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03110135 ` CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:` BUILDING ADDRESS: PERMIT NOO 3 110135 19444 GREENWOOD DR OWNER'S NAME: PERMIT ISSUE DATE WIN ALBERT L AND JANE E TRU 11/21/2003 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 +00 LICENSED CONTRACTOR under SDECons of CON {w I hereby affirm that 1 am Beenae aver pmvid.ma nr crops,9(commencing lob Description Sa' with Scclior7BW ufrDNW,A3.rthc BuiWEATION ssixa%C d ,andmyliccnm is ±may ire sen rnrtea t. . REROOF y z License class' tic. CONTRACTOR: TOM MCAURTHER COSTRUCTION f n1 understand my plans shall he used as public retards u C to L'cemed Professional c7og OWNER-BUILDER DECLARATION 2¢q I retch,afErm that 1 em exempt from me Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any City or county 5 m which tequir.a Permit to construct,alter.improve,demolish,or repair any stmctum -ii prior o its issuance.also requires thcapplimalforsuch permitur rile a signed statement EaGmat be is licensed pursuant to the provisions,of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valu,$tioFn000 cH (emnmeacins wi th Section 7000)or Division 3 of the Business and Professions Code)or i $ that he is exempt therefrom and the basis for the alleged exemption.Any violadon of Section 7071.5 by any applicant for a permit subjects the applicant o a civil penalty of not mom than five hundred dollars nkRXI). APN Number Occupancy Type 01.az ownerofine property,or my employees with wag.as their see compenadon, 37504020 . 00 will dhr the work,and she structure is not intended or offered for sale(Sec.7040,Business and Professions Code:The Contactors License Law does nor apply to an owner of Required Inspections property who milds or improvesthereon,and who does such work himself.,through his . ton employee..,pmvided that such improvements Are not intended or offered for ale.IL however.the building or improvement is sold within one yeti of completion,the Mart- builder will have the burden of pmving that he did not had lel or improve for purpose of r� alc.). 1,as owner of the property,am exclusively contracting with licensed contractors to D aces 03 consumer the project(Sm.7044,Business and Professions Code:)The Contractor's Li - C cense taw does not apply to an owner of property who builds or improvss thereon,and who contracts for such projects with a enntaetor(s)licensed purauantto thp Contractor's License Taw. BUILDING 1 tie Law. under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby allmm under penalty of perjury one of the following decluations: `J I have and will maintain aCcnificam of Consent n selNature for Worker's Compcn- .ti.n,as provided for by Section 37M of the tabor Code.for the performance or One work for which this permit is issued. ❑1 have and will maintain Worker's Compensation insurance,as requited by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number art: Cp 'cr. .It CE RTIFICATEOFEX EM4 OM WORKERS' COMPENSATION INSURANCE (This section need nm be complcmd if the permit is feroe hundmd d.11uf(Slip) or Was.) 1 cenify Not in the performance of the work for which this pumit is issued,I shall not emPloyanyp.so ayq+�neeap wheeo a bjauothe W.rkers'Compensatinn Laws of Cal' rni n L4yTJ f Z C� a 1 /vPPI'eanu rte ✓ n ' NOT u c PL f. et k ng ,is Cenificau or Exemption.you shouW hello bjc t m the Worker's Compensation provisions of the Labor Crude.you mon J z forthwith comply with such provisions of this perm it shall be deemed ranked. Z O CONSTRUCTION LENDING AGENCY 1 hereby affirm that them is a construction lending agency for tM performance of GS► Ne work for which this permit is issued(Sec.3097,CO,C.) 'sd 0 Under(Name z Lender's Address � f J Q 1 ttNe that I have read this application and sum that the shove iws rclatian is Ct.Ubuilding 1 agree w comply with all city mtl county ordinances and cute laws relating to V buileinge.nsncd proantl hereby euthonre apresenutives of this city to char upon the } C anovcmejudgrcris.property for Inspection which ms. (We)agree to save,indemnify and keep harmless the City of Cupertino against H h incoiti.0 consequence of the costs and expenses may in anyway accrve against aid City Uz ineof DERSTingorthis permit. " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 5 REGULATI �� Z Re-roofs Sgn ore ofApplin Co tactor Dacey HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hararduus matenal As defined by the Cupenin.Municipal Code,Chapter 9.12.am tnc Health and Safety ' ode,Section 25532(x)? ❑r. �N. All roofs shall be inspected prior to any roofing material being installed. Will thea secant or future buildin exca equipment If a roof is installed without first obtaining-an inspection,I agree to remove rap 6 pram use a em or devices which it harzrdoas air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? ❑Yes 1 have mad Ne harafdous materials reyuimments under Chapter 1.95 of the Carrot, nia Health&Safety Code,Scmuons255()5.25533md25534.1 undemand thaifthe building dos not contently have a ten L that it is my responsibility w nrufy the cap.,of the rete' mcnuwhea monb�Eel dorwissu cc ofa Ce,dfcam.f. army. q(� �„.�'7 ° )w�� Signature of Applicant Date s/ T� / i Owficroraum.n.dagmm Date All roof coverings to be Class "B" or better Community Development Department Building Division City of Cupertino �i 10300 Torre Avenue 4 CITY OF Telephone: (408)777-3228 U P E kT I N O 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 with the above stated policy on re-roofing. Homeowner's Name: Job Site Address: —! y� ! 6'rt✓PAn1.1 NrA D r-s Roofing Company NaVe. fir7y" l"11j(, A r h d' �04 s- $ Ll d; 'I on Applicant's Signatu p\ �� //lii�+� Date: I `� Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO Q REROOF CUPEkTINO PERMIT APPLICATION FORM APN# O �Date: Building Addressja Owner's Name: Phone#: Contractor: V\/ ' Phone License#: Contact: /� Pho #: g Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof O Built-Up roof ❑ Asphalt Shingles ,X Asphalt Shingles . Oy r, ❑ 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: Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planni ept. if there are an restri ons: LJ Cost of Pro' / � ��pe of Constiuc i Occupancy grou : . � Qty. if A li e Fee ID Fee Description Fee Group BPERMFEE BldgPermit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING L3 73 � 3 01-