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04110077 ' CIT Y OFCUPERTINO BUILD No PERMIT �r- 6UILDINGADDRESS:' "' PERMIT NO. - _. _ 04110077 . . . �.__ ._.. ^ OWNER'S NAME: FERMITLSSUEDATE ..OW . _ ONE:^ - ' - .. SANITARY GAkOL NO: A1CHITEcr1ENGINEER:, - BUILDING PERMIT INFO ' BLDG ELECT,...,: PLUMB 1 .. MECH _ o , our : LICENSED CONTRACTOR'S DECLARATION ' Y.' 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description _ Skiith Seeon7 qof Divixian3of Ute Bunn nand rof.W,I.aCode.andmylicenais mum aerfat, License cid Lm.f 'fS / REROOF ' �'o °am c°"D to CONTRACTOR: GENOVESE, BUILDERS INC ARCHITECTS D TIONy� {q- ,Ac ... -.. '�a ' tun rsud YPlens¢ha1lMuuda plXC rtcnmb . - _- .. _. . ... DyU m Licensed Professional. G S 'OWNER-BUILDER DECLARATION J'7 aI hereby.(Sinn that 11. eacmprfmm the(moons Cod :License Law for tW - •G - - p O following reason.(Section 7031.5,Business and Profeminns Code Any city or county - ,. , -s $ prior requtroa a permit re cnavuct,plum improve,de Permit t or repair any uaamum prig to its issuance,also requires rhe applicant tforhe SuchCon rc tor's Nese signed suument. RIM that he islia"acdpursuantmheprovisionsMthcCommctor'xLicenseLaw(Chapmr9 Sq.Ft..Floor _ Val$lafyi 00 - s $ (commencing with Smile.7000)of Division 3 or NC Busirtcesand Normal...Conic)or - vim' - .. Nat he is exempt thereRom and tW basis far the alleged exemption.Any vW floa of Semon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of - APN Number Oe . • not morn fn I..hundred dollars(5500). - Occupancy y Typ 01,a owner ailing property.army employ=with wages a their sole compensation, 34248004 00 _ will do the work,and the structure is automated aroffeted formic(Sm.7Daa,Business - and'PmContractor'sto fessi°ns Code:The Liam Law does not apply an owner of _ Required Inspections "propentlywhobuilds orempiatinch improve wbo am notihbo3 himmlfor through his -. - own cmployeea,Provided theoauch improvements ere notinsnded oroRered for mle.IL -' - •� -� t,.. _ however,Ne building or improvement is to withi i ts.year of compla mn,the owner- ' builder will have the burden of proving that he did not Wild or improve fur purpose of safe.). C],1,as owoer of the Property,am exclusively contracting with licensed contractors to construct the project(See.7044.Business and Professions Cmeq The Conuactorh Lt. came law does not apply to an owner of property who W lldx or improve Nemon,and -• - — -— `` "` _ - - - whocontractsfor such projects with a eontuctoKO licensed Lomat ,to Ute Contractor's .. _ _.....__..._...._.-.-.._..-.- License Law. ❑Ism exempt underSee. .B k P C far this moon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury am of tW following declarations: I have and will maintain a Canifato of Consent to self-insure for Warkcfa Compact. sabon,as provided for by Section 3700 of the labor Code,for the performance of the , work for which this permit is turned, , ❑1 have and will maintain Worker's Compensation Insurance;as required by Suction ' 3700 of Ne Labor Cade,for the performance of the work for which this permit is issued. FarW rknex/c� penLmLt__imt)� airier and PuftY Wrau: - , 7 Z 1r /'u^r/ Polia7-�o.I f-0It - CERTIFICATE OF EXEMPT!0�NS -WORKERS' .- .. - ! COMPENSATIONI RA CE. - - - (This amount need not bccomplmed lithe permit is forum hundred dollars($100) or lax.) 1 certify that in the performance of the work far which this permit is issued,1 shall or employ any person in any manner so as to Wcome subject to f Workers'Compensa0on Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should - become subject to the Worker's Compensation provisions of the labor Code,you must 0 O forthwith comply with such provision or this permit shall W doomed revoked. Z`•' CONSTRUCTION LENDING AGENCY H^ Ihemby.Xion that there isoco"aWctinn lending.Sawy for me perfmmme.1' !�t7 the work for which this permit is issued(Sec.3097,Civ.C.) ALender's Name z Lendeh Addtas U 0 1 certify Net 1 have read this application and soon that the above information is {f.F eonoet.1 agree to comply with all city and county ordina ms and sum laws minting to 0 U building construction,and hereby authorise mproan viva of this city to enter upon thc W above-mentuncd property far iapea'don Protons.. (We)agree to save,indemnify and keep harmless the City of Cupcnino against P.. M Imbilitles,Judgments,mm and ex acs which may in say way aamc against said City U'z inconsequence of the gumfo th'I permit. -- APPLICANT UNDE T- COMPLY WITH ALL No N-POINT Issued by; - Date SOURCEREGULA Re-roofs arum of anVConuacmr etc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will f applicant sir future building accupantrote arhandlc ha olous material as defined by the Cupertino Municipal Code,Chapter 9.13,and tW Health and Safety Code,Section 35533(.)' All roofs shall be inspected prior to any roofing material being installed. -------- Yes Na Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove .it W.m.ux air conumim"u a defined by Ne Bay Area Air Quality Management all new materials for inspection. District? �``''Nu ❑Yes \ IhavcmW the bacardous 25505.2553aterials 3 aments 534,1t dersChapur 695 flubs Califor- nix Hcal'e.Safer c,Satoa 8505.35533 and 853d.Iundcrsund thazifthc Wilding docs not cu a u"aL that it is my rapansihility to nutty the occupant of the mquirem met pd or4)issuance ouCc 'sau�Qc pan O `-SignatueofApplicant Date -� Orad mivcdegret ! ( Data All roof coverings to be Class"B"or better Community Development aClOF 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPERTINO Building Department JOB ADDRESS:` PERMIT # (� ©`tif©o �' OWNER'S NAME: e/✓ ,o PHONE # qO GENERAL CONTRACTOR 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 rJ✓tom .P e u Cf Septic Tank Sheet Metal Sheet Rock Tile 454 '(�A;7v er/Contractor Signature ate Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 CUPERTINO 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 Crty;..the:following steps are required: .. - ' . t-: z 1).Pre-inspection and/or tear,off,approval.,! y rF 2) In-progress inspection approval. 3)' Final inspection approval:' a) Spark arrester installation. 5; If plywood is installed; a plywood:nail inspection is_required., Any roofing which is applied without first obtaining an inspection, will require_the removal of all new material downto the sheathing, so a proper City inspection can be''performed NOTE:- If you call fora plywo'o`d nail'inspection and the job is not ready, si ..:you will be charged a re-mspectiofrfee_of$176.18. The reinspection fee must be paid before another inspection can be scheduled IMPORTANT: . . 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 theaime on inspection. ' I understand and will comply with`the above,stated policy on re-roofing. r . ,/� .�✓ /� Homeowner's Name: jobSite.Address: - �Roofing Company Name: c c4,11-c-�s Date: Applicant's Signature: - Greg Casieel Building Official - . . Revised 11/2/04 , •, .- :,, . . . 'a fwd nn Recycled Paper .. CITY OF CUPERTINO REROOF o L CUPEPTiNO PERMIT APPLICATION FORM APN# Z D Date: r S 9 Building Address: Z,- ` 5c6 Owner's Name:. � Phone#: �— Contractor: P one #: License #: 3 6f-70 ✓r5if 6� 'l �t^_s Contact: r1 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. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: {^r ���/ � G(^�,/ �✓vJ �d�s 'P�t��oJ �����+��.� �4�-f Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are anrestrictions: LJ -- Cost of Projeyrt: 2 Type of Construction: Occupancy group: srtj Q . if Ap4liqAle 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 j 3 ��