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04110094
CTTY OF CUPERTINO' �.-.. .:. .y73 ,� z .. Ci1NT12A OR A1�+'+v11VXi�1�1 " suILDlrvc mvlsloN... . , PERMIT .-,,. BUOAINGADDRESS: ., -. " DAN-ELLIOTT'S ROOFING 'CO - �- P—ArrND) 4110'094' 20771 MC CLELLAN RD OWNER'S NAME: -, PERMITISSUEDATE CHARLES SWOP. 2669 COIT DR' 2004 ONE: .." ..- .. - - .. - -. SANITARYNO._ :._...,_..-. CONTROLNO.= ARCHITECYENGINEER: - - -BUILDING PERMIT INFO " BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION •-_ - - - ..JOI7 Descrlptlon .: ' - - 1 hereby affirm that 1 em licaused under provisions of Chapter 9 (commencing - - .. ....- with Section 7").IDlvistom Sof the Business and Professions Code and my license is infullIm..nda 2 �!/ Llaenw leu =" 3 Lic: M Dare�S_ — CanlH��—� . REROOF . . - ARCHITECPSDECLARATION..._ In hdersiand my plans shall be, used u public records Licensed Prof ..i.e.] OWNER -BUILDER DECLARATION Law for I hereby afTuat Not I.am exempt treat use, Contractor's License the following reason. (Section 703 1.5, Business and Profusions Code: Any city or county- r a to construct, altar, improve. demolish, or repair any structure' _ - ' - / -8854 3 which mquirse Permit ! priorm its issuance, also requires lW applicant renews permit to rile a signed statement Uccnee law - - -.. � .•-. Sq. Ft. Floor, Area _ ._..' Valuation --- Nat he is licensed pursuant to the prrviaims.f the Contractor's (Chun" (commencing with Section 7") of Division J of the Business and Professions Corks) or ,. —.. _ e that he is exempt therefrom, and the basis for do alleged exemption. Any violation of e - - Occupancy Type'- Section 7031.5 by any apphcanlfor a Permit subjedu the applicant to a civil penally of not mom Nan five hundred dollen ($500). . 0.1, as owner often property, or my employees with wages as lheirsole compensation,. %"'' -° Required Ins :. will do the arena and the structure isnotiomnded oroffered forsale(Sec. 7044, Business..- and Pmfcsaiou Code The Connector's License Law ducatnot apply m an owner of Pections- eny who builds doenauchwork M1imself orNreugM1his that Suchimprovementstate not earofdoroRUW am providedmpr pmvld line owforestsner. howeer.th.esildingr. iNatvementis wit year ofimpovOfrNe ownc. builder Ne building -'--' of MvingtoldwiNinot builder will have the burden of proving Nat M did not Wild or improve far purpose of sato ). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Prefoemons Cade:) The Contractor's LI- cense law does not apply to an owner of pmperty who Wilds or improve Neuron, and _ who cantrecte for men prefects with a contractor(s) Iicenud pursuant to Ne Contractors License Law, - - ❑IsmexemptunderSec. .B& P C far Nis reason - Owner Data , - WORKER'S COMPENSATION DECLARATION I hereby 4101^ under penalty of perjury one of the following declua0am: - - - - - I haw and will maintain a Ce tificete of Consent to salf-insure fm WorkersComper- sation, as provided for by Section 37011 of dm Labor Cade, for Om Performance of the work for which this permit is issued _ --__---- I haw and will maintain Worker's Compensation Insurance, as required by section - - - ' - - - ' 3 of Ne Labor Cotlefor Ne performance of Ne work for which Nia permit is issued. My Wopyll�ke Compensation Insurance ten or and Polley number am: - Cameth las IA ra,ne&-- Policy No.:W('.OS'r_foy0luou CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (pos secti on Aced not be completed ti the Permit is for one hundred dollars ($1001 or less.) 1 cenify Nm in the performance of the work for which this permit is issued, I shall not - employ any person in any manner an as to become subject o the Workers' Compensation _ Laws of California. Dem Applicant NOTICE TO APPLICANT: If. afmr making Nis Certificate of Exemption, you should become subjttt be fee Worker's Compensation provisions of the labor Code, you must forthwith comply with such previsione or this Permit shall W deemed revoked. ON LENDING AGENCY CONSTRUCTION ��- is a c lending agency for Nc performance of I heathy atm Net mere is s ed (Sm ' feeLa work fur which Chia permit is issued (Sec. J097, Civ. C.) lender's Name lcndeh Address 1 cenify that 1 haw read this application and state that the above information is - contact 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby suNurim representatives of this city to enter upon the .1owwroendumed property for inspection purposes. (We) agree to saw, indemnify and keep hanalm s Use City of Capons- against 7 liabilities, Judgments, costs and expenses which may in any way accroe against said City uence of the grana. of Nis permit ANT UNDERSTA DS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date 0.ti/6 Re -roofs of Roof ofApplicaHAZARDOUS MATERIALS DISCLOSURE 1.1 DeuT,pe ill the applicant or future Wilding oecupanl stare or handle basdous material d by Ne Cupertino Municipal Code. Chapter 9.12, and the Health and Safety mybs ction z5532(an '- Yes •MJ NoIf -All roofs shall be inspected prior to any roofing material being installed. inspection, a roof is installed without first obtaining an I agree to remove ill Ne applicant or future building decorum uta equipment or devices which rdaus air contaminants u retired by Nn Bay Arca Air Quality Management t all new materials for inspection. Yeses I have mad the haaarNms materials reionanu to under Chapter 6.95 of be Califar. ria Health& SafelyCdde, Sections 25505.25533 and 23534.1 understand that if the building dao nos cusmmly haw a wn.4 tliatgl'u my mspomibiiity w notify dw occupant of thc qd meat i eater ni NleaaanceoraCertficaugrOcapaney. g natureofApplicant Date _.._ - All roof coverings to be Class "B" or better caner ar a,T norixed agent Dam r . CITY OF #UPERTINO L . f - Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department. JOB ADDRESS: PERMIT # AO 771 M(a l `a 1 Gam!/G© ?V OWNER'S NAME: 71, aA _ f PA( G5 PHONE #YDS sSr-75 7 GENERAL CONTRACTOR: - FAX # 7-14 7 I am not using any subcontractors: pC ,Lk:: (/.c./ ,r - Signature Please check applicable subcontractors and complete the following- information - Date Owner/ Contractor Signature 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 . Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 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 shallbe inspected prior to any roofing installation. . To receive a'final sigmoff from the City,:.the:followirig steps are required: t 1); Pre -inspection and/ tear offapproval = 2) In -progress mspection approval. 3) Final inspection approval. " a) Spark arrester installation. If plywood'is installed; aplywood nail inspection is•required., •'Any, roofing which is applied without first obtaining an inspection, will require the removal of all new material dowi to the sheathing, so a proper City inspection can be performed 7i NOTE: If you'call for aplyivood-n il-inspection an11 d the job:is not ready, youwill be charged,a-r"e-inspection fee of $176.18. -The re -inspection fee must a be maid before another inspection can be scheduled i IMPORTANT:' _ 1r•' *' Flat roofs must have a minimum of 1/4" per -foot -slope and demonstrate that there is no ponding, " An I.C.13.0. report is required to be on the job site at the time on inspection. I understand.and will comply with th'e above stated policy on re -roofing.... 7 Homeowners Name: �1 r / \ � P7dyr l lian� 1 � �— iM ✓1 i � Job Site -Address: ' D % 7w- -- Roofing Company Name:Xf 5 +'� Date:L / —c�f :. Qty, if US Permit Fee Plan Check Fee CITY OF CUPERTINO 12EROOF ,, FTS(, ..._• CUPEI�TINO PERMIT APPLICATION FORM APN # l Date: Building Address: b -O CA 1—1 1 AN� Owner's Name: a eu>i- Phone #: YaNca2s@�ea��s %T;-ZA0 Q Contractor:c 1 , // Phone #`. wvy. 00- �GX8 q 3'L^j License #: Contact: jPhone#: L10 U I � �k`33%G` 1q0 $- SS q-73L� Cupertino Business License #: Type of Roof Covering: Existing: ❑ Built -Up Roof Proposed: ❑ Asphalt Shingles ❑ Built -Up roof ® Wood Shakes M Asphalt Shingles ❑ Wood Shingles ❑ Wood Shakes ❑ Other (Specify) ❑ Wood Shingles _�__ Number of existing coverings ❑ To be Removed ❑ Other (Specify) ❑ Provide I.C.B.O. Report # 3 Gl �$ ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic ; Job Description: (2Mnove S C x 11-310 Se a a �nqs�Residential [ Comm repial Fire Zone: Yes ❑ No �Confirmed Tre there Cost of Project: are an4g1S43to Type of C nstructi n�Occupancy AA .uA Qty, if US Permit Fee Plan Check Fee