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05050062 CITY OF CUPERTINO `x°" '°+f z BUILDING DIVISION PERMIT CONTBACTQRINFORMATIO BUILDING ADDRESS: PERMIT NO. R A CONSTRUCTION 05050062 OWNER'S NAME: PERMIT LSUE DATE NE: SANITARY OL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 umZ, LICENSED CONTRACTOR'S DECLARATION 0 o Job Des�rip n m 1 Mmby affirm that 1 am licensed under provisions Of Chapter Y(commencing F n A ithll mion and cffCr Division Sof the eusirem and Rofessium Code.and yliccme is �B E® in Ibn forts and ercea Np�e Z License Clam C3q see g Co33 3 REROOF W/COMP '—O DauComracmr 'y _ ARC i CTS DECLAR TION � r _� /t� z1 undcrsond my plans shall be used as public rtcmds !/r ;G� Licensed Professional 1005 g OWNER-BUILDER DECLARATION ContrON p p'r. s Z 1 hereby afErm Nm I ore exempt from tM Cssion, is License Law for IM Ynpi®N1nJ gMtq,�l O O following mason.(5®Bun]fly L5,Business end Pmfcssinni Code:Any city Or courtly which rtgaires a reunion conamar,alter,improve,demolish,of repair any swcture prior m its issuance,also raquire,Ne applicant for such permit to file a signed smement —�a that is licensed pursuant to the provisions of the Comractori License Law(Chapter 9 Sq.Ft.Floor Area Va D3 On il=-•O bman mencing with Section 71111(k)of Division J or Oc Business and Professions Code)or .ya Out he in eacmpt therefrom and the basis for tha alleged cameption.Any violation of Section 7071.5 by arty appliantfar a permit subjects the applicant to a civil penalty of 35VNS�er00 Occupancy Type not more Nan five handrail dollars($50U). I,uowncr oftM propcny,mmY emPloyas wish wagesudeir sole compensation, will do the work.and the stucco¢u not intended oroffamed rorrale(Sec.704,4.Business Required Inspections and Proressiona Code:The Conarra,m•a Li..Law elms.1 apply 0 in owner or fl P property who buildam improves thereon.and who does such work himselror through his own cmployen,provided thmsuch improvements are not intended moRered forsa4.If. however,Ne building Or improvement is sold within me year of ea npledon.the ownery builder will have Oa burden of proving That he did nm Wild Or improve far purpose of sale.). ❑1.as owner of Ne property,am exclusively contracting with licensed conractors to construct Ne project(Sec.7144,Business and Professions Code:)The Contractor's Li me raw dors not apply to an owner of property who Wilds or improvea dtemon,and who contracts rot such projects with a eomractor(s)licensed pursuant in the Contractors License law. O 1 am eacmpt under Sec .B&P C for Nis reason Owner Data WORKER'S COMPENSATION DECLARATION 1 Mrtby inn under penalty of perjury oOc of the following declaretinm: I have and will maintain a Certificate of Consent to self-imam for WorkcesCompen- i9n,m provided for by Section 370 of the Labor Code.for the room ince of due 7a037'W rk for which this permit is issued. 1 have and will maintain Workc/s Compemation Insurance,m required by Section of the Labor Code,for Ne Performance of Ne work for which this permit is issued. y Workeri Compensation Insu <e canter and Policy number am:rrier. Policy No.: 3 CER IFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE This;section need not he eomuciad if tM permit u fsnone hundred dollam($100) Or less.) I cenifv Nat in the performance of the work for which this permit is issued.I shall not employ any penton in any manner so as m become Subject u the Workeri Compcnsati9n Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions or the Labor Codc,you must OO forthwith comply with such provisions or this permit shall to deemed revoked. Z " CONSTRUCTION LENDING AGENCY (. .N., I hereby affirm that there is a construction lending agency fonts performance of C 7 the walk Tor which this permit is issued(Sec.30197,Civ.C.) W Q lender's Namc fY lenders Address U O I certify,that 1 have read this application and slate Nat the above infomaimm is concca l agree to comply with all city and county ordinances and stale Taws mlating to OU Wilding commotion,and hereby authorin taprcumadvcs of this city to cnur upon Ne } W above-mentioned property for inspection purposes (We)agree to arc,indemnify and keep harmless the City of Cupcnino against F'y Liabilities,judgments.costs and expenses which may in any way see=against said City UZ mconscqucnceofthcgramin or thispermit. ^s APPLICANT UNDER If AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 1% SOU sCE -A S. !{�� S ( Re-roofs AP Signgturc of plicaHV ARDO Data / HAZARDOUS MATERIALS DISCLOSURE Type afRoof �� dl the applicant or future building Occupant store or handle havardous notarial dc0ned by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety ole.Section 25532(4)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building Occupant us,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it harudnn air contaminants as dclined by the Bay Area Air Quality Management all new materials for Inspection. isbicl? A ❑Ycx Nu V (l IMv Saal the M1ma res materM255uimmcn534.1 under deaperdOw if the Wilding or- is Health&Smny Code.Sccdonhatit i2 my rand spons5i4.1 to nourndthmcup Wilding Jona not currently have a tenant,that it is my responsibility m nodly the ncupant of she rcqubC ems 4,t `'-1 poortoissunccnfaCcrdOcateOfOcapancy. SSgI1atu a ofApplicant Date ��; v All roof coverings to be Class"B"or better Owner .6.d agent Dae v Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 QICITY OF Fax(408)777-3333 UPEkTINO Building De artment JOB ADDRESS: 3 � `� ^ / PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: / FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following ' ormation: 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 6-01w,ner/Contractor Signature Date Community Development Department Building Division i O , sr City of Cupertino E 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 4UPEkTINO 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. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate that there is no ponding. 2. An 1.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. Homeowners Name:/ Job Site Address: s.� Roofing Company Name: ��X GT�� Applicant's Signature: Date:'/ 0 Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO �� REROOF CUPERTINO PERMIT APPLICATION FORM APN # Date: Building Address: 7,1:3 �e, Owner's Name: Phone#: �G 2s7- Contractor: — Phone #: License#: Contact: Phone#: Cupertino Business License#: OW Type of Itoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles Zr Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) 6 Other(Specify) Ccj .0 Number of existing coverings El I.C.B.O.Report1# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will-Comply With Cu ertino's Tear Off Policy: M' Job Description: Residential Commercia ❑ uwJ C 7° Fire Zone: Yes ❑ No ® Confirmed with Planning Det. if there are any restrictions: Cost of Project: Type of Construction: Occupancy group: poo kz Qty. if Applicable 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