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04080204 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRAC!TI`OR4NF,ORMATION :'. RT fTl O WP ft IT JT t. .•AB::'•., :w sl'A,rev BuaolNc noDRtss: MONKS ROOFING +- PERMITN 040802 OyI OWNER'S NAME: FERMITISSUEDATE nz ONE: SANITARY O. OL NO. ARCHITECr/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 =00 LICENSEDCONRACTOR'SDECLARATION JobDescri tlOn w.C I hemby affirm that 1 am Iicenacd under provisions Of Chapter 9(ommcncing p nF a9 with Scetion]IXXB o- Busincv aM PmICSs_iytyC Yliccme ix s in 0B forte and /) 7 oq? Liner. ue.g REROOF W/ COMP. Dam can DEC QQ A n'E HCS DEC N a-s 1 understand my phos shall w uxd ss'optic records 2 �yU ;0� Licensed Pnrfcssional 5 OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Committees License Law for the u n O following mmrn.(Section 7031.5,Business and professions Cole:Any city or county which.quires a permit in crown,arm,improve.demolish,or.pair any xtrucmre Fly prior m its issuance.also requirms the applicant for such Permit Rlc a signed customer, < Na he islicerscdpmsuanttothe Provisions ofthe CommsuisliaxnxLaw(charter 9 Sq.Ft. Floor Area Valuat on ,FG (commencing with Section 7BOB)of Division 3 of thc Businessand Professions Couc)or y that he is...of 0icmfrom and the bash for the alleged exemption.Any violation of rn.o7.i�,,ys,.,.,a, Section 7031.5 by any applicant for a permit subjects one applicant to a civil penalty of 3-9 Nfta grOO Occupancy Type not mo.Nan five hundred dollars($500). ❑1,as owner of tM property,or my employees with wages as their sale compensation, will do the work and the structure is not intended or offered for ale(Sec.7061,Business and Professien Cada:The Canmcmes License law does not apply to an owner of Required Inspections property who builds or improves thereon.and who does such work himself or through his awn employees,provided that such improvements are not intended oro@red for sale.If, however.the building or impmvcmcn,is sold within one your of completion.the owncr- wildcr ,will he.Ne burden of proving that to did not Wild or improve for purpose of sale.). 1,as owner of the property.am exclusively contracting with liecnsed contractors to construct the project(Sec.7014.Business and Professions Code:)The Contractor's Li cense Law docs not apply in an owner of property who builds or improves thereon,and who contracts for such projects with a cmaractor(s)licensed pursuant in Iw Contractor', . License4ff E] Law. 1 am sacro',undo Sec. .B&P C for Nis retia Owner y �� Da. �\ WORKER'S COMPENSATION DECLARATION 1 hereby effort under penalty of perjury one of O.following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compcm senium.as provided for by Section 3700 of Ne Labor Code,for the performance or the work for which this perms,is sound. have and will maintain Workers Compensation Insurance,as required by Section 3700 of the labor Code,for d.performance of she work for which this permit is issued. My We fompensation Inman carrier and Polity n/umbeers q�� Cagier N t policy No.:/)-�V CERTIFlCATE OF EJ EMPrION FROM WORKERS' COMPENSATION INSURANCE (This section need not w compiemd finite permit is return hundred dollars(SIM) or Ictus) I certify that in Ne performance of the work for which this permit is issued.I shell not employ any pmaon in any manner an as in become subject in the Workers Compensation Laws of Caliromia.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject be the Worker's Compensation provism.of the Laver Code.you tru .J Q forthwith comply with such provision or this permit shall be deemed mvoked. Z'" CONSIAUCf10N LENDING AGENCY 'rt rA I hereby affirm thatthereis a construction lending agency for the performance of !Yi 7 to work fur which this permit is issued(Sec.3097.Civ.C.) toe] L cmler's Name Lenders Add. 7 IL O 1 certify that 1 have rad this application and sum that she short Information refning h Ire. E' bonding l agree to comply with all city and county roadws Of and sus enter sating,o 0 ahovcrgcotionedon.and hereby authori.mpresenulivesafthisCity,o enter upon the Y' ahovc(We)are property for inspection keep ha F a (We)agree,o sa..imemnifm and keep hymn9dookens Wayhe se or caainst id Cit, rq liabiliues.judg n.costs and a'enes which may in any way accrue against mid City r�-79(� z in eonseque o Nd granting of Nis permit. '-' APPLICA y DERS A DS AND L COMPLY STN-1 ALL NON-POINT Issued by: Date SOURC ULATION •' r/ CJ V Re-roofs Signor of Applicro UCOMMerer Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will one applicant or future building Occupant store or handle hvudous material as defined by the Cupertino Muni trip otic.Chapter 9.12,and the Health and Safety code,stiction 25532(1)1 All roofs shall be inspected prior to an roofing material beim ❑Yes p P Y g being installed. Will the applicant or future wilding occupant on cquipmat or devices which If a roof is installed without first obtaining an inspection,I agree to remove in havardnus air comamin ms u Jcfymd by Ne Bay Ama Air Quality Management all new erials for inspection. 7d. strict? ❑Ycs I have real the hmaNnusmamrials requimmcnts under Chaps 6.95 oftle CalifonJ- Halth& army Cade.Secden 25505.254)3 am125534.I ralcosami mifthe wining not c nthy he. .nam.union ex myl(sporribility m notify the occupant of the �C imm (wnitting emy/yF}yn p faccoiratoaroeap� LgnatoreofApplicant ate ner or uthonzcd agent ' e All roof coverings to be Class "B" r better Community Development 10300 Torre Avenue l-�L_ / Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building De artment JOB ADDRESS: PERMIT # Svc ; N W . 0'-f0T0 OWNER'S NAME: Sbk J c>c PHONE # GENERAL CONTRACTOR: yv- \)rJ )CS ",( 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 Septic Tank Sheet Metal Sheet Rock ile Owner/Contractor ignature Date Community Development Department } Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 ' PEkTINO 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 Lwith the above stated policy on re-roofing. Homeowner's Name: Sar Job Site Address: Roofing Company Name: c S r(IU0 b l A plicant's Signature: Date: !/ �7 0 ® Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOFCITY OF CUPERTINO PERMIT APPLICATION FORM APN #� Date 55 2 � o 1 I Building Addr VSs: J J Owner's Name: Phone #: ohlV v_uvU tri a2 D ContractL Phone#: _(7 n License#: C 602 o 7 Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles �® Asphalt Shingles Wood Shakes ❑ Wood Shakes Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings -2— ❑ 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 Descri tion: b4c gxS 1 Residential Comm rcial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are anrestrictions: LJ Cost of Proje r Type of Construction: Occupancy group: O� Q . if A 1' t ble Fee ID Fee Description Fee Group LV 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 � 6 �