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04060116CITY OF CUPERTINO BUILDING DIVISION PERMIT CO �� RACT(7R INFOluvrAT10 ,u BUILDING ADDRESS: DONE RIGHT INC PERMIT NO. 04060116 OWNER'S NAME: PERMIT ISSUE DATE 2 JNE: (402)372-2777 SANITARY J6,11411 0 AOL N0, ARCHITECT/ENGINEER: BUILDING PERMIT INFO -PLUMB BLDG ELECT MECH 0 LICENSED CONTRACTOR'S DECLARATION of Chapter 9 (commencing I hereby affirm TNI licensed under provisionso with Section Tll(IOluf Division=is Job Description. - P on.� tl\v\IIPI RL]S t� �® it, full m rad ffec REROOF W/COMP. vr'y 11y� - LicenmC Lk.M C IITECTS DECION LA JUL 2� 2004 I undersand my plans WII W usul u p records BUILDING Licensed Professional DER DECLARATION OWNER -BUILDER axe Law for the 1 Nrtco .(Tuns that 11. exempt from the Comm Any city at county Co eLicense AC following mama. (section.I,t7(131.5, Guiness and Professiunsd. Which permit m encs alley. impmsu or aWro or mPale any ewment pylar a, s atm the h permits statement I%Issuance. applicant for such rumor' LBIC fl1 Ft. Floor Area Valuation salgae(Chapt [sed nt to pro Sq. Code) or u sineslLlttnYlaw(Code)or mornm1ncing itrSemanIMINofDivisionfof Business (commencingwith Section7000) of Divisionr of al tpunexempton. Any sive he u a••mpI Nue(rom and the buts for the alleged exemption. Any violation of 3®kM]HTft0cr 00 Occupancy Type Section 7031.5 by any applicant for. permit subjects the Applicant la a civil penalty of not mom than Ove hundred dollars (5500). ❑ 1, u owner of the property, or my employees with wages as Nair sure compensation, Required Inspections will do the work and me strunort is not immrdea or offered forsal. IS". 70th, Business and Professions Code: The Ccnerommes Lt..Law docs not apply 10 an owner of q p property who bulldaoromproves Nercon, and whodecseuch wmkhimselfor through his own employees. provided Nm such Impmwments are not Intended croRercE for sale. If, however. the Wilding or improvement is sold within on year of completion, the owner. Wilder will haw tie burden of proving That he did not Wild or imrrow (w purpose of sale,). 1, as Owner of the property. em excursively contracting with limited Contractors m, maki IN pmjeu (Sec. 7044, Business and Professions Cade:) The Conlncmrt Li. cense law dots "o,apply to an owner of property who Wilde or improves Ihemon, and, who commits for such prejeeu with a contractors) licensed pursuant on the Conlrutors License law. ❑ l am exempt under See. B A P C for this mount , Owner Data WORKER'S COMPENSATION DECLARATION I hereby M. under Penalty of perjury one of the following dwlanlions: 1 ham and will maintain a CertiOcale of Consent m salf-Ovum for Workers Copper. , sauon, as provided far by Section 3700 of the Labor Code, for ted performance of the work for which this permit is issued. ❑ 1 haw and will maintain Workers Compensation Insurance, as required by Section 7700 of the labor Code. for the acirmamanc of the work fogwhich this permit is issued. My Workers Com lion I 'u and Polity�ncujm�per / Cartier. A ' 5AA - mI PoIIry No.: f/<i /� I ERTIFICATE OF EXEMPnON PHOF1 WORKERS' COMPENSATION INSU ANCE Cn'is suction need nal he comPlemd It the permit is fm onchundrtddollus (glm) or ICaa.) 1 certify saw' in the performance of the work for which this Permit is Issued, I shall not employ any person in any manner m w an income subject to that Workeri Compensation Laws of California. Deo: ' Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of ted Labor Code, you most forthwith comply with such provisions or this pe hnii chair Ise deemed ranked. CONSTRUCTION LENDING AGENCY 1 herchy affirm Na' NCM la A construction lending agency for dm Terfu 1pfrom of the work for which this permit is issued (Sec. 3097. Civ. C.) Tandem Name Lender's Addm3s I Certify dual 1 have mad this application and use, that the above information is ' comcel. 1 agree 0 comply with all city and county oNinances and sure laws muting to building connotation. and hereby authorise im munuthm of Nis City to color upon the aWw-mentioned property for collection purpose. (We) agree to saw, indemnify and keep humorous the City of Cupertino against Ilablliticajudgments, costs and expenses which may in any way accrue againtluid City e(W"2 in consequence of the gre ofthis rermil. APPLICANT UN DS AND WILL COMPLY W T ALL ON -POINT Issued by: Date SO URC RR ( J( (' Re -roofs Signe) manvconuscmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding acupantpom uhandic hasaedou material u de0ned by the Cupertino Monteal Code, Chapee 9.13, and the Health and Safety .do, smednn mount /p All roofs shall be inspected prior to any roofing material being installed. 0y. HNu If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant six cyuipmem of devices which cm0 hafardous air conuminanu u Fred by the Bay Ama Air Quality Management all new materials for ins tion. Diatrict7 ❑Yes Nu Ihew renal the hanadious..flat$ mqummoonts under Charter 6.95 of me Califar iia HcalthkSafety Ca to.. 23505, 35533 anU2353d.lunderstand lhulfNC Wilding JeCs nowu h enan4 Net it my mspouibili'y m notify the occupant of the mqui11 il ab, met pdorto issuance oraCCnifmau,ofOccupancy. Slgnat of Applicant Date All roof coverings to be Class "B" or better auNomad areal Oae ao 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 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>4 / t 1-r/y`krZ',1 t° Ae, Job Site Address /0 � Roofing Company Name: A plicant's(Si�gnature: Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper t ac,70 CUPERTINO t CITY OF CUPERTINO o �� REROOF PERMIT APPLICATION FORM APN #�� Bldg Permit Fees BUILDING Building Address: Energy Owner's Name: Phone #: 1 Contractor: Phone # BUILDING License #: Seismic Commercial BUILDING BPLANCHK Contact: Phone #:-• � Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof e Asphalt Shingles ❑ Built -Up roof s-�Asph'alt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing covering ❑ Provide I.C.B.O. Report # Cl To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description-' Residential ❑ Commerdal ❑ Fire Zone: Yes ❑ No ❑ Confirmed with anning t. if --- there are an frictions Cost of Project: r r --Type of C c ' n: Occupancy p: x, Qty- Annn14caltbe Fen, ID Fee Descrintion 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 � zs��