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05100046L °O -�i nF� a �yyU 4LLN °s �00 Le�xm v —us _za EFC d�$ F W a V LL F U CITY OF CUPBSION P CONTRACTOR INEORMA ON PERMIT C r1°;ws. B UILDING ADDRESS: R ROOF ROOFING P PERMIT NO. 05100046 22276 S D N7A C.T. OWNER'S NAME: P PERMIT ISSUE DATE CHRISTOPHER HAMTON 5 5577 VASSAR DR 1 10/11/200S ONE S SANITARY NO. CONTROL NO. (408)265 -9270 ARCHITEC IENGINEER: B BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION J Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70Kf of Division 3 of the Business and Professions Code, and my lice.. is to famx anQctf« 7 b$ R REROOF -T O TILE, IN � Dalc�n� ll• U 1 Conlrxur �����pas -- �LId I ARCHITECTS DECLARATION 1 understand my plants shall W used u Public mrnrtls NOV i Liccnud Pmfessfona) N OWNERm e i7 2005 exempt D on 1 construct. 1 r3 "V1i if' 22Q0(] m requires do, i Sq. Ft. Floor Area i -. - ". .p (commencing wish Section 7") of Division 3 of doe Business and Pmressinns Code) or e e - -� ❑ � � sv� N/ Nat he is exempt shcafrom and the bases for the alleged exemption. Any violation of r O Occupancy Type Section 7031.5 by any applicant for a permit subjects Nc applicant to acivil penalty of r not more than live hundred dolls. ($500). wi Las ownerof she t Required Inspections themme, ra is c Pr fework a amy wh bu C Oavc N a , h.cw,,lthe building d of proem i I w D 1, as owner of the Ionian, am exclusively convecting with licensed mmnctom to emnStmet the project (Sec. 7004. Business and Professions Code:) The Contractors Li ecrom taw dons not apply to in owner of propeny.who Wilds or improves thereon, and who contracts for Such projects with a contractor(s) licensed pu.uam W N[ Comenctors License Uw. D 1 am exempt under Sec. . B k P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury one of the following declarations: " " 1 haw and will maintain a Cenifica c of Consent to self -unite Tor Worker's Compen. sation, as provided for by Section 37W of the Uhor Code, for the performance of the work far which this permit is issued. D 1 have and will maintain Worker's Compensation Insu.nce, as refund by Section 37W of the Later Code, for the peROrmarme of the work Tor which this permit is neaten. etl. My War s Camj rounk(m�.II.�n,sunna arria and Policy so mMraare: i Canicr. k vx,., Jk Policy No.: ©Z 1 I 'O S CERTIFICATE OF�P ION FROM WORKERS' COMPENSATION INSURANCE ocis section need not becompleted Ki W remit is formic hundred dollars (gIIX) ter less.) I cenlfv that in the performance of Oc work for which this Permit is issued, l shall not employ any peon in any number m as m WeOme subject m the Wrolora COmpeosmtim Laws of Ci lifmmia. Date Applicant NOTICE TO APPLICANT: If, after making this Cenificate of Exemption, you should hccx me subject m me Workers Compensation provisions of the Lator Code, you must a F CITY 0, �UPEI,TINO F Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax(408)777 -3333 Building Department JOB ADDRESS: 2L L� 9 PERMIT # 61r d OWNER'S NAME: I aw�O PHONE #43C GENERAL CONTRACTOR 6 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature 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 I/ Roofing 1a C�g7 S6 $' Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date CITY OF UPEkTINO 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 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. 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: H ­' c Job Site Address: ``1-l-Z-1 6 Roofing Company Name: i ApplicanYsSignature: Date: tU -<<' p} Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper ca CITY OF CUPEkTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM or /a-r--D V9 APN # -�, S� cDZ ©t g. BPERMFEE Date: BUILDING BENERGY Building Address: Q BUILDING Owner's Name: BSEISMICRE Phone #: BUILDING BSEISMICOM Contractor: Phone #: BUILDING License #: \«"vt \Zcot' � 'yOS''165 �iJi b Plan Check Fee BUILDING Contact: Phone #: BUSLIC Cupertino Business License #: o^.K 1108"26 S' 4a--) 0 Type of Roof Covering:' Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ .O'-Other(Specify) ( 1;2- Wood Shingles Other (Specify) � N Number of existing coverings \ ❑ Provide I.C.B.O. Report # f2' To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: \ tL C-tr(%�.t �Y�..� ¢- s�'�.��. �C 1`���^livY �3 •�L� -r,�. j ���1.�{ ` \\ Residential' Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: / Type of Construction: Occupancy group: 00 " Qty. if Applicable Fee ID Fee Description Fee Group A BPERMFEE Bld Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING A