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03060167 I CITY OF CUPERTINO �r 7 BUILDING DIVISION PERMIT CONTRACTOR INFORMATION . BUILDwc nooaess: APACHE ROOFING PERMIT rvo.03060167 }.a C• L-0060 ORANag Air OWNER'S NAME: 5829 EL DORI DR PERMIT ISSUE DATE NE. (408) 363-0205 SANITARY NO. CONTROL NO. ARCHITECtIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 led, LICENSED CONTRACTOR'S DECLARATION I hereby from that I am licensed under provisions of Chapter 9(cummencing Job Description f with Section 7000)Of O io�of the Business and Profession,Code,and mylicenscis Zt o. inrullfomeandefkct' I /Q � 4 ( REROOF F11YALE0 j ? Liccnu Clays�—r4 LIC.N 't, Datc 'L.\.1✓^ a+✓—Cunlracler ^� ARCHITECTS DECLARATION WI understand my plans ahall no used as public records JAN 0 6 2004 Id.o t; Licensed Professional S OWNER-BUILDER DECLARATION 1 '<2 I hereby affirm that I am exempt from the Common's License Law far the BUILDING O O following reason.(Section 7031.5,Business and Professions Code:Any city tar county <m fl! which requires a permit to construct,alter,improve,demolish,or repair any structure oZT poor ba its issuance,also requires the applicant for such Permit to Glee signed statement G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation rcF (commencing with Section IitW)of Division 3 fthe Business and Professions Code)or 'RE Nat he is exempt therefrom and the basis for the stcged exemption.Any violation of 35717057 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy But mom Nan ave handled dollars($50% ane. P y Type ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work.and the strunum is not intended or offered for sale(Sec.7744,Business - .it Pmrewiona Code:The Conuacter's License Law does not apply to an owner of ME Rpnired Inspections property who builds or improved themon,and who does such work himselfor trough his 307 - INSULATION own employees,provided that oven improvements are not intended oroffered formic.If. 601 - ROOF TEAR OFF however,the building or improvement is sold within one ye¢of completion,Ne owner- builderwillhavetheburdenofprovingthathedidnotWildorImproveforpurposeof 602 ROOF PLYWOOD NAIL k.) oa . 603 - ROOF BATTENS El L m owner of ct properly,,Business exclusively contracting with lift hedommanmam i- consuruct the Lawdes not pplytoon wneof andprop Professions Code:)The Conmcmrs Li- 604 - ROOF IN—PROGRESS whocoawdmsr such apply loan itha of property who sed purrimproves thereon,and, who se Lacufor such projects withacmntmcmr(s)liccnxd pursuant to the Contractor's .. License Law. ❑Ism exempt under Sec. .B&PCfor this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under Penally of perjury one of the following declarations: I haw and will maintain a Cenificam of Consent to self-inwm for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for to ponformande of the work kfor which this permit is issued. L71 nave and will maintain Worker's Compensation Insurance,as required by section 3700 of the Labor Code,for Ne performance of the work for which this permit is issued. My Wmime,Com`pensainto Imunnec artier and Policy soul erram: Carrier.S 1 11 K. I"1-va G Policy No.:"S$ -�3 _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Cniiuction need not rte completed if ule,drenh is for one hundred dollars($IQ)) or lea) I certify that in the perfmmanm mf Ne work for which this permit is issued,I shall not employ any person in any manner so as In become subject to the Workeri Compensation Laws of Califomia.Data Applicant NOTICE TO APPLICANT:IC after making this Cenificale of Exemption,you should become subject to the Worker's Compensation previsions of the Labor Code,you must .JO forthwith comply with such provision or this Permit hall W deemed revoked. z51 CONSTRUCTION LENDING AGENCY rrt .N. I hereby alarm that there is a construction lending agency for the performance of C' ti the work for which this permit is issued(Sec.3097,Civ.C.) Ifl A Leduces Name O' Lender's Address � z U Q 1 dimity inn 1 have read this application and sura that the shove information is correct.1 agree 10 comply with all city and county ordinances and state laws relating to 0O building construction,and hereby autharim representatives of this city to enter upon the U above-mentioned property for inspection purposes. wgy (We)slime to saw,indemnify and keep harmless the City of Cupertino against to Imbilities,judgmenu.cosunnd expenses which may in any way accmeagainnmid City r( v/ C)Z in consequence of the granting of tmit is PerU APPLICANT UND RST DS 0 WILL COMPLY WITH ALL NON-POINT Issued by: D3ate SOURCE RE '✓-g` 0 Re-roofs tgnam PAPP nVConL CLO,/HAZARDOUS MATERIASDISCLOSURE Data Type of Roof Will ore applicant or future building mcupant stare or handle havardous materiel as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cade,Section 25532V07 All roofs shall be inspected prior to any roofing material being installed. ❑Yea Will the apideautor future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hasmdous air cnntnminants as defined by the Bay Arca Air Quality Management all new materials TOC inspection. iStricl? qaIN� ❑Yes (INV I have mad Ne haaardous materials requirememn under Chapter 6.95 of Ne Califor- ! /� .is Health&SafelyCadd,Secuuns25505,25533 and 25534.1 understand that ifthe Wilding decant currc Ll how a tenant,Nat a is my responsibility to amity the occupant of Ne myui hid n m ppecmiasscancc ofd cemire-of Uuu Ignatu ofA plicant �' Date ° t3 All roof coverings to be Class "B"or better ser out fixed a6 nl Dec Community Development Department Building Division `! ! City of Cupertino i� 10300 Torre Avenue CITY OF Telephone: (408)777-3228 Fax: (408)777-3333 U PEI�TI NO 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 " 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. 3 understand and will com/ply'with the above stated policy on re-roofing. Homeowner's Name: Job Site Address: Roofing Company Name: Alicant's Signature: Date:Ls CA/�61NOC� Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper T t CITY OF CUPERTINO 3 6 °1 G7 _ REROOF CUPEkTINO PERMIT APPLICATION FORM APN# > Date: Building Address: Owner's Name: P one #: f{/ Contractor: h �- Phone#: r re4 G7/ ��f`9_ Cl/Cy License#: ? !! Contact:/ I Phone#: 8S$ellyr Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ ilt-Up Roof ❑ Built-Up roof CY Asphalt Shingles -0--`Asphalt Shingles ❑ Wood Shakes L1 Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) El Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# LY`fo be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Com2ly With Cu ertino's Tear Off Polic Job Description: TP�vz a Y X- iv �a lr� GDy+ Residential Commercial Fire Zone: Yes ❑ No ❑ Confirme ith Planning Dept. if there a an restricti ns.) u Cost of Proj,e>zt: Type of Con to Occ pancy S-olJ Qty. A I e . Fee ID Fee Descril2tion 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