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04030179 CITY OF CUPERTINO BUILDING DIVISION PERMIT ¢,t,PNTRACTORINFORMAWON: BUILDING ADDRESS: PERMIT N0. T D ROOFING 04030179 ' OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECt PLUMB MECH 1� 0 � 0 L Op LICENSED CONTRACTOR'S DECLARATION lob Description w❑ 1 hereby affirm that I am licenced under pron visioof Chapter 9(commencing =N Fw with Sectun7")of Division 3 ofthe Business and Pmleesioas Code,and my license is in full foreeand effrt.,y Ci LeN 66 aa- REROOF IW�ulrr rp�gggll(��y},�pp {y®. Oviz Licence Cl s .Jf�Cunlrazlor OQ r+ �" `"a�a'stmro ARCHITECTS DECLARATION I understand my plans shall be used u puhlie records MAR 3 0 2004 wMo Licensed Professional S OWNER-BUILDER DECLARATION ®� pp�pw�, P 1 hereby affirm that I am exempt ffum the Contractors License Law for the V ISL®�Y\V1 p O following moon.(Section 7031.5.Business and Professors,Cade:Any city at county x m which requires a pewit to construct,alter,improve,demolish,or repair any structure w�'^ prior to its issuance.also squires the applicant for such permit to file a signed statement 5Ea that he isliocnsedpursuantmtheprevisionsofBic ContracmriLt..law(Chapter 9 Sq.Ft. Floor Area Valu tion ,Fe (commencing with Section]BOB)of Division 3 of the Business and Professions Code)or ave•R R that W is exempt chemfmm and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of 3 M_1 er0 0 Occupancy Type not ream Wan five hundred dollars(SSW). I,ns owner of We property ar my employees with wage az Weir cele compensation, will do the work and the sweturt is not intended ra.Mrasl forsale(Sec 1814.Business and Profession Code:The Canuacwes License Law docs oat apply to an owner of Required Inspections property who builds or improves Orison,and whodoessuch work himself orNmugh his own employees,provided that such improvements one not intended oroffem l for cele.If, however,the building or improvement is said within one year of completion.We owner- Wilder will have Ue burden of proving that he did not Wild Or improve for purpose of sale.). F9 h as Owner of the property,am exclusively contracting with licenced contractors to construct the project(Ste.7W,Business and Professions Code:)The Con rachm's U. ceme law does not apply to an owner of property who builds Or improves themon,and. who contracts for such pmjecu with a conuactor(s)licensed pursuant to the Contractors License Law. I can exempt under Sec. ,B&P C for this mason owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby aRrm under penalty,of perjury one of the following dcclanlions: I have and will mainuin a Certificate of Consent to self-insure for Worker's Compen- ion,n provided for by Section 3100 of the labor Code,for the performance of the w ork Lak for which this permit is issued. 1 have and will maintain Workers Compensation Insurance,u required by Section of the bor Code,far We performance of We work for which thisperi,is issued. y Workers Coompennsation Insurance canier and Policy number are:ncer. 51 Q LQ. -r 3.lV�P Polity No.: 14 a t S CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thisseclion reed not W complewd if the permit is[crone hundred dollars SIOI) or ca.) I certify dust in the Pcdmmenee of We work for which this peered 6 issued,I shall ml employ any person in any manner so as to become subject to tW Workers'Comfxmaauon Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Campcnsmion provisions of the Labor Code,you must .J O forthwith comply with such provisions or this permit shall W deemed invoked. 'Z CONSTRUCTION LENDING AGENCY 1 hereby affirm that Nem is a construction lending agency for the performance of X 7 We work for which this permit is issued(Sec.3091,Civ.C.) Wp Lender's Name W a Z lender's Address U C) I certify that I have sad this application and sum that We above information is ly F COOCCL I agree to comply with all City and county Ordinances and sum laws relating w p V building convection,and hereby authome mpremmativcs of chis city w enter upon We 04 (We)agree to save,indemnify and keep harmiless; an Be City niCupcnitaagainst / C Uh in consequence of the mstsang expenses which may in any way ecemc against aid City U z A APPLICANT of UNDERSTANDS granting Of this permit. C//`-y� r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RE�`'yyAAP�ONS. I d 01 76A�� J 101 o Re-roofs Signature of AppbcanbCantrzcmr Date HAZARDOUS RIALS DISCLOSURE Type of Roof Will the applicant or future building occupant swm or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code. smtim zss3z(an Yes All roofs shall be inspected prior to any roofing material being'installed. Will the applicant or fw Nu re building Occupant Use equipmentor devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hconcomitantsrdous air concomitants ve defined by the Bay Area Air Quality Management all new materials for inspection. Disaic,l ❑Yes Nu I have mad the hvaNnus materials mquiremen¢under Chapter 6.95 of the Califon niaHeal th&Safety Cod,Secdms25505,25533 and 25534.1 undcrsund chat if We building 3I does not currently has,a mane,that it 12 my responihihty w way de�eupant of dic l quimmcnks hi unbcmespriorwissumccofaCcnficam f0c ancy. Signature of Applicant Date 30 authodaaa ascot Dam All roof coverings to be Class "B"or better PTY Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 INUPEI�TINO Building De artment JOB ADDRESJ✓S: . 3E MIT # Io 433 )ehiSov� AVQ. 04. o OWNEWSN Stv\h Z o H PHO a.og) 2-55 -5r.92- GENERAL 69zGENERAL CONTRACTOR: FAX # 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 T l> Roo n a 3 155 Septic Tank Sheet Metal Sheet Rock Tile 19 ' o `� .6 /Contractor Sign lore —`� Date i Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 *UPEkTINO 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. 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. atn Homeowner's Name: .J eY)n zIt � � Job Site Address: 11 4 e YX Soh J e Roofing Company Name: i D )too f, tt cl A plicant's Signature: Date: Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper ' CITY OF CUPERTINO RERooF v,? v � 7� CUPEkTINO PERMIT APPLICATION FORM APN # 6 _ ;z-9 0 ,4 -7 Date: 3 19 o �{ Building Address: 10433 DCvttSon -A Owner's Name: Phoney S` - 3691 j f_ ` �f z In c\.v. 9 Contractor: Phone #: License# l D moo F V\ to8 89 a. 88 -9. 6 6 G Contact: 1 Phone#: Cupertino Business License#: Le's �i oatn Ko8 89 -. 8 Vy-a- Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof A' Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) q Other(Specify) �wg� Number of existing coverings ❑ Provide I.C.B.O. Report# .2r.S 6 ATo be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: np r_n . _ 3 L JrI - Residential EA �L Co cial F1l Fire Zone: Yes ❑ No 14 Confirmed with Plann' De t. if there are any restri ons: Cost of Project: Type of Construct y�n: Occupancy grou $ l0 01570he - daor Qty. i Appliq'able 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 Fe77