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04090003 CITY OF CUPERTINO BUILDING DIVISION PERMIT {CONTR°ACTOR INFORMATION BUILDING ADDRESS: OLD COUNTRY ROOFING A PERMIT N°04090003 n335 FILICH All OWNER'S NAME: FERMTT ISSUE DATE JOE DING ONE: SANITARY N0. CONTROL NO. (707) 864-5552 ARCHITECT/ENGINEER: BUILDING PERMIT INFO B DG ELECT PLUMB MECH 0 till LICENSED CONTRACIOR'SDECLARATION JobDescri n VALED inF 1 ocreby affirm Nm 1 am licensed under provisions of Chapter 9(commencing P `f wish Section 7M)of Division 3 of be Business arta Profeuioni COW.and my license is 5,N in : lo=neC REROOF W/ SHAKES p 2 Lieenm L'¢.II e/s �/a.s ARCHIEC !,M12? 2OOI I understand my plans shall W used as public records �pBBf ,60 BU'®®� fffppp C Licensed Pndessienel OWNER-BUILDER DECLARATION f 1 hereby alarm that 1 am exempt from ft Contractors License Law for the ¢O O following mann.(Section RD 1.5,Busincu and Professions Cade:Any city If county K which requires a permit no convect,alwa impmw,demolish,or repair any structure m—rn prior to its issuance,also requires the applicant(orsuch permit to rile aligned statement nnn that he is licensed pursuant to the provisions of the Contractor's Liccom Law(Chapter 9 Sq.Ft.Floor Area Valuation w�$ (commencing with Section 7000)of Division 3 of NC Business and Professions Com)or _ dust M a exempt therefrom and the beau for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a Civil penalty of 3 7411b tQLLfbe1O 0 Occupancy Type not?,r, than 0w hundred dollars(5500). yds,u owner of the property,in my employees with wages u their sole compensation, will do the work and the 6wcture is not immuded ser offered for talc(Sec.7044,Business and Professions Cods:The Conuacmrs Licanse Law docs not apply to an owner of Required Inspections property who builds or improves thereon,and who doessuch work himselfor through his own employees,provided that such improvements tic not inunded or offered forsale.If. however.Ne building or improvement is writ within one year of Completion,the Comics- builder will have the burden of proving that he did not Wild or improve for purpose or aalc.). Q 1.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.1014,Business and Prefessiom Code:)The Coefeactur's Li- cense law does not apply to in owner of property who Wilds or imp ems themes,and who contracts for such projects with a contractors)licensed pursuant in the Conference, License law. ❑lam cacmpt 7p,Scc. ... PW for/ 'O LI n Owner_� ✓ Dew (`j D`f// WORKERSCOMPENSATIONDECLARATION 1 Wreby aRmt under penalty of perjury one of the following declarations: 1 ham and will maintain a Certificate of Consent to self-intim for Worker's Compen- sation,a provided for by Section 37W of the Labor Code.for the performance of the work for which this permit is issued. Q'rave and will maimxln Worker's Compntsation Insu mance,as required by Section 31M of the Labor Cade,for late performance of be,work for which this permit u issued My Work s Co.eeasyuanrmurarmcmicrand Policynum 2.S 1Z Carrier. Gtr k Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (mise section need not becompleted if tW permit isforone hundred dollars(31(m) or less) 1 certify that in fact perfmmuce of the work for which this permit is issued.I shall not employ any person in any manner so a to become subject to the Workers''Compensation Laws of California.Dau Applicant NOTICE TO APPLICANT:If.after making Nu Cenifcme of Exemption,you should become Subject w the Worker's Corepcnsaum provisions of the Labor Code.you miss .J 0 forthwith comply with such provision(to this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY Ihereby affirm that then is a Construction lending agency for the performance of C' the work for which this permit is issued(Sec.3097,Co.C.) W Q Lender's Namc M. z lender's Address V 0 1 codify that I have read this application and show Nat be,above information u F' correct 1 agree to comply with all city and county ordinances and sum laws relating to building covection,and hereby aur orim drucsenutiws of this city m coot upon Ne r W nahove-mentioned p.,City for inspection purposes. (We)agree to saw,indemnify and keep harmless the City of Cupertino against U Z il liabilities, nts lities,judgme ,costs and expaa cwhich may in any way accrue against said City mequmm of Ne granting of this permit ^ APPLICANT UNDERSTANDS NO wILL COMPLY WITH ALL NON-POINT Issued by: Date y SOURS,.\E(�yp/y�yJc��'ULATIONS. f/ 1/!/./ti'.y g Re-roofs , Signature l'ApplicxnUCOmmemr Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occupant stun,or handle hvallous material u defined by du Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to an roofing material being❑Ya N, P P Y g ginstalled. Will thea applicant or future building=upant use equipment or deices which If a roof is installed without first obtaining an inspection,I agree to remove nn s pan Area emitict? us air contaminants a JCOncd by the Bay Ama Air Quality Management all new materials for inspection. District? ❑Yes I have reel the haaaNnus maorialsreyuimrncnu under Chapter 6.95 ofIW Califon o nice HhI rmilI haw,.Sccuom 255(I5.2myrespd25534.1 to army lam cupartuiWing // Joa not rtently how a tenant thnt it is my responsibility w nudity IW w:cupent of lac myt uwhichm..hein(I'd.,toismancea.Cenifu...10c�p�ancy. SignaureofApplicant Date ' All roof coverings to be Class"B" or better OwmC6,awbomed agent Date -xN Community Development m 10300 Torre Avenue ?Y' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 [UP ERJIN0 Building De artment JOB ADDRESS- PERMIT #© t /0335 ihe�� e OWNER'S NAME: pg w�nJ PHONE # GENERAL 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 Septic Tank Sheet Metal Sheet Rock ® Tile Owner/Contractor Signature Date Community Development Department Building Division 1 City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 CITY OF Fax: (408)777-3333 IkUPEkTINO 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. S G N Homeowner's Name: FJ Job Site Address: 3 cJ S j-- / /J Cl-I Yl ✓c Roofing Company Name: L� �j/D(/1 N i/4� d-?0(0F7/V C �p A plicant's Signature: �lam/ Date: /3o�rJ L Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO OREROOF p � U ��3 CUPEkTINO PERMIT APPLICATION FORM '4111PN # 3 _+ �5 y 3 0) Building Address: 0336 - /IVO -1 f-1 Vc: Owner's Name: Phone #: o6 �11V6,r719 J `f(3d, 3Y- 3 (jo0 Contractor: Phone #: License #: CQA6� DOFff4G y o u 77a�a &30C 6 Rs —7-3 / C tact: Phone #: Cupertino Business License #: cs 0 �a 3 o Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles XN Wood Shakes X 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. Have Read, Understand and Will Com l With Cu ertino's Teaz Off Policy: b Description: 14tsrnOVc5- LsXtSTtN ycf71- o f 5/4yd7etfQ pus 4I..L- 30 " r2 a CI,�: s r5 ' -L%�v Z Residential A Commercial F1Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy roup: !� DPO Lr Oa ( 3 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bld- Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCH_ K Plan Check Fee BUILDING BUSLIC Business License BUILDING � 7o , �-6