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04010098p CITY OF CUPEM-1140 BUILDING DIVISION PERMIT CONTRACTOR INFORMATION BUILDING ADDRESS: R E ROOFING & CONSTRUCTION'TttNO04010098 OWNER'S NAME: PERMIT ISSUE DATE ROBERT MACI ONE: SANITARY N0. CONTROL NO. (408)925-9995 ARCf11TECT/ENGINEER: .. BUILDING PERMIT INFO BLDG ELECT PLUMB0 MECII 0 0 0 LICENSED CONTRACT'OR'S DECLARATION I berth, afrrm mai 1 em licensed under provisions ar Chapter 9 fcnmmcncing Job Des B[� ��® with Section 7")of Division 5 of the Business and Professions Code, and my license is eV inrmlto. aha ter t,-51-7z-�C�� . REROOF cl License Cl Liyg Date mach")RA JAN 1 0 2004 ARCHITECTS DECL RATL l undersun my plansshall W used as puhllc ne o,da BUILDING Licensc l Professional OWNER -BUR -DER DECLARATION I hereby affirm that 1 exempt from the Contractors License Law for the 170 : Cnde: Any city or county ]lour 3. Businessandmpr whfollowingp greason. permit improve, tic t improve. doio li which rots ore pair any avement permit seapliMS t e pplicalter. t. prior us its censodpalso mquims the applicant for such permit actos Lice s Signed statement issuance. thathe is cens�J pursuant 70th) the Conuanor inti (ChapterCore) Sq. FL Floor Area Valuation (Commencingwith Section]( Nn) th Division J Professions or ofprovisions sion 3 vi Cnttc)ser mat he is eaempt therefrom and the aper for the alleged exemption. Any p of th .1Businccsandmi. Ay l natty Ser any mitsubjccutheapplicanUoacivilpenaltyof 31WBi211"cl-00 Occupancy Type nos more man r Wnama dons: (ssa0). P Y YP 1, as owner of the property, or my employees with wages as their sole compensation, will do the work and the awcmm is not intended or offered rofsale (Sec. 7064, Business and Professions Code: The Contractors License sew does nor apply to an owner or Required Inspections progeny who builds or improve thereon.and who doessuch work himself or through his Own employees, provided that Such improvements are not intended reoffered for sale. IL 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 Saks). ❑ 1. as owner of the pmpeny, am exclusively contracting with licensed convectors an construct the project (Sec. 7064, Business and Prefessiom Coda:) The Contractor's Li cense law does not apply to an owner or property who Wilds or improves thereon. and who contracts for such projects with a contractor(s) licensed pursuant o the Cunlractor's License Law. ❑ 1 am exempt under Sec. . B & P C for this reason Owner Due WORKER'S COMPENSATION DECLARATION 1 hereby anter under perulty of perjury one of the Following declarations: 1 have and will maintain a Cenifrcate of Consent to self-imum for Workers Compen- sation, as provided for by Semon 37W of the labor Code, for the performance of the work for which this permit is issued. I have and will maintain Workch Co rreMellon Insurance, as myuired by Section W of the labor Cred, fo me KK.rmanec of the work for which this pe.i, is issued My nrke Compensmirn lnsunna carrier and Policy number Tare: V1IAj� C.Z. I �T� 11A jl Policy An.: _/ 1 I I Oyu CERTIFICATE OF hxENPr10N FROM WORKERS' COMPENSATION INSURANCE (Thr secrira need not W complcted irtbe permit is for one hundred dollars (SIRB or less) 1 certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any mamar m as to becomc subject o the Worksrs Compensation - Laws of California. Dam Applicant NOTICE TO APPLICANT: If, after making this Ceniricate of Eremitic., you should become subject to the Worker's Compensation provisions of the Lahor Cnde, you must forthwith comply with such provisions or this permit hall be deemed revoked. CONSTRUCTION LENDING AGENCY I hcrchy affirm that there is a construction lending agency for the performance of One work for which this permit is issued (Sec. 3W7, Co, CJ Lendcr'r Name Lender's Add. I certify mat 1 have read this application and sum that the shove information is correct. 1 agree to comply with all city and county on inancer and state laws reluing to Wilding construction. and hereby antboriae representatives of this city to enter upon the ahovcathque onco for pct purposes (We) agree to says, indemnify and keep hersnkss the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City tin de grunting nsequenee of Ne gmming of this permit. in this R ,APPLICANT UNDERSTANDS AND WIL COMPLY WITH ALL NON -POINT SOURCE REGULATION3. Issued by: Date (/ ""�/ W V/ _ Re -roofs M,rao re of APP icandsC.. rw,.r/ Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicam ser for.. building occupant store or haodlc hazardous maanal as derided by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety. Section 25532(4)? pYe ' All roofs shall be inspected prior to any roofing material being installed. fc. - If a roof is installed without first obtaining an inspection, I agree to Will She .ppreantor mare Wilding«)rpam rscty9ipment Or di which remove t hasardour air aro Ode inane as do Encd by the Bay Arca Air Qual ity M anagement 7 / all.new materials for inspection. ❑Yes I have read Ne Moodnus materia, mmuntk quiteents r Chapter 6.95 of the Carrot me Health &Safety Cole. Sections 25505.25533 and 25534.1 undcnurd mat if pre Wilding free nm currently have. tenant, than it is my respunsihility m party the occupant of the uirtmcriu�wW c ac�c oft Ccnfcate f1Jcpa� ^c�y l/ Date Signatur-eofApp 2to All roof coverings to be Class "B" or better owner m,ranori>�I a em/ Date CITY OF UPEkTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Telephone: (408) 777-3228 Fax: (408) 777-3333 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 lab�ove stated policy on re -roofing. Homeowner's Name: Z0\3 I \ALAS Job Site Address: � 911 0 �)RAke _�R_ Roofing Company A plicant's Sign Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper 1I2doy • CITY of CUPEkTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM 00/0 APN # /Z 1 �_ � 1_ 0 2_ 0 Bldg Permit Fees Date: I III I 0 q Building Address: fj pp Owner's Name: I A AS Seismic Fee Res Phone #: 2 i r 2-1 i Contractor. � Phone #: � 2� n � License #: Contact: Phone #: Plan Check Fee Cupertino Business License #: Type of Roof Covering: Existing: Proposed: O Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles Wood Shakes 13 Wood Shakes ❑ Wood Shingles ❑ Other (Specify) ❑ Wood Shingles Other (Specify) Number of existing coverings Provide I.C.B.O. Report # �4o, i (o To be Removed C ! ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description:'Tewy\g pl5r if 1 UA^1e)',- 0,�- W0019 5-1iKY_et ttQSrKt,_ 1Z"GDX tr ASTM 1 v 11 -It TW t:"i CuQGvteT� l� Residential Commercial ❑ Fire Zone: Y s ❑ No ❑ Confirmed with P ping Dept. ' there are any r tri ns: lJ Cost i:oject: (f� Type of Const ron: Occupancy roup• r . UO ` Qty. r ADuli 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 -� -2-f-a 7