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04080259 CITY OF CUPERTINO .,w; rw`t? BUILDING DIVISION PERMIT '�GOLVTRACTOR INFORMATrON BUILDING ADDRESS: WOODS ROOFING PERMIT"04080259 OWNER'S NAME: PERMIT ISUEDATE Aft GLENN MILLER 21 79 STOMP. A31PNITTR STE 22 1-11 1'�C)(714 ONE: SANITARY N0. CONTROL NO. 831 637- ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I� 0 Loa LICENSED CONTRACTOR'S DECLARATION l� w I hereby affirm that I am lianmd under pmvuiom of Chapter 9(commencing Job Descri BLL is wiNScnion7")of Divi' n3of Ne Businw Nofcssions Code,Mdmyliccnuis ^tRinrunmm.milaf.en 3 3 REROOF License Cluf -o Data + ARC nr,T 1S 2004 jc� I undcrstanJ my psrta shat be uuJ as public mcor a w G Licensed ProfessionalI ®I s� a 3 OWNER-BUILDERDECLARATION �Y1eMpp <z I hereby affml that It exempt from the Comncmrs Limn.Law far the ��yy po following maxim.(Seedom BBl.5,Business and Pmfectiom Code:Any city or county K$( which requires a permit to construct slu,impress,demolish.or repair any structure prior to its issuance,also wouires tbe applicant for such permit to rile a signed etamment that he is licensed pursuant the provisions of the Common's License Law 9 Sq.Ft. Floor Area Valuation tt sx. (commencing with Section 70Mp)of Division 3 M the Business and Professions Code)or — that he is exempt therefrom and the bass far the alleged eumptam.Any violation of Section 7031.5 by arty applu ns for a permit subjects the applicant m a.ivil penally of 3 96TNefi"er0 0 Occupancy Type not more than lost hundred dollars($500). ❑1,as owner of the property,or my employees with wages u their In compcnsmion, will do the work and the structure is not intended orofc d far isle(See.706X,Business and Professimas Code:The Commilari samees Law donot apply to an owner of Required Inspections property who builds or improves Nemon,and who dura such work himself at through his own employxs,Provided Nut such impmssmanu arc not intended...Broad for sale_If, however,the building or improvement is old 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 the property,am exclusively contracting with licensed contracwrs to construct Be pmjecs(Sec.70",Business and Professions Cade:)The Contractor's Li- eman taw does not apply m an owner of property who builds ar improvss Burton.and. who contracts for such pmjccu with a conuactoKs)licrmed pursuant to Be CamOelars License law. ❑lam mrnpt antler Sec. ,0&PC fn,his mason Owner Dau WORKER'S COMPENSATION DECLARATION 1 heaby affirm under penalty of perjury ane of the following dcdanfions: I have and will maintain a Certificate of Consent in self-insure for Worker'sCompen- astion.as provided far by Smom 37M of the Tabor Cod..far the performarme of the work for which this permit is issued. have and will maintain Worker's Compmuwon Insuomm.as required by Section 37W of the tabor Curie,for the performance of the work for which this permit is issued. ' MyWorker's pre ion In carrier and Policy number am: Caller: S. T"' Policy N.ASS CERTIFICATE OF EXEMMON FROM WORKERS' COMPENSATION INSURANCE DIdissee wit need not be completed if flim permit is foram hundred dollars(SIM) or less.) I minty that in the performance of dm work for which this permit is issued,I shall not employ,any person in any manner u as in become subject in the Workeri Comp wastion Iaws of Califomia.Dau Applicant NOrICE TO APPLICANT:IL after making this Certificate of Exemption,you mOUW become subject to doe Workers Compensation provisions of the Labor Code,you must .,Q forthwith comply with such pmvisioru or this permit shall W deemed revaked. Z '� CONSTRUCTION LENDING AGENCY I hereby aMma that them is a construction lending agency for the performance or C the work for which this permit is issued(Sec.3097.Civ.C.) 117 Q Lcndcr's Name a Lcnder's Address V Q I=try that 1 haw read this application and sum that the above information is Is. F correct I agree to comply with all city and county on ivnas and sum laws relating to . p t..) building construction.and hereby authonse mpraxntatim of this city to enter upon the shove-(We) nedare to erysam for emnifyian kc,hs. (Wc)agreem uses indemnifyand hicp human the Cityof against against U Z incoidespaso me the command of thisamit. may in any way accme against sold City �{�lZ-J-s („) z in caarsequcnce of the gmming of/thAatypJermit. / Ile - SO IBCA D`9' WILL��333MPL,WITH ALL POINT Issued by: Dale SOURCE L O (Y/// rut/' O a Re-roofs Signal of ApplicaHU ARDO Dim HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant r future Municipal ooccupantrmreor handle Hcafdouamaunal u dc0netl by the Cupertino Municipal Code.Chaps.9.11,and rime HalthanU Satiety otic,Section 35532(a)? All roofs shall be inspected prior to an roofing material being Installed. C]Yea B+t�- P P Y g g Will the applicant of future building occupant use equipment or dcvias which If a roof is installed without first obtaining an inspection,I agree to remove mit hacardous air contaminants as defined by Be Bay Area Air Quality Management all new materials for inspection. District? ❑Yes "Q fug far- Ihave mad thom,Sctions urialsmg3sai sunder Chapurdicomand diatrie,Wilding � A nss nolth&rentlyCode,tersurnshat 5.iti2mymxu173536,1 in noulytthesup Wilding \\�\��/�LJ�� Joel not currently base tenant Ws it s my aup.mibiliry m noulY Uma°taupe f the 7 mqulmmem a.Los. 'nyyyrrpa..'car enifm.mcf0cyyr Signature ofAppli nt '), Date 1" � ofC(/!`/ a O gr ��... �.wn.� ow>�umonxQ�em`b Dam 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 �UPERTINO Building Department JOB ADDRESS75 3 ` O PERMIT # ��. C)" $ 0 2 S OWNER'S NAME: C4Lq,, PHONE # - S GENERAL CONTRACTOR: ': FAX # I am not using any subcontractors:/0-- k)OV7t 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 Septic Tank Sheet Metal Sheet Rock Tile -SOL Owner/ ontractor S e Date Community Development Department Building Division IMIN City of Cupertino !, 10300 Torre Avenue O ®CI[TY OF Telephone: (408)777-3228 Uf L k I I O Fax: (408)777-3333 Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to perm t 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: Job Site Address: 7 5 3 1'o b l . Roofing Company Name: � TJ sQ 5 ,p A plicant's 7�/� /Signature: Date: \AI�IND�X1 . Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO o 0 2 REROOF I CUa(PERTINO PERMIT APPLICATION FORM APN # 3 (-j -Z 6 a O�F— Date: �6 y Building Address: S 3 6 Owner's Ne� /y^w , e a Phone#:�s Contractor: Phone#: License#: �Ir1rt�'r (a qa-oyo 3 5/ 3 / Contact: Phone #: Cupertino Business License#: GJ (-S1O- 8963 20 I Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof `)c Asphalt Shingles 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: Job Description: 'Vo (_2) - GL4w 0 s 6 4 Sr0 ez_k Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed wit ning Det. if there are restrictions: LJ Cost of��c� nd Type of Con n: Occup cy g up: 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 1�