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030801211K2 CC Ut1 i iau u. N 'SOS �00 u—re aFt] CITY OF CUPERTINO `� a * s V".�,' . BUILDING DIVISION PERMIT INTORMATION.. aCONTRACTt�R BUILDING ADDRESS: TIP—TOP ROOFING PERMIT NO 03080121 ONNAME: 1160 NADINE DR PERMIT ISSUE DATE TOM NE: (408)370-6425 SANITARY NO. CONTROL NO. ARCHITEC (ENGINEER: BUILDING PERMIT INFO BLDG ELECr PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affim hat 1 am licensed under provisions or Chapter 9 (commencing wish Sectio ]0Or)urDivision3oflhe usirinimil Prof is ions Ca .enQmy license is in tun frmc cffectr�2 / REROOF F�NALE 0 Dole�) Dam Cuntrumr ARCHITECT RAT ON Imo&.mndmypldasshallhomedn 'emcnrJ, SEP 10 2003 Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I em exempt from the Contractors License Law for theBUILDING following reason. (Stebun 7031.5. Business and Professions Cade: Any city or county which requires a permit in construct, alteq improve, dcmnlL h, or repair any structure prior In its issuance, also mquires the applicant for such Permit o file a signed statement Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contmcmr's License Law (Chapter 9 (commencing with Section 7") of Division 3 of the Business and Professions Coot) or 34215053,00 that he u axempt sherefrom and the basis for dm alleged exemption. Any violation or APN Number Occupancy Type Section 7031.5 by any applicant for a permit objects the applicant to a civil penity of not mom than fin hundred unit... ($500). ❑ I, as owner of the property. or my employees with wages u their note compensation, e Inspections p will do the work and she structure is not intended or offered for sale (See.?Obs, BusinwRlnad Code: The Conwort License Law does not apply to an owner of and Professions Codm OU N 3 0 7 I NSULAT progeny who builds or maroons Hereon, and who doe3such work himself or through his ve - i own employees, provided tom such improvementa art not intended or offered for sale. If. 601 — ROOF TEAR OFF however, the building or improvcmcm is sold within one year of completion, the owner. builder will hoe the burden or proving that he did not build or improve for purpose of 602 — ROOF PLYWOOD NAIL "k')' 603 - ROOF BATTENS ❑ 1, as owner of Ne property, am.elusively contracting with licensed contractors to construct the project (Sec. 7W. Business and Prmfwion ewe:)The Cofactor=Li• 604 — ROOF IN—PROGRESS ane law does not apply to an owner or property who builds or improves thereon, and ' who concocts for such pmjecu wish a contracio (a) licensed pursuant to the ConuacsoM1 License law. ❑ 1 am aempt under Stt. . B A P C for this mason Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ore of the following declarations: Worker's Compe I have and will maintain a Cenificam Consent of Conseno ael6insuse for Workre Titian, as provided for by Section 37M of the labor Code, for the performance of to work for which his permit is loved. ' ❑ I ban and will maintain Workers Compensation Insurance, as rcquimd by Section 3100 of the labor Code, for use pe for tore. of the work our which this psem n is issued. ,My Worker's Cnmpensaicyjraunna carrier and olicy number - *I: `/-'1`C/�afD J` Policy v, CERTIFICATE OP E%EMPT10 OM WORKERS' COMPENSATION INSURANCE (This section need not be eompinteJ Rose permit is for ane hundred do][. (SIM) or Mss.) 1 cenify that in the performance or the work for which this permit in; issued. 1 shall not employ any person in any mMner 0 as to become subject to the Worked Compersadon paws of California. Dare Applicant NOTICE To APPLICANT: IL after making Nis Cenificam of Exemption, you should bttome sohje0 to the Worker's Compensation provision or the Labor Code, you most forthwith comply with such provisions or Nis Permit shall Yse deemed revoked. CONSTRUCTION LENDING AGENCY , I hereby aRrm that there is • emtstme,drn lending agency for the lerfurman a of the work for which this permit is issued (Sec. 309'1. Civ. C.) Lenders Name Lenders Address 1 minify that I have read this application and sate that she above information is Cooper. 1 agree to comply with 411 city and county entireness and state laws relating to building Construction, and hereby authodn mprcamba ws of this city to enter upon the ahovnmenioned property, for inspection purposes. (Wes) agree to save, indemnify and keep harmlw the City or Cupertino against Iinbilities,judgments, costs and expenses which may in anyway action, against said Ctry in consequence of the granting of this rrr'''111 permit. APPLICANT UNDER TANDS D WILL COMPLY WITH ALL N N -POINT Issued by:9 Date r SOURCEREG Re -roofs ' gnamrc oMppliaH Di1e ZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant tar future building Occupant store or handle hansurtus memdel as derincd by the Citation Municipal Code, Chapter 9.12, and the Health and Safety CUJe, Section 25532(x)? k4Ne All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove the Will the applicant or future building occupant use equipment or devices which It hazardous air contaminanpts� as dclincol by the Bay Arca Air Quality Management all new materials for inspection. istrin? / — o ❑ Vies I have mad Ne hazardous materials requirements under Chapter 6.95 of the Califon ria Heal" Safeiy Code, Sections 25915,35533 end 25534.1 understood Nm lithe Wilding Jse oat curter ly how a te ant, Nnt it is my tesponi hility I nobly the ac .pant of thc rcgamc mace tpdnmiaa.anecer.eerd •atea f S' atureofApplicant Date All roof coverings to be Class B" or better wncr tar authod'rcJ ogcnl tc t W, 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. 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 " 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:�(�� / PO S a Job Site Address: (0 32'0 40 G� d Roofing Company Name: / I P—r o -p A plican" Signature: Gregoeel Building Official Revised 1/30/03 Printed on Recycled Paper Date:--��YQ,3 • I@ 00C CUPEkTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM 03,,&611 APN # Date: y Building Address:/ k Owner's Name: Tm /Qmfng o Phone f- p �^ / Contractor.• Phone #: 4v 2 S License #: Cont one Cupertino Business License #: Plan Check Fee BUILDING BUSLIC Business License Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles P Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Other (Specify) ❑ Wood Shingles )d 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: ea V- 9A -a- kQ- � � ntK p. / n n Iae-h-b Q / Residential Commercial E]�/A Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are any restrictions: LJ ost ofPrpj t: 60 Type of onstructi Occupancy group: ^3----�, [J Qty. if/ Anolical5i f Fee 1T) FrP Iircrrintinn P.. r,1 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