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05080128 ' CITY OF CUPERTINO BUILDING DIVISION PERMIT pNTRACTORINFRMATION BUILDING ADDRESS: PERMIT NO.0 5 0 8 01 Z 8 Z FW T.N OWNER'S NAME: PERMIT ISSUE DATE CATHERINE OUIHUIS 08/16/2005 ONE: SANITARY NO. CONTROL NO, - 7ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSEDCONTRACIOR'SDECLARATION JobDescri tion I1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing P Section]0011)OfOiviaionlaf the BusinesaanO Br fcssinnsCode.andmylicmtuisBmrceancqq REROOF—T/O COMP. & INSTA WFE T 5 YR. ense 1 C LIc.Yu — Contractor PRES . E` t,r s� ARCHITECTS DECLARATION CONTRACTOR: AMERICA' S ROOFING'" ¢< I undcrsunJ my plans shall W used a public menrda r /�® a u. Licensed Professional /}vls s'` im r ~P /V r d ,�c0� OWNER-BUILDER DECLARATION `IHyE�`/J�-B j <I 1 hemby infirm that I an cacmp from the CDmfxelors License Law far the ©0� a a follnwin6 mason.(Seetun 7031.3,Business and ProfessfOns Code:Any city or county <m�+ which requires a permit ms cnnstma..fur,improve,demolish.or repair any at.[.. prior o its issuance.also requires the applicant for such permit to file a signed statement < thus heislicensed pursuanttotheProvisions ofNeCom ent,'.Lk..law(Chapter9 Sq.Ft. Floor Area v�(]///y /� Valuation 99th (commencing with Section 7")of Division 3 of the Business and Professions Code)or as//�!/ay+� $•]000 y NH at he exempt therefrom and the baso for the alleged exemption.My violation of O O R Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ane APN Number OwLi Type oat mart man five banded dollars(SSW). P Y YP 1,as owner of the property,army employees with wages es their Calc compensation, will do the wort and the swcme is not intended oroRerad forsake(Sec.]Osq Bunwas and Pmfetiav Code:TTnc Conaanara Littrue Law does not apply in an owner of Required Inspections propeny who buildsorimproves thereon,and who doessuch work himself or Mmugh his ..employ=,provided mat such impmveseenu..at amended or offered forsake.If. however,the building or improvement is sold within one year of Completion,me owner. builder will have the burden of proving that be did not Wild or improve for purpose of sok.). ❑1,as Owner of the property,am exclusively contracting with licensed contractors to camvun the project(Sec.70,14,Business and Professions Code:)TIe Ci ntruur's Li. cense law docs not apply to an owner of propc ty who builds or improves thereon,and who contracts for such projects with a eomranar(s)licensed pursuant to me Contractor's Lucerlssal.it CKamexew ,B k P C for Nu rtaun mpt under Sea 130TOO n Date WORKERS COMPENSATION DECLARATION - - 1 hereby sf arm under penalty of perjury,ane of the following declarations: 1 have and will maintain.Cenifiate of Cement to saINnsure for Worker's Camper. ion,as provided for by Section 3]00 of the Labor Code,for the performance of the k far which this pnmit I.issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section of me LaWr Code,for me performance of me work for which this permit is issued. Worker'a Cn ensauan Insurance carticr end Policy number art: rtier. Policy No.: _ CERTIFICATE OPE PITON FROM WORKERS' COMPENSATION INSURANCE (Thu section need not W compkeud if tW permit is for onehundmd dmlars(5100) or less) 1 ccnify mat in the performance of me work for which this permit H issued.I shill not employ any person in my mannerfw as tp bcea�bjeeHo the Workeri Compensation Laws of California.Data f b NOTICE TO APPLICANT:If,after making Nis cnificale of EaC�emption,you should become subject to the Worker's Compensation provisions of the Labor Code,you most 0z forthwith comply with such provisions or this permii shall W donned mvoked. ZZ CONSTRUCTION LENDING AGENCY [-s l hereby affirm that inert is a commotion lending silently for the performance of Cl, me work for which this permit is issued(Sec.3097,Civ.C.) I17 Q Undoes Name = z Lender's Address U 0 1 amfy that I have read this application and sue that me i Wa information is (f. F corecL I agree to comply with all city and county ordinances and sum laws relating to 0U Wilding coaraction,and hereby iumorfx apresenutives of mu city m enter upas the Lq above-menuomod ons. for inspection purposes. f+ 4. (We)agree m save,indemnify and keep harmless the City of Cupertino against ilf)Z IiacmactI.lud6m fMecostsang of this ,.it. may in any wayamuc against said City („) z in conuquencc of me gaming of this ,.it. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6 Cir SOURCE REGULATI e. - `/ C.� '' Re-roofs Signature ofAppliceHCOUS MATERIALS DISCLOSURE Data AZARDERIType of Roof Will me applicant or future Wilding occupant amm Or handle harardaus material as dcrined by the Ci penins Municipal Cade.Chapter 9.12,and the Hcalth and Safety code,prca zss3z(a)] �N, All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment ordcvices which If a roof is installed without first obtaining an inspection,I agree to remove it hannalous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection. strict? ❑Yes 1 have mail me hvardrms materials myuiremenm under Caspar 6.95 of the Cakifor .in NeslN A Sa CLYCOM,Sectors 255)5,25533 and 25534.1 undcrsLVM tout if me Wilding does rot currently hose a tenNL Nat it u my ra miumbil ity m notify me,cap.,of me mquircmc"hichmustWmctpnoftuissuanccafacerficaeof Occup � $igna[ure of Applicant Date Owner or a`umarize�t ��Data All roof coverings to be Class"B" or better Community Development 10300 Torre Avenue iJ• Cupertino CA 95014 Telephone(408)777-3228 � CITY OF Fax(408)777-3333 UPEkTINO Building De artment JOB ADDRESS: � 1` PERMIT # OWNER' NAME: V �� v PHONE # CM > l GENERAL CONTRACTOR: ^ FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation 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 b�Wn-er/ Signature Date Community Development Department }a Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408) 777-3333 CUPEI�TINO 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. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. 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 com ly with the above stated policy on re-roofing. Homeowner's Name: Job Site Address: 1 b KV- L/�(Cw ��' Roofing Company Name: (� Applicant's Signature: Date: Greg Casteel Building Official Revised 11/2/04 Onn�nN nn Onn.rinrl Denny CITY OF CUPERTINO . REROOF $CUPtnvbf ERTINO PERMIT APPLICATION FORM APN# 3 Z G � 1 p 10q Date: 25 "l Building Address, t� � Q Owner's Name: CAl; vt Phone#: 0,A 2R B 36 Phone#: Licens #: 2c, ov- Contractor: � - (�: _ Contact: ` Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof �� G1- Asphalt Shingles tYAsphalt Shingles Jam/ '{.� ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Numb b of existing coverings 75 El Provide I.C.B.O.Report# B� O be Removed ❑ Provide Mfgr. Installation Specs I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job De cription: l i, I Q O Residentiak2l, Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: ��� Type of Construction: Occupancy group: Qty. if Applicable 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 3 - 77 � q -2-3