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05080110 " CITY OF CUPERTINOY^ r*`.' BUILDING DIVISION PERMITaCONTRACTOR IN'FOATION "Gtir.A szC 'sur BUILDING ADDRESS: SIMON SAYS ROOFING PERMIT"x'05080110 18901 PT7NT)7RGAqT AVE OWNER'S NAME: PERMIT ISSUE DATE fIdlh LETICIA KING 3866 REXWOOD 08/12/2005 NE: SANITARY NO. CONTROL NO. (408) 531-9700 ARCHITECT7ENGINEER: BUILDING PERMIT INFO BO EO PLO MEOCH 30o LICENSED CONRACIOWS DECLARATION Job D(SSCrIpI100 I 1 hereby a(Rrm that I am licensed under pwvideres of Chapmr 9(commencing with Section 70BB of Division 3 of dm Business an Professions Codc.e my lice.is n� Wm11 WcrensI.a�nd REROOF--T/O TAR & GRAVEL, RESHEET 1/2" CDX Used 7[ `'« " D 30 YR. COMP ARCHITECTDECLARATION understand undernd my plane shall he used as public records S ] Licensed Profcmonal N OWNER-BUILDER DECLARATION I I binary affirm that I em aempn from the Contracting License Law for the p o following mason.(Section 703 1.5,Business and Prefessiuw Cade:Any city or aunty which requires a permit to construct.altar,improve,demolish,tar repair any i trusum prior an its Issuance,also mqulros the applicant forsuch permit To rile a signed mmmem €< IhalheislicensedpuraanttolheprevisionsoftheContracuu'Liawclaw(Chapter9 Sq.Ft. Floor Area Valu ilA.995 3 (commencing with Section 701 of Division 3 of the Business and Professions Cots)., Nat he Is excmpl therefrom and the basis for the alleged assumption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant W a civil pewby of APN Number Occupancy Type nil more to.to.hundred authors(SSW). 37533030 . 00 ❑I,uowtterofthepmpeny,mmycmploymwiO.M.dmbsoleamPemllom. wifi&de,work and the structure home intended or offered fnark(Sec.7044,Business Required Inspections and profession,Code:The ContacWg r's License Law donot apply W e an owner of q p property who Wildsorimprovm thereon.and who doaweh work himselformoigh his Aj.n� /yg own employes,Ping or improvement improvements artact year o(dmoQered fierstalsmeows. [I/(YC�a y`' however,the building w Improvement b sets within one Xv of ampletian,Ne owner. �A{714q� builder w01 have the burden of proving that he did net build or Improve for prywe of p sand. s!y//yJ�© El law rima not ap1.as owner of the property.am ly 1 W an owner of property y contractingrtwho i with licensed anuaclan W who contracts forsuch projects scontncro , licensedCersonalt the ConWr'sLI- �} ruct the License law. PnoF rt) builds or improves thereon.and, / cep p j ( purswniWthe Contractors /� glom exemp�uodm Sec7044,Businevpa�Prorcssio BkPCfar this rtawn Owner Data ._ _.—.. :e .............. .... . V WORKERS COMPENSATION DECLARATION - i hereby Aram under penalty of perjury one of the following declaneions: I hamand will maintains CeniftamofCowent W self-Invert for Woraces Compen. �:uw ,tion,as provided for,by Section 3700 of rix labor Cade,for the performance of the work for which this permit is issued. _ have and will maintain Woulmes Compensation Imuran,,as required by Section 3 of lho labor Code.far the peRamunce of to work for which this permit is issued. My Wodsefe C+om ¢tion In nate artier and Polity number art: Cartier. D U� Polity No,:Zee 'OV '1—t C HCATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE (This suction need not uncompleted HThe permit is portion hundred dollars($100) or less) 1 anify that in the performance of the adds for which this permit is Wood.i shall not employ any person In any manner an as W become subject to the Workers'Campenaelon Laws of California.Data ' Applicant NOTICE TO APPLICANT:If,altar making this Cenifiam or Exemption,you should become subject to rbc Worker's Compensation provisions of the later Codc,you most O'Z. rarthwith comply with such provisions or this permit shall be deemW mused. ZQ CONSTRUCTION LENDING AGENCY [-+ I hcmby Affirm that Vert is a construction lending agency far the performance of (ir',7 de,work fur which this permit is issued(Sec.3097,Civ.C.) W 0 Limiter Name a z Lender's Md. U Q I=try that I have mad this application and seta that the above Information is D, correct.I agree to comply with all city and county on inances and sum laws relating W 0 building construction.and hereby athoriae mprmautim of this city m enter upon ace [7d above-menumed property for inspection pompoms. py (WI agree ea ave.Indemnify and keep harmless the City of Cupertino against ,.yy liabllidesjudgments,coats and expenses which may In my wry acme against mid City U z In comegecrme of a Souring of IN is ., APPLICANT ERSfA ILL C PLY WITH ALL ON- INT Issued by: Date SOUR 0. ,� `/' 'I Re-roofs Signalureaf AppliantoConuactor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicant or fuum building oecup t Pare or handle huallous manorial as dented by the Cupertino Municipal Cade.Chapmr 9.12,and the Health and Safety cna, Yen:ss3z(ar 0Lr. All roofs shall he inspected prior to any roofing material being installed. Yat nu V TAU the applicant Of future building occupant use equipment or dcvica which If a roof is installed without first obtaining an inspection,I agree to remove it hamardnw air contaminants a defined by the Bay Area Air Omifty Management all new materials for inspection. hitt? /J ❑Yea ❑Nu e�r I have mW the hvaNnus mseriah requirements under Chapter 6.95 of he C,lifor. /G�1//!_!_�7f/ p�iy(��,/a • ria Health @SarcyCode,Sccdm 25505.25533 and 2553/.l understand des if the Wilding Jes nil curtcnlly ha a mnent.Oil responsibil'ty W nodry the oatsryryrynnn t of the rcyuiremcmv whit at bag met r a aara Ainam.r Ocamtod Signature of Applicant Date Owmrorau�zod.sml a Dam All roof coverings to be Class"B"or better Community Development 10300 Torn Avenue Cupertino CA 95014 Telephone(408)777-3228 aOF Fax(408)777-3333 �UPERTINO Building De artment JOB ADDRESS:/?4PERMIT # oi � a,� Q,u� 6s-6(fo�ia OWNER'S NAME: jPHONE # 7• -( / S-q GENERAL CONTRACTOR FAX# I am not using any subcontractors: S ezdg 2 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile G..s Owner/Contra or Signa a Date„ Community Development Department Building Division City of Cupertino 10300 Torre Avenue qURCITY OF Telephone: (408)777-3228 PE TFax: (408)777-3333 . INO 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/a " 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: Roofing Company Name: Applicants Signature: Pp Date: / Z os Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN# 7S, 3 Date: p�Z p s Building Add re s: 7?�O / Owner's Name-L v Phone#: 2 5 3 G S Contracto : I Ph #:#: License#: yoS s3i- 47 o u ��'t9�f g Contact: Phone#: � Cupertino Business License#: 2305 3 Type of Roof Covering: EXIS ►ng: 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 u ertino's Tear Off Policy: Job Descript' n: 7 s�^�i `e b X . Gt �D y� Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning D there are any restrictions: Eept. if Cost of Project: Type of Construction: Occupancy group: A ! S 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 os