No preview available
04080149 CITYOFCUPERTINO ..... BUILDING DIVISION PERMITCONTRACTO R.INFUR'MA.TIg1 �<s BUILDING ADDRESS: PERMIT N0. 04080149 ('1740 1,ARR34 OWNER'S NAME: PERMIT ISSUE DAIS ONE: SANITARY OLNO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u00 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am focused under provisions of Chapter 9(commencing P with Section W)qB of Division 3 of the Business UPotfiesums Code,and my license is ^' imm�mderr t. �� S 3 REROOF W�PLY WOOD CDX 1 ��� D lam Liccnu _ Lk.g De ��// c0ED °°H r CONTRACTOR: ALL AMERICAN ROOF N U 1 do card my Plan°shall he used Ass public recons ,.0� Licensed Professional AUG sy 2004 OWNER-BUILDER mDECLARATION 0:7' 1 hcmhy alRrm Not 11. ucmnl from tiro Contractors e:Any c Law for the O O following mann.(SeNan 71D L5,Business and Profeaiuns Code:Any city ar county which rectums a Permit m construct,after,improve,demolish,or repair any stractum R1 III-DIM; prior an its issuance,arm mquirw the applicant for such Permit in fila.signed Moment E S Gthat he is licensed pursuant the provisions of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area a--"O 0 0 ser- (commencing with Section 7000)of Division 3 critic Business and Profusions Cndc)or 4� y Met he"exempt therefrom and the basis for the alleged uempdan.My violation of Section 7031.3 by any applicant for a Permit subjects the applicant to a civil penalty of 'APN Number Occupancy e liar man than five hundred dollars(SSW). P Y 'J Try,P ❑I.a Owner ofdm pmpery,or my employees with wages u their role compmmon, 31602039 . 00 will do the work,and theatrumum is notinundedoro slid fataele(Sec.]044,Business .it Professions Cade:The Comm m' License Law dots not apply M an owner of Required Inspections propeny who builds or improves thereon,end who does such work himsel f or through his awn employees,provided that such improvementsan notimanded oraRered forsale.If, however.the building or improvement is writ within one year of completion,the Owner. builder will have the burden of leaving that As did not build ser improve for purpose of - eicJ. 0 1,as owner of the pnpeny,am exclusively contracting with licensed contractors to constmct the project(Sec.7044,Business and Professions Cade:)The Contractor's U. cense law docs not apply to an owner Of property who Within or impraves thereon,and, who contracts for such projects with a comvcmr(s)licensed pursuant to the Contractors License Law. 0 l am tannin under Snc. ,B&P C for Nis mann Owner Dale WORKER'S COMPENSATION DECLARATION I hereby ARine under Penalty of perjury one of The following dwlaations: I have and will maintain a Canifinm of Consent to eelf-insum for WOrkersCampen- IC31]"W lo.,a provided for by Section 3700 of the Labor Code,for On perf omen of the rk for which this Permit is issued. I have and will maintain Worker's Compensation Insmnm.a reuired by Section of Ne Labor Code,for Ne Performance of the work for which this permit is issued. yWorker'sCompensation lnaunnu rtier wdPolirynumber 'F'✓-�G Poli' ryp.: ZJ ,�QO'i2 CERTIFICATE OF EXEMPTION OMWORKERS' COMPENSATION INSURANCE (Thissection road notbecample cd if the Permit is fmonchundmd dollars(SIM) or Ica..) I certify that in the Perfurmance of Ne work for which Nis Permit B issued,)shall net employ any person in any manner an As se become subject to the Workers'Comparniu n Laws of Calif..!..Dam APPlicant NOTICE TO APPLICANT:IL after making this Cenificam or Exemption.you shmW . become subject to the Workers Compensation previsions of Ne Ichor Code.you must .7. O faMwith comply with such provisions or this Permit he deemed revoked. .Z.tCONSTRUCTION LENDING AGENCY [-t I hereby affirm that them is a construction lending agency for the performance of �i > the work for which Ni°Permit is issued(Sec,309],Civ.C.) W Q Lender's None �z Lender's Md. L3 Q I certify,tial 1 have read this application and sum that the shove information A correct.I agree to comply with all city and county me mares and state laws miming to 0 U building construction.and hereby auNa n reprounulim of this city in man upon the above-mentioned pmperty for inspection purposes. (We)agree in save,indemnify it keep harmless the City of Cupertino against tF-t h liabilideb judgments,costs And expenus which may in any wey Berne against rid Cily V Z in consequence of the gmnung of this permit. " APPLICANT UNDERSTANgSANR WIL COMPLY WITH ALL NON-POINT Issued by: Date TIONS. SOUtE RE / r/ G —amu 'nu � Re-roofs Si um Ol AppIMaruConOwter Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant stem mhandle ha haus mamnal a defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safely "AigglAcode.Scotian zss3zmr Yes lrNa All roofs shall be inspected prior to any roofing material being installed ❑ WIII the applicant or future building occupant use equipment or dcvicea which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants u defined by the Bay Area Air Quality Managcmem all new materials for inspection. District? ❑Yes No ^// 00, riaHca,&SOil Cock.Sections 23505.15533 and 255J4.1unJcrsund Nalildm Wilding ((// Jacs n4z ot c n0y aro a tenant Nat it is my omO lit,m nntil'y dm mcupwt of the myuirem t nmuubcme u u ofa ellifeam,�(OccupAn Signature ofApplieant D Ie 44 2 f �`rl All roof coverings to be Clas �B o better Owner or authanvcd agent Dowd - Community Development 10300 Torre Avenue ;v Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building DepArtment JOB ADDRES& PE R ©Lio 9 D t,4 OWNER'S NAME: S c ++ ONE # Z5' 5 0 GENERAL CONTRACTOR: r •� F # d 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 `�, Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue 4 CITY OF Telephone: (408)777-3228 U P E T I NO 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 NaW: ` ' e Job Site Addresses lU 7 !6) Roofing Company Nola �CAU,i A plicanYs Signatt)�: • Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO 00 REROOF • CUPERTINO PERMIT APPLICATION FORM APN# Date: / j> Z vQ7 / Building Address 107 Lary. W N Owner's Name;^ 1 Phone#: Contractor: / Phone#: ZLicense#: Contact: C /� / Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ 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. •rFireZone: ave Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Description:.., lecke_ a� - ., s�� li t Wool CNV sidential 14( Commercial ❑ Yes ❑ No Confirmed with Planning De t. if there are anrestrictions: u Cost of Project: goo, ,011-e Type of Construction—: Occupancy group: Qty, if A cable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING