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03070203CI'T'Y OF CUPERTINO x ;3.�sdwZra .sea uy� 'z BUILDING DIVISION PI RMITCONTRACTrORINFORMA�ION BUILDING ADDRESS: D Sc D CONSTRUCTION PERMITNO03070203 OWNER'S NAME: 1447 HAMPTON DR. PERMIT ISSUE DATE LE Ne: (408) 666-5298 SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO Build- ELECT PLUMB MECH t� 0 t� LICENSED CONTRACTOR'S DECLARATION Job DesCrII lr 1 hereby affirm Thal 1 am licensed under provisions .(Chip,., 9 (commencing with Section lakpnf, Division 3 Orlin Business and Professions Cnde,and my license is,iRtf P j� Al fore. nod effect. REROOF cenacClam�__ Lic # ,T Dale Contractor ARCHI]BCTS DECLARATION I R 2003 I understand my plans shad he used a re public cords p AUGAUG � Licensed Pmfcesinnal OWNER -BUILDER DECLARATION B U I LDI I tl G BUILDING I hereby n(Srm thmon I Law for the from Ne CnntraotCo Code: Any city nr manly I.S.cBusin e: Any im reason. ]101.Business and which u construct, tlue improve. demolnslish. which rtquima a perm. demolish, of...ir any Ammum Permit gon relaun alaentto the Ih. ildomnnl relaunch Isee salga(Chapt cot re applicant thane islits icensedof the wit pureuatn Sq. Ft. Floor Area Valuation .Business nd Purlaw(Chapter9 (commencing Division3 oftheeged axe oration. Any vi Com) or 7") of Division (commencing with Sutton and do that he is exempt therefrom and me buffs for the alleged exemption. Any violation of 37515009.00 APN Number - Occupancy Type Section ]031.5 by any applicant for a permit subjects the applicant to a civil penally of not more than rive hundred dollars(M). ❑ I, as owner of the mercury, Or my employees with wages as their Sole Compensation, — Re�tSIred Inspections ' P wtlldothcworlt and the structure is not intended OroRered for talc (SCC. 70m, Business and Proressiom Code: The Clummrofs LtLt..Law door nor apply to as owner of propeny who builds or improves thermen. and whodas such work himself orlhrough his 3 0 7 - I NSULAT N own employees, provided that such improvements us not intended ConRved for sale. If, 601 — ROOF TEAR OFF ' however, me building or improvement is sold within one year Of completion, the owner. builder will have the burden of proving that he did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL sale')' 603 - ROOF BATTENS ❑ I,asownerofthepmpeny.ameaClmivelyc.nuactingwimlicensedContractorsI. 604 construct the project (See. 7(111, Business and Fourteenth;Codep The Contsacmri Li - ROOF IN -PROGRESS cense Law does not pply to an owner of progeny who builds or Improves thereon, and who contracts for such projects with a eontrmour(s), licensed pursuant to the Conlrsnori License Law. ❑l am exempt under See. ,B 6 P C for mh...a Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby ruff ren under pemlty of perjury one of ths, following declarations: I have and will mainuin a CCrufcam of Consent to self -Insure for Worker's Compcm action, as provided for by Section 37M of the labor Code, for the performance of the work for which this parmil is issued. ❑ 1 have and will maintain Worker's Compensation Imunna, u required by Section 37M of me labor Code, for the performance of the work for which this permit is issued. My Wor is Co pematioglnwnnee Cartier and Polity nlbe art: "�Q[v• a,: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thi merino need not be completed If the Permit is for one hundred dollars (Slap rlr tela.) . 1 eenify mat in the pnf reamen of the work for which this permit is issued. I ahall not employ any person in any manner sO as to become subject o the Workers' Compensation Laws of California. Dale Applicant NOTICE TO APPLICANT: If, after making this Cenificale of Exemption, you should become subject to the Worker's Comte alumina provisions of the Labor Crude. you must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby ruff rm mat inert W eom"Itina Lading agency lm duepenboumanm of the work for which this permit is issued (SCC. 309], Civ, C.) Lendce. Name - Lendee.Addrom 1 certify that 1 have read this application and Sum that the above information is correct. l agree to comply with all city and county mJimrunuca and slate laws relating 10 building construction. and hereby authorise representatives Of this City IO enter upon the above mentioned property for impaction purposes. (We) agree to save, indemnify and keep hasmless the COY of Cupertino spins) liabilities judgment, costs and expenses which may in any way same against said City in consequence of the granting Of this perm it, APPyWICCANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date AROGRCE REGULATI S. Re-roofs Type of Roof Sigm,4g_pApp1lcamhCmmNctm Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupi m store or handle hamdous material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety ode, Section 25532(a)? All roofs shall be inspected to an roofing material being installed. " ON. prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant Or future building occupant use equipment or devices which It hovardous or cmuaminants m Joined by 0. Bay Arta Air Quality M ...... cat all new materials for inspection. istrlct? ❑Yes ON. I have read the huandous materials mquimmem under Chapter 6.95 of me Califon Na Hearin A Safcty Clyde, Sections 25505.25533 am25531. 1 tndcnund mol ifmc huilding �I maca not currently neve s mount, mat it is my rtspmarmilily m madly the oecupul of the ; RyW Cuts which must be mel priorto issuance ofa CClYfcale Of QWpancy, T— Signature ofApplicant Date All roof coverings to be Class "B" or better .mC,)C�.d1 egcnt ' Community Development Department Building Division City of Cupertino ' 10300 Torre Avenue CITY OF Telephone: (408) 777-3228 U P E IST I N O 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 Name: L P,,zI ��y E�cb� Lir.it Job Site Address: ,�0 )4 �� 77'1% 121— Roofing Company Name: F/ 4:f C:4 Applicant's Signature: 4 i <✓ ��d' Date: 7— Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper • ary o CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM 0 ? J 7 Ja 0 3 APN # �s _ /S� Bldg Permit Fees Date: -3 Energy 4>7- r 1 —O Building Address: Seismic Fee Res BUILDING BSEISMICOM Owner's N BUILDING Phone #: fie✓ t � BUILDING !G'i.��'-2S'.5 —6rSI Contractor: Phone At: License #: Contact: Phone #V.,r, _3 /3 ,_�,��j- Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built-_up•ro6r yt' Asphalt Shingles B- iisphalt Shingles ❑ Wood Shakes ❑ Wood Shakes Cl 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: y n �y 3-D6'1 Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost -of Project: Type of Construction: Occupancy group: 2 �� Qty. i ApplieaI5le 1 Fee ID Fee Description Fee Grotto % 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