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04040029 CITY OF CUPERTINO BUILDING DIVISION PERMIT r CONTI2ACTUR,4$F,OR VMA 1'I n 'v ?n..nM, ,�q BUILDING ADDRESS: MANADA ROOFING INC PERMITNOO4040029 OWNER'S NAME: PERMIT ISSUE DATE DEEPAK MISTY 24717 FAIR VIEW AITE nA /ng./,;Inna ONE: SANITARY NO, CONTROL NO. (510) 881-4727 ARCHITECTIENGINEER 10 SB1- ARCHITECTIENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 a�A t 0 0 C"Z' LICENSED CONTRACTOR'S DECLARATION lob Descri non r�s�mtlQl d FF I hereby"am Nat 1 am licensed under provisions of Clopmr 9(commencing P `calk LE a¢ with Section 7000)of Division 3 of the B. and Profeadans Cade,andmylicemeis av"al qz<< iicenfnree as APR �a 2004 License C1111 �L�j er 8007)/ REROOF Dam tern rd�idmy cal ARCHITECT5�ud ur R ION ards Ole 3sw Licensed Professional BUILDINGOWNER-BUILDER DECLARATION 1 hereby aRm N rat 1 am exempt from the Conuanors License Law for the r p O following ramen.(Section 7031.5,Business and Prefcsiom Cade:Any city or county $ which numias a permit to convect,alter,improve,demollah.ar repair any structure I-ZT Pd.,it,its issuemcc.slgs requiter the applicant for such permit to file a signed sumencnt that he is licensed pursuant m the larval mnof the Cantnlars Liccnse Law(Chapter 9 Sq.Ft. Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Profcsstana Cale)or $ the he b exempt Bvrtfmm and Ile Inger for me alleged exemption.Any violation of Seeing 7031.5 by any applicant fora permit nobjecu the applicant to a civil penalty of 3 6Ad14e 12Ibcr0 0 Occupancy Type not more than five hundred dollen(5500). �1.u owner of the prepany,or my employaa with"gas as their note camper ation, will do the work.and theawclum is not handed or offered for sale(see701 Business Required Inspections and Pmad ft om Cade:The Conuanrars Liceve m law does act apply an owner of fl P property who hu ills or i mpmv themon,end w ho dans such wark himself or thmugh his own employees,provided thatsuch improvemenmare not intended araRered forale.if, however,the Wilding or improvement is said within am year of completion,the owner. Wilder will have the Wrden of preving that he did not Wild or improve for puryose of ale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(See.7011,Business and Pmfnsdans Cham)The Conuacmr's Li. ' eonse law does not pply m an owner of property who Wilda or improv themon,and whoconmacu for such pmjeeu with a contractor(s)licerued pursuant to the Commenters License law. O l am exempt under Sao. ,B k P C far thio mason Owner Data WORKER'S COMPENSATION DECLARATION 1 bemby a fmm under penalty of perjury one of to following declwions: 1 have and will mainuln a Certificate of re of Consent self-insure far Worker's Compere action,an provided for by Section 3700 of the labor Cade,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 37W of Jan labor Code,for the performance of the work for which this permit Is issued. My Workers Compenation Immune artier and Policy number art: Ca n 5771lrTGI G FCTIFICA OF EXEMPTION R rnMPENSATIONINSUR ICES , Obi,section read not uncompleted If lW l vomit Is forage hundred dollars(SIM) err lea.) I cenify that In the performance of the work for which this permit is III I shall not employ any cannon in any manner an an;to become subject a the WorkesCompansadon Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making 04 Cenificam of Exemption.you should become subject to the Worker's Compcnatian provisions of the labor Code,you mug ,J O forthwith comply w W such provisions or thio permit shell W demand evoked. 'Z"' CONSTRUCTION LENDING AGENCY [-iE2 I hereby alfina that then is a construction lending agency for the performance of C,7 the work for which this permit is issued(So.3097,Co.C.) I51 Q Leaders Nemo Dz Lenders Address V O 1 anBy Nat I have mad this appli.ti.m and sum that the shove infmmNun is It, torten.I agree to comply with all city and county ordinances and sum laws mlatlng to DU Wilding commuction,and hereby autharim reprommaiv of this city an enter upon the W ahovcmemioned property far Inspection purpaxa Ff^'i (We)agreeto ave,indemnify andkeep hay inns We CityofCupcnit ageing zf0.q liebiliti(We)a Tee ts.to mu and demnif expenses which maytnanywyey of Cu inn mid City in his Permit. U^ APPLICAeW UNDERSTANDS nce of the Standing of tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEREG IONS. Re-roofs Si ngor ApptcanVContncmr Dem HAZARDOUS MATERIALS DISCLOIIR Type of Roof Will the applicant or future building occupant smrc or handle hanmdous material as tiered by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety ace.Seeder,255324» All roofs shall be inspected prior to any roofing material being installed. [_]Yes Will the applicant or future Wilding occupant on,equipment or dcvlens which If a roof is installed without first obtaining an inspection,I agree to remove coir he ecdnus.1,convoinanu as Jc cd by the Bey Area Air Quallty Management all new materials for inspection. District? ❑Yns No Ihaw mad theCodevardaos 2M5.25533mmenu under Chanter, thaafdm Califon /)// / ria r not currently Sactentlyyhow 4Secdomhat it i my m3nd25334.I in erstoodmoify t th ccumux,Woftng he /�� /_,,r/_/C�/•� . docs not curendy hate a mnsnh that it u my responsibility,m notify the occupant of me or ulmmcn ustbemet rmiss on ceni0cam ofQapumy $ig�na erre Of Applicant Date All roof coverings to be Class"B"or better Owner or�ied agent Dom g CITY OF CUPERTINO o � REROOF = CUPERT `INO PERMIT APPLICATION FORM APN# 3 G / ( / � Date: Building Address: b 7.5© e0,d ve Owner's Name: Phone#: esz 5- i2 Contractor: Phone#: License#: 7ga ) 50077 Contact: Phone#: Cupertino Business License#: oy� Ei2 � Z Sia-76 a—GS Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles e1"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: 7ec� roF� Y�sTi%v� S r- Pe 3-0? Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with PI mg De t. if there are anre tc ' s: LJ Cost of Project: -of Cons t' Occupancy oup: / r-3 Qt if A is e 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 AI 'V 3 aC10F Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 1,UPEkTINO Building Department JOB ADDRE S: p IT 7 4 Jj2 Ci OWNER'S N T/z PHO GENERAL CONT CTOR FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin 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 Gla 6� r/Contractor Signature Date i Community Development Department W10300 Building Division City of Cupertino Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 CUPEkTINO 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: D42 Q/ K /Il5 T� f✓ Job Site Address: 75 O y ;Z(?e cis Roofing Company Name:�/y/S�iCI )2 KII G' _7ec"C. A plicanYs Signature: 1 I�f4�.�/ _ Date: Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper