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04080171 F�1_U ITY OF CUPERTINO `4TOR BUILDING DIVISION PERMIT C ONT"C_TORINA) , ILDINC ADDRESS: OLD COUNTRY ROOFING PERMIT N0.04080171 OWNER'S NAME: PERMIT ISSUE DATEONE: SANITARY N . CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 u00 LICENSED CONTRACTOR'S DECLARATION (� 1 hereby affirm that 1 am licensed under pmvi ions of Chapter 9(commencing with Sc lian700Krof Diviskm3ofthc Busin.sndP sshm'Code,andmylicenxis �'�� imm� adderre �� 3 REROOF W/COMP. j�Z Licean CI Lic.k Can can 'I OCT /Z 2004 A HITECTS DECIAR T N y a -zden:und my plans shall M used es public records 3 qq Licensed Professional w OWNER-BUILDER DECLARATION ' (\Y—� y I hereby off rte that I am exempt from the Conuedor's License Lew for the BUILDING En following mason,seefian](n 1.5,Business and Professions Cade:Any ally or county +�$ which requires a permit to construct.alcor,improve,demolish,or repair any swetum y.� prior.its issuance,also mquires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractor's LicenxLav,(Chapter 9 Sq,Ft. Floor Area Valuation i2 $ (commencing with Section 70[1 of Division 3 of the Business and Professions Cale)or 3 that W B exempt thcmfrom and Ne basis far the alleged exemption.Any violarlon of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 AH14 NOf0er 0 0 Occupancy Type Am mom Nan row hundred dollars(5600). ❑1,as owner ofthe property,or mycmployeas wide wag.As their sale eomrieneadon, will do dee work,and the stature is notiamm ed wo@red crania(Sec.1044,Business and Professions Cade:The Contractors License law does not apply m an owner of Required Inspections property who bu II ds or i mprovss thereon.and who dos sash work himself or through his own employees,provided that such improvements are not Intended Mortared founds.if. however.the building or improvement is sold within one year of completion.the owwr- builder will have the burden of proving that he did not build w improve far purpose of sale.), ❑1,as owner of the property,am"elusively conmxting with licensed contractors to construct Ne project(Sec.7044,Business and Profeasiwts Code:)The Commemrs U. cense law does not apply An an owner of interiorly who Wilda or Improv.thereon,rad who contracts for such pmjec%wide a cvnwcmr(s)licensed pursuant in the Convactors Lace.Law. El I are exempt under S. ,B&PC for this.,Arm Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penury of perjury oma of the following declarations: 1 he.and will maintain a Certificate oconsent to self-imum for Worker'sCampen- sation.n provided for by Section 377 of the Labor Code,for the performance of dm work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,n m uimd by Section 3]00 of the Labor Code,for the performance of the work for which this permit is issued. Cam oher's.Campentation naunitce canis Pdl'<Poll �I CEw�nRTIFlG 1TEa!0.-ENSATI NIN FROM WORKERS' COMPENSATION INSURANCE Clow section need not W completed if the Permit Is forombund.d dollars(SIM) or less.) 1 certify Not in the Perfume""of to work Iw which this permit is issued I shall not employ any person in any manner n as in become subject to the Workers'CompennBon Laws of Calif..!..Dale Applicant NOTICE TO APPLICANT:If,after making this Ccatfcate of Exemption,you should become subject m Ne Worker's Comperma..provisions of Ne Letter Code,you must .J O forthwith comply with such provisions or this permit shall W deemed revoked. 'Z % CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructinn lending agency,for dee performance or (lir>-s one work for which this permit is issued(Sec.3097,Civ.C.) 0.Q Lendces Name Q z Lander's Address U Q 1 certify that 1 have read this application and sum that the shove information u LL H comecL 1 agree to comply wit all city and county ordinances and state laws relating to 0 building construction,and hereby authorize mprosenutivrs of this city to cale"rnn the W ahow-owntioned property for inspection purposes. y (WA)agree in new,indemnity and keep harmless But City of Cupertino against fq liabilices,judgments.costs ndexpc.m which may in any way accrue against mid City _ U Z, in cunuquence of the granting of this Permit. - APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR E ULATIONS. � J q" "a if Re-roofs Dole ig an I'Applica.90maoxwe Da HAZARDOUS MATERIALS DISCLOSUR4-� Type of Roof Will dm applicant or future building occupant now or handle havardous material as defined by the Cupertino Municipal Cade.aspect 9.12.and the Health and Safety ode.section 255320)?0Yes All roofs shall be inspected prior to any roofing material being installed. Nu Will the applicant or future building occupant An,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit havamous air contaminants As defined by Ne Bay Area Air Quality Management all new materials for inspection. District, J C]Yen IOnu I have mad the hzxmdous materials requirements under Chapter 6.95 of the Califor. nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand Nat if the Wilding dace not rally have a ratan that itis my reapomihility m noddy the occupant of the req 'ne which must Wm pooh.Waseca ofa Ccnificam of Occuproy. Si atU of Applicant late 1 All roof coverings to be Class'W l better Own r hmi.d agent Dam / Community Development J �( D/ / 10300 Torre Avenue - Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADD S: PER # ot 19- i 0l l OWNER'S rt PH 4M - j -3M GENERALCONTRACTOR: FAX # _ 3O .I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following 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 Ze Roofing Septic Tank Sheet Metal Sheet Rock Tile r/Contractor Signature ate �1 Community Development Department Building Division J City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P F IST 1 N 0 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 Y4"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•% Job Site Address: a O a O A C�1<! CH ,e; els L 4-V C� Roofing Company Name: QLD Gp f^ 6L:ffz: Aplicant's Signature I U/ Date: �� Y \ilI4S1ND�Xl Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO 0 REROOF CUPERTINO PERMIT APPLICATION FORM APN # Building Address: Q () IQ o C�'-hC l4—If? Owner's Name: on a2ILe . 6� No a� 99C a � 3 � Contractor: Phone #: License #: QLD C.oNNr ocne,06 '1oF - ea F30 o 6 C act: Phone #: Cupertino Business License #: / c�SScsTC f M YOB b`a 3=3 OeD O 3 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof `< Asphalt Shingles X Asphalt Shingles Cl 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. Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ob Description: r.-4 ism o vcs tsx i 5-0 tic y L X25 0 1- i- NST/+�t Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are an restrictions: U Cost of Pro'ect: Type of Construction: Occupancy group: 7¢ O O 0 0 3 Qty . A ca le J, 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 z077