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03070227lop lug Iq )WU xLL�O �00 -Zt NOR N OR ti to �z JO 'U �z T CITY OF CUPERTINO BUILDING DIVISION PERMIT GONTRACTnR�INFORMATION RUu.DINGADDRESS: 497 PATNROW DR RONNING ROOFING CONST PERMITN003070227 OWNER'S NAME: 868 HILLSDALE AVE PeaMIT Issue DATE KEN ONE: (408)265-8053 SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACI'd., DECLARATION Job Description P 1 )form that 1 em under provi.i of Chode, 9 (commencing gl g with Division 7of the Businusand Prufusinm Cotic.and myliccnse is ion? of MeThi ear ria �� f+ Pf,. •k�rB 11(.met(gHpae Lren rases anti mrre[(. % G REROOF ' License u LIc.N Da¢ Cut, DEC ARCHITECTS DEC AT10N 0 7 0009 AUG L J I icommtamd my plans shall he mod ss public meords 9 gByy((vvyy �� Licensed Prafesiional OW NE6 BUILDER DECLARATION BV O �.{Jy g3ei�51 1 hereby .term Nal I em exempt from Nc Contractor's License Lew for the following noon. (Sedan toot.. Battu and o county nm Cole: Any city which myuiru a Permit Improve. demolish, Ire any atrucmm vs,. de s construct, eller, nt 88000 prim In slissuance. re for asig w(naremcm ensedpalso n: to the the isionanf farsuchpermitmfiles Law (comm islicensedpuction to of theContractor'suanssand enxlawlChaprer9 Sq. FL Floor Area Valuation of Division 7 of the Cotic) or see with Section ]000) of exe and Profeon. 36230013.00 Mat he 6e basis alleged Any (hat he u exempt therefrom and the bili+ for Ne alleged exemption. Any violation of APN Number Occupancy Type P Y YP Section )071.5 by any applicant for a permit subjects the applicant to a civil penally of - not mon Nan five hundred deltan(SS00), C1 L u owner club property, m my employee. with imagism Manacle compensation, 3 05 -FRAME qd InsPeCtlOn$ will do the work entl Me+netme is morlmosided or offered for sale (Sec. Tull Business and Professions Code: The Contactme, Lt... Law does not apply to an owner of pmpeny who builds or improves Nemon, and who daassuch work himselfor through his 3 0 7 - I NSULAT IY own employees. provided No such improvements an not intended or offend for sale. If. 601 - ROOF TEAR OFF however. Ne building or improvement is writ within ane year of completion. Ne owner. builder will have the burden ofpmvi.g Nat the , bu e did ns,ild or improve for purpose of 602 - ROOF PLYWOOD NAIL uta.). 603 - ROOF BATTENS ❑ I.a+Owner of Me property, am exclusively commetingwith licensed conuectomta 604 - ROOF IN connmct the proper (Sec. 70", 0minu+and Prorcuions C.d.:) The Contractor's Li -PROGRESS - came raw does not apply to an owner or property who Wild, or improves (hemon, and, who contacts for such projects with aconuactor(s) licenced puissant to the Contractor's License raw. ❑ l am aempt under Sec. ,B&PC for this nsson Owner Dale WORKER'S COMPENSATIONDECLARATION I hereby affirm under Penalty of perjury one of the following 4claratiom: 1 have end will maintain a Cenifcam of Consent to self insure for Wmkda Compere ion, u provided for by Section 37M of Ne Labor Code, for Ne perromsance of Ne ' rk for which std. pit is issued. F1 ham and will maintain Worker's Compensation Insurance, u required by Section 1CM IR of Me Labor Cotic, for the performance of Ne work for which Nix permit is Issued. yWorker.Cnm�1fpensaIi//oJJ11� Insunx�//pp artier roti Policy num�bxer a11n/:rtier,s�t TQ t'/n.+vfi� Policy No.: Ay` -Ol CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not hecumpleted tithe permit Ie for one hundreddolhn (g IOG) cart) I certify Nat in the perfmmanee of the work for which this Permit is issued. I shall not employ any X.. in any man ssoh come subju(mthewfloari Compensation Laws or ciflifornia, Did _ Applicant NOTICE TO APPLICANT: If, Baer reek' g this Certificate of of Exemption, you should become Subject10the Worker's r+ComPcor Critic, of theLabor Coke, you mull miitihal rouhwilh enmPlY with such provisions or this Permit shell M deemed motet. this Farm CONSTRUCTION LENDING AGENCY I hereby Brim that then is a construction lending agency rot the performance of the work fur which this permit is iuucd (See. 3097, Civ. C.) Under's Name , Lcoden'. Add.. I county that 1 have mad this application and state that the above information is correct. l agree to comply with all city and county ordinances and sole laws totaling to building construction, and hereby aohorive rePruenni ivu of Nis city to enter upon the above mentioned property for impaction purposes. (We) agree to ssve, indemnify anti keep harmleu Ne City of Cupmnino ageing liabilities, judgments, costs and eapcnsca which may in anyway Beane against said City in consequent or the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Type of Roof Signature of Appliea HAZARDO DateHAZARDOUS MATERIALS DISCLOSURE tnnrc orhandleHealth us Will theepCup futurebuildingCode. lit scar u dconcd by Nc Cupenina Municipal Code, Chapter 9.12. entl the Health and Safety Charterand Conde. Seen.. 25532(x)? F-1 k. All roofs shall be inspected Prior to an roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which Iii h¢vamnus air contaminants ci desned by the Bay Area Air Quality Management all new materials for inspection. is(ric(? ❑Yes �jqu I have read the hmanduus materials requiremcros under Chapter 6.95 cilia Califon nis Health & Safety Code, Sections 25505.35577 and 25534.1 understand thm irthc building ?� O Jros no( currently hart a lenanl that it is my responsibility to entry, Ne .cup., of Ne ✓ requlgytmmuwhZus me(pnorxiammcmaracenincaworacamcy. Sgnature of Applicant Date � d�0 All roof coverings to be Class "B" or better 6 Owner or authorived ago at>� c ah, CITY OF UPERTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Subject: Re -roofing policy for the City of Cupertino Telephone: (408) 777-3228 Fax: (408) 777-3333 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 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: A ! --e_ I elJ h;v Job Site Address: Roofing Company Name: 20d� Il I ✓`C� ffae+f,K A plicant's Signature: Date: 7/ 3�) Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper 140 1 CUPERTINO CITY OF CUPERTINO7 REROOF b ° Z J PERMIT APPLICATION FORM APN # I Date: 3d O ? Building Address: ( 7V97�Y\ n�(J 2 Owner's Name: BUILDING Phone #: -e BPLANCHK Contractor: � P one #: a8)3�a 3��5 License #: Z/OS-Y7 Business License BUILDING Contact: Ph ne #: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ), Asphalt Shingles ,1231- Wood Shakes ❑ Wood Shakes 1Q Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings .2 ❑ Provide I.C.B.O. Report # sL To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: I Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are an actions: LJ Cost of Pro' t Type of Construction: Occupancy g Qty. if//�� Avvlioabe Fee ID Fee Description Fee GrouD 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 2'L,66�'� �g/3 7 2-D