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03120078CITY OF CUPERTINO < '"r�.�g.^" tr 'D�2s,�♦' "1�T COL\ -4 ATTIOL�i BUILDING DIVISION PERMIT AllRZil,�sO14`1 ,. au ADDRESS: 719, OROrRAND17, PT, SKYLINE ROOFING PERMITNO0312OO78 WILDING ONER'S NAME: PERMITISSUEDATE JACK R SEN ONE: SANITARY N0. CONTROL NO. (408)353-3.935 ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG. ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description I hereby under provisions oris 9 (commencingsis fm that I am the p Code, wird Section ]IXIo)or Division3.f NC Business and Professions Code, and my license is ) Bu ' in full force and effect. �1 REROOLa" License Class C-aq LI7�i 744 Date�2-IZ_P ContractotrKyt�,a�r� �mn Zz ARCHITECTS DECLARATION tdnmsnplans I W used apuhic Records q ' F'AA LELicense OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the roliowni ing uon. (S.Uun ]1131.5, Business and Professions Code: Any city or county ��� 19 2��4 which requires a permit to construct. aper, improve, demolish, or repair any structure poor to its issuance, also requires the applicant for such permit to rile a signed statement that he is licensed pooment,, the provisions of the Contractor's Liecmse Law (Chapter 9 Sq. Ft. Floor Area V uation (coni mencing with Sccli0, 7000) of Division 3 of the Business and Professinna Code) or BUILDINU Nat he u exempt therefrom and Vu basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 @093, McrO o Occupancy Type P Y YP not more Nan five hundred dollars (SSW). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work. and the structure is not intended or offered forsale (Sec. 706 , Business and Professions Code: The Comractors License Law d0es not apply to an owner .r Required Inspections proper who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvcmentd au not irnended.,offe..d for sale. If. however, Ute building or improvement !amid within one year of completion, the owner, builder will have the burden of proving that he did not build or improve for purpose of .1.1 ❑ 1. as owner of Ne property. am exclusively contracting with licensed contractors to consumer the project (Sec. 7004, Business and Professions Code:) The Comraaor's Li - came law does not apply to an Owner of property who Wilds or improves @emon. and. who contracts for such projects with a Otsonoor(s) licensed pursuant to the Contracnurb License Law. ❑ I OR, exempt under See. ,B&P C for this ..on Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one or the following declarations: 1 have and will maintain. Certipcme of Consent to sel6insue for Workers Compcm sation. an provided for by Section 3100 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section 3100 of Nc labor Code, for Ne performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Carrier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed lithe permit is intone hundred dollars ($IW) or lean.) 1 certify that in the performance of the work for which this permit is issued. 1 shall not employ any person in any manner, anssm cum, bja, o Workers'Compenmtima - Laws of Calif prm� Dam 7 —r» Applicant Applicant �,1 — NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions or the Labor Code, you must forthwith comply with such pmvisiom or this permit shall W deemed revoked. CONSTRUCTION LENDING AGENCY ' 1 touchy aMrm chat Umrt is it construction landing agency for Ne po formmm of IW work fur which this permit is issued (Sec. 3091, Co, C.) Lender's Name Lenders Address I certify that 1 have read this application and sum that the above Ormmatiun is correct. I agree 10 comply with all city and county ordinances and sure laws relating to building construction, and hereby audhmim representatives or this city to enter upon the for inspection purposes. ahovcmcmioncd Prefatorycosts (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities,cnqence emu, coals and which may in any way accrue against said City of thisexpenses of Ne granting this permit. A APPLICANT APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Dale SOURC REGULL..J�IONS. Re -roofs - y��L� /2—Y1 Signature l'ApplicanUConuaclor Dem HAZARDOUS MATERIALS DISCLOSURE Type Of Roof Will the applicant or future building Occupant stare orhandle haneNous maredal az defined by the Cup mflo. Municipal, Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? 1­7Ycs fi]'Flo All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant orfuturebuilding occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. ,strict? ❑Ycs Ihave mad the requirements under Chapter 6.95 of Nc Code, Srdmss 25505. rias nothffirently Code, Sections25505.25533itimyrsnd25534.1 to net and that if the Wilding Rod 55 Wilding Jas not currently have a Ienanl, that it is my responsibility m nnUly the occupant of the �t J2�/�^O G regeircZewhi vatxme rtoiasuancenraCoodrecesorOccupancy . Signature of Applicant Date ba All roof coverings to be Class "B" or better Owner or authorize) agent Da,p LI u� CITY OF UPEkTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 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 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: 7A A L Job Site Address: —7-71-2— C)eQ 6, ZIIL JJ.-- P , Roofing Company Name: 4K\) L l .F_ A plicant's Signature: 4�2� _ ' Date: %Z` /2- O:f) Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper �),?? ? 9 2 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: 7A A L Job Site Address: —7-71-2— C)eQ 6, ZIIL JJ.-- P , Roofing Company Name: 4K\) L l .F_ A plicant's Signature: 4�2� _ ' Date: %Z` /2- O:f) Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper �),?? ? 9 2 L� ✓, CITY OF CUPERTINO REROOF 4CITO CUPERTINO PERMIT APPLICATION FORM APN # 3 ,z t 9 Oz 1 Bld Permit Fees Date: BENERGY Ener BUILDING Building Address: Seismic Fee Res 77/2- 040 G AM1= CTl Owner's Name: Seismic Commercial Phone #: BPLANCHK Plan Check Fee BUILDING Contractor: P one #: Business License License #: S YLI z P_oe_>FojC, Z -51/62 R Contact* Phone #: K c.A�, 0 Cupertino Business License #: t� ( (t Type of Roof Covering: Exigg: Proposed: TBuilt-Up Roof ,d Built -Up roof ❑ Asphalt Shingles gr Asphalt Shingles P( Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings / ❑ Provide I.C.B.O. Report # fd To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: �2 C_ pDx yWOZ wtr)Ut- S30yo (� PEhALTS r �c�t1Tu Residential z Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are anrestrictions: LJ Cost ofProject: Type of Construction: Occupancy group: <Op, 6© Qty. if ADDlicable Fe..P In BPERMFEE Bld Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING