers o All roofs shall be inspected prior to any roofing material being installed. Will thea applicant or future building occupant use e t or devices which If a roof is installed without first obtaining an inspection,I agree to remove PP g P Area n mil havardoua air contaminants u the ed by the Bay Arta Air Quality Management all new materials for inspection. D istrict' / ❑Yes 1 have mad Ne hazardous mmelmisrequioemcnts ud nr Chapter 6.95 of the Califor- sHealtheirSafetyCoae,Seenoas 25505.25533 and 25531.1 undrslae nd thalifthbuilding ars not currently have a tenant,that it is my responsibility to nouly the Occupant of the poortoissuance of a Cerlflcat,of Occupancy. Signature of Applicant Dalor authorized agent Date All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: SO S Soufti De �ny� 7f/vcC PERMIT # 6506-00 6 OWNER'S NAME: PHONE # 'T V-67 3-0 2 GENERAL CONTRACTOR- jj�ZFAX # 5;J- — 3 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information 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 Tear '5 e Septic Tank Sheet Metal Sheet Rock ® Tile Owner/Contractor Signature Date Community Development Department f� t Building Division City of Cupertino ' 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U rpC�I I�® 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: 'I. 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: LZVa2 alhzl lob Site Address: / 5-0 5-- So& Ai DP /fin 7—sl glyi e Roofing Company Name: 1!, 91Y) 7dAy Applicant's Signature: Date: 41 Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO CCr REROOF �� 0 CUPERTINO PERMIT APPLICATION FORM APN# 366 (0 12 Date: Building Address: % �fiti � � De�%nav I3Ivee Owner's Name: Phone #: Coope' ahte Coni pot)V Contractor: Phone #: License#: 6en�ra'1 e0AHIIX Ced 5-59 6 73 r'0079 V 5713 Contact: Phone#: Cupertino Business License#: oke. A(q I'd k7 5_S O6 — 2 6 Type of Roof Covering: Existyrg: Proposed: d Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles El1 Other(Specify)_ 2'� Other(Specify) �S y foOn, /& Nup er 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: Remove 4yisfiYn /'00.10 lhfA// new, Residential ❑ Commercial Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: 72`q-79Type 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