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04080230" CITY OR CUPERTINO I �.-• BUILDING DIVISION PERMIT CONTRACTnB TNVORMATION.',, , �.a,,,. nuIL2cnnDTR TATM IN KEVIN FARRER ENT.l INC. PERMrr No. 04080230 OWNER'S NAME: PERMITLSSUEDATII HY N lI VON T"TTTat COM nn NE: SANITARY 0 OL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH j LICENSED CONTRACTOR'S DECLARATIONO 1 hereby afifon that 1 am lianud under provisions .(Chapter 9 (commencing Jobe O D with Section 7M)) of Division Sof the Budnca and Professiana Cade, and my license is infull force and effect ' 7 713 nse LiceClass T7 Llc.p REROOF W/ COMP. Dau V Contractor &Ely !J pa n SEP 6 6u ARCHDECTS Ds ECL 'or public c 1 understand my plans shell he used m public rcrnrJs J (t [7 j='w, ry a� n�r.�. - Licensed nnal j OWNER -BUILDER DECLARATION II\\\VII O hereby - I heathy affirm that I oat exempt from the Convector's License Lew for the U VIII❑III /%�V following mason, (Section 9031.5, Business and Professions Code: Any city or county llf Which hipitres a PCmtit m contract, &Iter, improve, demolish, or repair any structure 2 prior to its ismance.also requires the applicant forsuch Permit to rile aligned summer that he is licensed pursuant o the provisions of the Contractor's License taw(Chapmr 9 Sq. Ft. Floor Area Valuation 6 (commencing with Section 7") of Division 3 of the Business and Professions Code) ar - that he is exempt therefrom no Ne basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant m a civil Penalty of not marc than five hundred dollars ($500). �p 3 MNIxf�u�ef 0 0 Occupancy Type E] 1. u owner a(the pmprny, or my employees with wages as their sole compensation, will dome work, and the swctum is not intended ar offered for mle (Sec. 7044, Basin.. and Professions Code: The Contractor's License Law docs not apply to an owner of Required Inspections pmpeny who builds or impmwcv Jtereon, and who does such work himself or through his own employees. Provided that such improvements are not intended or offered far role. If, however, the building or improvement is mid within one year of completion, the owner. builder will have the burden of proving Nat he did not build or improve fur purpose of talc.). ❑ 1, As owner of me property, am exclusively contracting with licensed Contractors to construct the pmject (Sec. 1044, Business and Pmfcanions Cotler) The ContracbhS Li. ant Law docs not apply to an owner of property who builds or improves thcmon, and W ho Contracts for Loch PmJecta W a, a C.Mobaor(S) IICented parment us the COnubam's License Law. 0 1 am exempt under Sec. , B & P C far this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby offinn under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to ul6insum for Worker'sCumpen- maim, as provided for by Section 3100 of Ne labor Code, for the perfurmance of the work for which this permit is issued. r have and will maintain Workels Compensation Insurance, as required by Section 3 of the Labor Cade, for the performance of the work for which this Permit is issued. My Wark es Cnmpensatinn Insurance canter and Polity, number am: tamer: 5TATQ-L,A.vD Policy No.; Z-g5-1�66 fi CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be Completed if the MM it is for one hundred dollars is IW) I)f ICSM1.) I certify that in the perfnrmancc of dtc .,it for which this permit is issued, I shall nut employ any person In any manna so as to become subject In IIIc WOrkerS Compensation Laws of Callfnmla. Dale Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of me tabor Code, you must forthwith comply with such provision or oris perm it shall he deam al mvoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a ermtruction lending agency for the performance of the work to, which this permit is issued (See. 3(bH, Civ. C.) Lender's Name Leaders Address I Certify that I have read this application and stare that be above information is cormet. I agree to Comply with all city and county Ordinances and sure laws plating to building construction, and hereby aarhmim mpreumativn Of this city to enter upon the above-mentioned (ha inspection Pappous (We) agme to save, indemnify and keep harmlea the City of Cupertino against l,reproperty Iiaconsequ consequence of ts, gran and expcnus witch may in any way &teat& against said City in conuyucnce seri thegmming of this permit. APPLICANT UNDERSTAND ND WILL COMPLY WITH ALL NON -POINT SOURCE R/� ldWd Issued by: Date Re -roofs Z iY/� / aiqimfl��m App ment/Caoll Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will to applicant ser future building occupant state or handle havuduus material as derined by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety Semtex 2ss3zca)9 ❑Yrs �'No All roofs shall be inspected prior to any roofing material being installed. Will the applicant Or future building Occupant use equipment or devices which If a roof is installed wilout first obtaining an inspection, I agree to remove LL it ha'mmous air conuminann as defined by the Bay Area Air Quality Management District? all new mat erials-fo IC In pection. ❑Yes 9Nu I have read the hanot ousmaterials requirements under Chapter 6.95 of the Califnr nixH.Ilh&Safety,Ctl,Sccdons255D5,25533.d25534.1un&c ndmatifthC building ams not cuaemfyhase a N�rym (T7, t is my nespnminirry to nndfy me p t nr me �/• / Ll a myuimm Bis Nth most La prfortoissuanccnfa Ccniricate ofa uPm / Signator fP licant Date gjzti oy A I roof coverings to be Class "B" or better own res man Feat Da, E Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 I��•��,.�ililll-�i�l JOB ADDRIYERMIT "7C� Z Kll��ti �iV # oy02;Oz36 OWNER'S NAME: PHOrffef 510 - el.5 % GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: Z(�(6 Date 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 Plumbinge v N Roofing TORIF 200 6 Septic Tank J/ Sheet Metal Sheet Rock Tile Z(�(6 Date CITY OF UPEkTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Subject: Re -roofing policy for the City of Cupertino Telephone: (408) 777-3228 Fax: (408)777-3333 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. b. 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 ,,theabove stated policy on re -roofing. Homeowner's Name: N Y U r J k< O 14 Job Site Address: Z-- N Roofing Company Name: � 2 � Q Q r I ti.J 6_ III1� � /'e -/) Revised 1/30/03 Printed on Recycled Paper Date: r] C El `ITY Or CUPLKIINO CITY OF CUPERTINO REROOF O PERMIT APPLICATION FORM r Qty. if, AnnlZable) Fee ID Fee Description Fee Group BPERMFEE APN # [ BENERGY z BUILDING Building Address- ddres: P,V Seismic Fee Res BUILDING BSEISMICOM Owner's Name: v CO — BPLANCHK Phone #: BUILDING Contractor: " J one A S O rte? Q 1 SC (ZcbF A?sio -77/-(y5 License #: . Contact: Phone #: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles fk Asphalt Shingles 0, Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report # 0( To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job 'In S 5 7A C L- 2 9 Residential G25� Commercial ❑ G Q Fire Zone: Yes ❑ No ❑ Confirmed with 1 l tfing Dept. if there are any r stnctions: ❑ Cost ofP ject: Type o Co ru do : Occupancy g(oup: O D r Qty. if, AnnlZable) 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 Iq -2GF(:�_3 ,,ta r (a, /-,�