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04090070 CITY OF CUPERTINO $ �nwg, ?� BUILDING DIVISION PERMIT trCONTRAC�'TOR INFORMATION �i >.� �'zR�h.�.� M..£:P$i3-..3La. ,�'•'�+ky 5 e'3��i�M=Nh:PFIUt�' BUILDING ADDRESS: PERMIT NO. REAL-T INSPECTION & REPAIR SER 04090070 AM STATES DR PERMIT ISSUE DATE {ONE: SANITARY 'CONTROL NO. (AnD) COG-2244 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 asi00 LICENSED CONTRACTOR'S DECLARATION Job Descri (] in� I hereby affirm that I am liaemud under Provisions of Chapter 9(commencing P with Secli 7U'XBmf Division Sof NC Bu upmfessimns Coda,andmylicenwis FINALED in full fort effect. nt2= Licemc LIC.11 REROOF W/SHINGLES ^Vi Dam ARCHITECTSConD reCLAR TION - APPLY 1/2 " CDXr 30#FELT SEP e3 2004 wnxrstandmyplaraahad El Km m PRESIDENTIAL TL W/RIDGE VENT Dgu G Licensed Pmf ssinnal U L®I `' 3 OWNER-BUILDER DECLARATION 0k IG hereby al7rm Nal 1 am exempt from the Contractor's Liecnu law for the F.00 following rr ..(Section RD 1.5.Business and Profea6uns CCM:Any city ar county m which requima a Permit in consumer.after.Improw,demolksh,or repair any stmctum prior m in issuance.also mqunis the applicantorsuch permit to Bre a signed matement < that he isliccneedpurmanltodoprovisionsofMeContractor'sLicenseLaw(Chapter9 Sq. Ft.Floor Area Valuation as (commencing with Section 70(10)of Division 3 of the Business and Professions Code)or i Nat he is exempt therefrom and the bmu for the alleged exemption.Any violation Of Section 7031.5 by any applicant for a permit subjects the applicator o a civil penalty of ApN Number Occupancy Type not mom On Ow hundred dollars($%(B) P Y YP ❑I,"Moscrof Neproponri or my employee with wagmss Neirulc compensation. will de the work and Ne structure is nolimuoumd or offend for safe(Ses.1014,Business 36923035 . 00 and Professions Code:The Contractors License Law does not apply to an owner of Required Inspections property who builds or improve thereon.and who does such work himself or through his Own employ=,provided Nat such improvements sum nothranded rroRered forsake.It. however Ne building or improvement is sold within one yea ofcumpletion.Meowxr- builder will haw Ne burden of proving that be did Int build or improve for purpose of sok.). ❑1,as owner of Ne progeny,am exclusively contracting with licensed enroll to conswct NC project(Sec.7044,Business and Profusions Code:)The Conoacur's Li- come Law does not apply to an owner of property who Nil"or improv Nemon,and who contracts for such projects with a contractor(s)Roomed pursuant o the Conummes LTaw. I am eaemPt under Sec ,B&P C for Nis mason Owner Dae WORKER'S COMPENSATION DECLARATION 1 hereby affirm un"r penalty of perjury one of the following declarations: 1 hew and will maintain aCertifieam ofComent in ul6inmm for Workeh Compen- t n,as provided for by Section 37M of Ne Labor Cade,for Ne performance of Ne work for which Mia permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3900 of the labor Code.for Ne performance of Ne work for which this permit is issued. ray Workers Compensation lnaunntt carrier and Policy number an: 17`amcr: Policy No.: CERTIFICATE OF EtrEMP 10,2OM WORKERS' COMPENSATION IN TITis section need not bre completed Kthe Formals for one hundred dollars(SICO) or Icss.) 1 certify Nat in the p ofirro nce of the work for which this Permit u issgeQ.I shall not employany person irony manncrsossmbrco subjocuo IM Work.yy��os�pensatir_n Laws of Calif`omia.ON I APPlicant JJ bwQT1ic s10 APP ICA :If,atom making this visions of of Exemption,you should Wep)re subject y the Worker's Coons or ons provisions of de Lad r Co",you must .,2 faMwith comply with such previsions or Nis permiuhall be deemed revmkcd. - z CONSTRUCTION LENDING AGENCY [—i I hereby affirm that Nem is a construction lending agency for Ne performance of LL' the work for which Nis permit u issued(Ser.3091,Civ.C.) !y Q lender's Name z Tender's Address U Q I coolly than I have read this application and slow Nal the above information is E-' cancer.I agree m comply with all city and county ordinances and slide laws mining to �U building construction.-and hereby amhorin mpreumtives of Nis city m enter upon Me shove-memiuned property for inspection put,owea F G3. (We)agree to saw,indemnify and keep harmless Ne City of Cupertino against fq ale liabilities,judgments.costs and espenses which may in any way getout against laid City �7 (-7 ,Z, in consequence of the granting of this Permit. ^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL NON-POINT Issued by: D SIS�SOU GEZeL �//J� rcof ApplicantrConuacror /D Re-roofs HAZARDOUS MATERIALS DISCLOSURE Lmtd Type of Roof Will the i,licam m furore building occupant stem or handle haaNums"aerial as defined by Ne Cupertino Municipal Co",Chapter 9.13,and the Health and Safety Cade,OYooca 35532(a)? )(No All roofs shall be inspected prior to any roofing material being installed. Will Ne applicant or Toren Wilding attupam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it Numerous air comaminano is defined by Nc Bay Ams Air Quality Maoagemcnl all new materials for inspection. District? ❑yes Ihave mal Neh ,ardous materials requimmenta under, Chapter 6.95oftheCalifor- niaHcalth&Safcty CC ,Sccdom25505.25533v 25534.1umkr d iHM building lov— does not currently have a irnan4 Nat it u my rcaponsihility m wtify Nc«Upmt of Ne neuirtm mustbcmctp' wma ecora m acm,ney. Signature of Applicant Date 49 Owner.,. nmi,e agent D e All roof coverings to be Class "B" or better Community Development 10300 Torte Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS: PERMIT # d;, 6 17 U) -ks 4 ids /,<. 0 (qo715 OWNER'S NAME: u PHONE # 4 6 - (off GENERAL CONTRACTOR: -TibREMOW # 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 Tile Contractor Signature l3ate Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 O Fax: (408)777-3333 UPEkTIN 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 co^m�ply with the above stated policy on re-roofing. Homeowner's Name: FJ� N Mu Job Site Address: /D 817 W • Roofing Company Name: ReAL- s�N,6`P�c�IO►� �e (2g�a2 A phcant's Signature: �L Date: '0YGreg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF RE R®®RTINO ' UTTOF ,JD��O CUPERTINO PERMIT APPLICATION FORM �V( APN # ) ?� 6 Date: Qb 3 6 Building Address: /ct ' 7 Il) . F A e Owner's Name: Phone#: 1Jo1�4 Mur:cr N Contractor: Phone#: License#: IRk t � s �EPar2 °/4(o - Z2 5/3883 Contact: Phone#: Cupertino Business License#: �reN« �c iD�t 96 —zZ '2Llb-�l 41 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X 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: TE atouC-- Z oo A"L V / °r,-b-1, 3 0-UF e LT �2Es1 TIA L W �ENY Residential Commercial ❑ NEw G"n612s OUSTOVt5 Fire Zone: Yes ❑ No Confirmed with-Planning I. if 1 there (e any restrictions: ' 'st of Project: Type ofns ctionj Oc pancy g p: /Z 600 i r if pWable 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 - 7 11 . 3�