Loading...
050400040Q zo F W a U U.0 U CITY OF CUPERTINO QLenders Z p W LL fA '"'i" ac*.Ys=k u',R1b,.#' t°v +'1T�L ca A "�:' as k BUILDING DIVISION pERNIIT �;C01'TRACORTNFORMATON BUILDING ADDRESS: ERMIT 4400 S O 4 0 0 0 4 """05040004 OWNER'S NAME: - PERMIT ISSUE DATE 4,1111,12 ONE: SANITARY O. CONTROL NO. ARCHITBCTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PO lMECH � LICENSED CONIRACIOR'S DECLARATION Job Description P 1 hereby aOhm Nal 1 ate licensed under provisirm of Chapter 9 (Commencing with Salton 70110) of Division 3 of the Bestows ark ProfesC pa Code, dreylicc.l. u«°1CC eff I.g REROOF W/SHINGLES rate contractor CONTRACTOR: RORAGEN CONST. ARCHITECTS DECLAI TI N C I ndc d my plane shall he used as public record, Licensed PndesCral OWNER—BUILDER DECLARATION I hereby affirm that I M exempt from the Conti%toes License Law for IIIc rollewinp reason. (Section 7M 1.5, Bestows and Profession, Code: My City or county which requires a Permit to wnumct, ,hen mepmm demoliN. m repair any structure prior b its issuance, alsu requires the applicant forsuch Permit to flit a signed sum ment Nat he is licensed pursuant to Nc pmvismnanr he Ctmarcter's License Law (Chap= 9 Sq. Ft. Floor Area ValUa"000 '7 � (commencing with Section 7") of Division 3 of the Business and Professions Code) or Nat he is exempt denefrom and the bars for use alleged exemption. Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit Subjects Ne applicant N a Clvll Penally of not more Nan nw humored dollars (SSW). 01, as owner oftne property, a my employers with wages as their sole compencodon, 36204032.00 Required Inspections will do the we&. ark the structure is not Intended of offered for aale(Sec. 7044, Business and Profession Code: Th Contractors Liam Law dors not apply b an owner of 9 P property who builds Or Improves diamond. and who doessuchworkhtm elf e,through his own employeea, provided Nal such Improvements are, nmtintewe l mortared for nle.lf. ' however, Ne building or improvement Is sold within ten year MCompletion. the owncn builder WII have the Which of proving Nn he did not Wild m improve for Purpose Of sale.). ❑ 1. a Owner of the property, am exclusively contracting with licensed contaClrn be construct the project (Sec. 7094, Businw and Pmfusiom Code:) The Contrsterl Lb Cense law does nut apply to in owner of property who Wilds or improve, dereon, and who contracts for such projects with a conuacmr(s) licensed pursuant to the Contratoes License Law. ❑ I am asocial under Sm. , B& P C for this mare Owner Dan WORKER'S COMPENSATION DECLARATION 1 hereby alum under penalty of perjury ore of the following declensions: I have and will maintain a CesiRcmb of Cement to seif-insure for Worker, Compete adon, as provided for by Section 3700 of the Labor Code, for Ne perfom ores of the work for which this permit is iaad. ❑ 1 low and will maintain Workers Compensation Insurance, a required by Section 3700 of the Labor Code. for the performance of the work foe which this Permit is issued. My Works's Compensation Insurance carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE ( dissection need umbecomPleted Iftie permlt Is foroa hundred dollen(SIW) m lea) 1 that er theperformanceymam> wart for which iaad. I shall lid �Ntlnit's ploy in symsa atobecome sub' M' Compensation Loewe of CCifoedl�Dab Lawso Califf Applkenl 11 YY — - N A�L Cwmik t.ri afar making this Certificate of Exemption, you mind u become subject to previsions steal of Ne Labor Coke, you mus come subject ti Wohero Csion or this forthwith Comply with such provision or this Permlahall be darned mwked. it CONSTRUCTION LENDING AGENCY I hereby affirm that then is • Construction lending agency for de performance of the wuh for which thts permit is Issued (Sec 3071, Civ. C.) Name Lenders Addax 1 anify that I haw read this application and sun but Ne,bow information u Correct. I agree te Comply with all city and County ordinances and same lawn relating to building convection, and hereby authoCa MPONCO IM of this City to Color upon Nc above-mentioned property for Inspection pugpaL (We) agree to ave, indemnify and keep harmless the City of Cupertino against liabilities, judgment, costs and expenses which may in my way acme against said City APPLIC uencc N C;C ANDS AN WILL COMPLY WITH AL NON -POINT Issued by: Date SOUR REG A ONS. / 5 Re -roofs Type of Roof Signuun Applies r Dab HAZARDOUS MATERIALS DISCLOSURE Will the applicant or fusee Wilding uccuport Core or basic hasrdom material as defined by the Cupertino Monte ipel use. Chapter 9.11, and the Health and Safety ewe. Sesion 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes No WIII the applicant or future building occupant use equipment m devices which If a roof is installed witt.first obtaining an inspection, I agree to remove mit ha7mlous air communities as dcflned by the Bay Area Air Quality Management all new mater' or inspecti6n. District? ❑Yes Nu / thaw road Neha»Nnamsb0525333remenu underChapler G95Ofthe Glding /•w Jr� / nu HwalN ctyC 333aw 25339.1 umkmatk thmifde building / Jres n that onea sn Nu h b my responsibility lar notify ac ant of the re ice roue roil priorbivusce ofe Certifines f cup ry. Signature App Italic Dale �{ All roof coverings to be Class "B" or bets r owner en reel . lied ,gen, L CITY OF UPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 10 ,v ,t/ PERMIT # ()s'O 9 G G 0 OWNER'S NAME: PHONE # L S't'y ? '79 GENERAL CONTRACTOR p -A FAX # 944— -673 8 I am not using any subcontractors: S gnature ate Please check applicable subcontractors and complete the following information: -5wner/ Contractor Signature Date 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 -5wner/ Contractor Signature Date Community Development Department Building Division r City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408) 777-3228 U � � ��' NO 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 1 " ` and manufacturers specifications on re -roofing. - - — _2. New 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. z, ; t" s:..4. To receive a final sign off from the City„ the following steps are, �r required: r 1) ; Pre -inspection and/or tear off approval., ' 2), In -progress inspection.approval: -=:3) inspection approval. a) Spark arrester installation. 5 If plywood is installed, a.plywood nail inspection is requrreds'! 6 Any roofing which is applied withouffirst obtauung an mspection, will require the removal of all new material'down to the sheathing, . so'a' proper City inspection canbe performed i w 7 7r•- NOTE: If you_call for a plywood.nail'inspection and the job is not ready, you.will be charged a re -inspection fee of. $17618. _The re inspection fee must be Paid before another inspection can be scheduled. r fl, IMPORTANT. L. - . Flat roofs must have a minimum of 1/4 '' per, foot. slope and demonstrate, that there is no ponding. I An I.C.B.O. report is required to be on the job site at the time on inspection. J understand and will comply with the above stated policy. on re -roofing..' Homeowner's Name: C A(o Ln/ e Job Site Address: © �A/Wa1 y Q%. ^ Roofing Company Name: © O N5 Applicant's Signature: a 9 Greg Casteel Building Official Revised 11%2/04 Printed on Recycled Paper • ' ' IaTY-0 $CUPERTINO CITY OF CUPERTINO REROOF D PERMIT APPLICATION FORM APN # !36:t d .- - Bldg Permit Fees Date: .-�—� 63Z Energy BUILDING Building Address: Seismic Fee Res BUILDING , Owner's Name: BUILDING Phone #: Co or: Phone #: _ License #:_ S 0 2S S g b' ContactPhone #: Cupertino Business License #: A ��/ 7!? Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof , . , - _ , , . ❑ Built -Up roof ,9 --Asphalt Shingles gr --Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑'"Wood Shingles i ' ' ❑ Wood Shingles C3-" Other (Specify)' ' `" ❑ Other (Specify) C Number of existing coverings ❑ Provide I.C.B.O. Report # ❑:-.To be Removed . ❑ Provide Mfgr. Installation Specs.' J. Off Polic ❑ I Have Read, Understand and Will Coaly With -,Cu ertino's Tear Job Description: , Q�� i_p,.�.Q,�•pt,rtY e5 ee ep ACS 4%l SIG✓ _ Residential A- Commercial ❑:.:cr,. FireZone: Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: 600 PA-... .. • Qty. if Fen T)Pscrintinn Fee Groun 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