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04090274Z' aD� n a 0n ;0 apo OC aat$� F�C 1 z z L cI 'Ci Bobo c oPVEisiorvNO PERMIT aCONTRAC;TORIIVFORMATION BUILDINGADDRESS: WILLIAMS ROOFING PERMI "04090274 OWNER'S NAME: PERMITLSSUEDATE ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EIPCT PLUMB MECH 0q 0 0 DECLARATION LICENSED CONTRACTOR'S DELLA Job Descriptio N AAO ��� under of Chapter v (commermin I MmbY arum that 1 am A under that I 1f�, with Section 700(o of Division 3 of One Business and Professions Code, and my he s Iljj ED in full ram ander f REROOF-T/O SHAKES INSTALL Incense Chat Lic. g °am\RCIITELTstOEZAN &---PLYWOOD/COMP SHINGLE O NOV 7 004 I undromnd my plans shall car Oacd as pabu� r«ards p Profes Licensed OW NER-BUILDER DECLARATION affix I nanny .(Erse hereby 11. exempt from she Contractors os Anyc Law for the ®J ® � m 7IDLA Businessand nm Code: Any city ofcounty follwhich requires. impmm, ri mash any awcwre which rtquims a Permit improve, de re eansuu4 same.applicant h Permit i priormits ensedOalsomquires theapplicmq for such Permit mice ssignedsu¢mcm issuance, also that pan,isim. Sq. Ft. Floor Area Valua t900 andProelaonsCodma9 (commencing with Section IIand of Division hamsof 3 of the Business avtl Code) or on. Any stir he u comps therefrom and the buts for th< alleged ezempton. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of not mom Nan Eve hundred dollars (S50)). 359260318.00 ❑Las ownv ofthe pmprny, Or my employee with wagossthev sole compenvtion, Required Inspections will dome work. end me swmum is not intended or offered for sale (Sec. 7W. Busitrss lons code: The Coaemes License law Wt apm ply an owner of and Pmrecsmrtines property who builds m improves thumon, and who does such work himself or through his Own employees, provided mat such impmmments tie not immndW oroffered for vele, If. however. the Wilding or improvement is sold within one year of completion, the avner- builder will have the burden of provin6 Nat he did nos Wild or improve for purpose of sal.). C] I, as oWKr of the pm,. , am eaeludively contracting with licensed com icbR to construct once projeR (Sm,. 7044, Buslneta and Pm issuhn a Craft:) The CO nfolte s Li- cense law docs not apply to an owner of property who builds or improves thereon, and who consracR for such pmjecu with a contractor(s) licensed pursuant o the Contrenoly LiUnae Law. 0 1 an emmpt under Sec. . B h P C for this moon Owner Data WORKERS COMPENSATION DECLARATION I hereby &M m under penally of perjury one of the fallowing declarations: I ham and will maintain a Certifcam of Consent to self -insure for Worker's Compcn- salion, u provided for by Section 3700 of the labor Cade, for the performance of the work for which this permit is named. ❑ 1 have and will maintain Worker', Ciao, a tim Insurance, ra mquirad by Section 37W of the LaWr Code. for the performance of the work for which this permit is issued. M misehiCosm..p_erupadori lnvsunmz ettim and olicy nuntsome: C TIFICA O—'t' FEXEM ON FROMW bRKERY COMPENSATION INSURANCE This section need not he completed if she permit is for one hundred dollars ($100) of less.) 1 cattily that in the performance of the work for which this Permit is imued, l shall not employ any para n in any manner so as to become subject to the Workers'' Com,temahou Lawn of California. Dam Applicant NOTICE TO APPLICANT: If, after making this Cari ficam of Exemption, you should become amijca in the Wotkm's Compensation provisions of the Labor Code, you must Forthwith comply with such provoitma or oris permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that them is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ. C.) Lender's Name lender's Address I 1 certify that I have read this application and sum that out above information is correct. I agree to comply with all city and county Outhouses and suite laws relating to building co omm on, and hereby aumarive mpmsenutims of this city in enter upon the above mentioned pmperly for inspection purposes. (We) agree In save, indemnify and keep harmless the City of Cupertino against j Iiabilitica, jvdgmena, costs and expense which may in any way accrue against said City in consequence, of the graining of this permit. APPLICANT NDERSTANDS AND \ COMPLY WITH-AIbNON-P INT Issued by: Date t SOURC LATIONS Re -roofs Type of Roof ©6' re ar AvvlicanVCanuaemr Dam HAZARDOUS MATERIALS DISCLOSURE Will the applicant Of future building occupant store or handle haaerdous material as di fined by the Cupertino Municipal Code. Chap¢[ 9.12., and the Health and Safety Cale, Scetion 25532(a)? All roofs shall be inspected to any roofing material being installed. ❑Yes ONO prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or Whom building Occupant use equipment or devise which it bro.doe air comam mmat as defined by set Bay Area Air Quality Management all new materials for inspection. Disuia? ❑Yes Nu (nave read set nail hmsmamrialsmquimrncnts under Chapter b.YSof the Califor- nix Code, Sccdnt.that 5 5577 and2553q.l building O not10 umo the Mthe docs not tumcn0y hast a tenant, then' a cspunxihility m notily she ax ant n the I rel La wIt hmust a rr.ccruricauc(Octa e. Signature of Applica Date All roof coverings to be Class "B" or better Owner or authoriacJ sim Dam 0 t Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 10 Building Department JOB ADDRESS: PERMIT # v OWNER'S N PHONE # 3 —/yZLo GENERAL CONTRACTOR: FAX # <7 D— 6 Z3 o yZ I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date �CIN Of UPEQ INO 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. 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: lob Site Address: Roofing Company Name:: W4- V2 A plicant'sSignature:L`" Date: Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper -CCS- c�n or CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN # r y BUILDING Building Address: Energy Owner's Name: BSEISMICRE Phone #: BUILDING BSEISMICOM Seismic Commercial Contractor: / Phone #: License #: �c-.L 5 ,S7D—/pZ3 /yL Business License Contact: Phone #: Cupertino Business License #: 5 ,GC - sib Wz -g6q7- Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles /111C 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. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: El Job Description:, �i46 - ,� /l os, t Residential 'P Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project:00 'J Type of Construction: Occupancy group: Qty. if AppliI & le Fee ID Fee Description Fee Groun / BPERNIFEE 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 LA