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04080106CITY OF CUPERTINO COIV RACT;OR INFUIWATIUN BUILDING DIVISION PERMIT Ai..'.y±.u.. dM185L[—iX BUILDING ADDRESS: R E ROOFING & CONSTRUCTIO PEMeO4080106 OWNER'S NAME: PERMIT ISSUE DATE 12 NE: SANITARY N O OL NO. ARC HMUC71ENGINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH 0 0 0 0 LICENSED CONIRA=R'S DECLARATION lob Description I hammy affirm that 1 am licensed under provisions of Chapter 9 (commencing P with,, I, 70llla fDivisio ofmW BusimsaaO Prof��s o ,antlmYliccnmis oda 22 u«se civ L. REROOF W/COMP. ALE® FAN Dam contractor ARC CI'a DEC R tun dmy Place she Wuwas rude AUG M 1004 Licensed Professional OWNER -BUILDER DECLARATION I hereby of ore that I am exempt form the Contractors License law for the following mann. (Section 7031.5. Business and Profevdons Code: Any city or county which requires a permit to convict. altar. Improve, demalkh, or repair any strumuro prior III Its issuance, also requires do applicant far meh Permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors Lkense Law(Chepmr9 Sq. Ft. Floor Area aw Somali I I T1151411on (commencing with Section 7000) of Division 3 of the Business and Professions Cale) or that he u exempt therefrom sod the bats for the allebed exemption. Any Amadan of �tva 3 AIM Y wwi� 0151&r 0 0 Occupancy I Pe P y ' T Section 7031.5 by Amy Applicant far A permit abjecu the aPPlkant to A civil pemhy of nom mom than five hundred done. ($500). J ❑ I.aowwoftepmperty,amyemployceawithwegeeuteiralecompenuuon, Required Inspections will do the work, and the structure is not ntended or offered for sam(Sec. 7(1 Business and Pmfasione Cade: The ConuLicense Law does not apply m an owner of escmr's q p property who builds or improves Nemo, and who Oat such work himaw f or through his own employee, provided Nat such I.P.W.ae, ice not intended aolfered Nhawa. If, however, Ne building or improvement is Bald within one yer of compledon, the owner. Milder will boom the buNcn of proving that he did cert Wild or improve for purpose of ick.). ❑ 1, as owner of the property, am "elusively contracting with licensed contractors to construct the pmject (Sec. 70441, Business and Profession Cade:) The Contractor's LL cave law dors not apply to an owner of property who Wilds or improves thereon, ad who convect for such project with a contactor(.) licensed pursuant an the Contractor's License Law. ❑sem "Ampt under Sec. B d: P C for this mason Owner Dau WORKERS COMPENSATION DECLARATION I hereby affirm under Penalty of perjury oro of the following declarations I have and will maintain a Certificate of Consent Woolf -insure for Workers Compare -iion, u provided for by Section 37011 of the Labor Code, for the performanceof tW for which this parrot is issued. 1 have And will maintain Worker! Compvuatian Insurance, ss mquimd by Section 300ofthe LaWr'Mam.9.thmmencemmmceof the work for which Nis permit iel iced. Workcf Campencoti a Instuvnce cam" And Polity n As art: Cartier. f Policy No.: CERTIFICATE 0 EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thiaxctinn need not W emapUmd if the Permit Is fmmmhundmd dolls. ($1 00) or lean) 1 « rdfy that in the performance of the work for which this Permit Is issued, 1 shall not employ any person In any manner an a m become subjoet to the Worker' Compensation Laws of California. Dat Appliant NOTICE TO APPLICANT: IL after making this Cenificam or EXAMPllon, you should become &object m the Workers Compensation provisions of Ne Labor Coca, ynu mum forthwith comply with such Provisions M, his permit NAZI W doomed revoked. CONSrRUC7nON LENDING AGENCY I hereby affirm that Vert is a construction lending agency for the, Performance of Ne wok for which this permit is fumed (San. 3097, Civ. C.) Lenders Name Lenders Address 1 cenify that I have read this application and sat Nu ted eWve information is comet, 1 Agree to comply with all city and county ordinances and sum laws rolating to building convection, and hereby authorime representatives; of this city to enter upon the slmvcmentmact! Property for inspection purposes. (We) agree to cove, indemnify es lith harmless the City of against s against Ilabiliu(We) judgments. case, and "pcnaaWhich hamnany way eCity f Cupertinoagainst City nccUN ER�nANDS AND WILL COMPLY WITH AL NOWPOINT APPLICA T Issued by: Date SOURCE R . U 7t v, ,. ( p �mL�DData / Re -roofs Type of Roof nu n ono r Data HAZA1{ppUS MATERIALS DISCLO tt�tEE Will the app man air future Wilding Occupant orh.N. hazardous mamrial As darned by the Cupertino Municipal ado. Chapter 9.11. and Use H"1th and SaQty Code. Section 25332(x)? All.roos shall be inspected prior to any roofing material being installed. ❑ Ya a Will dm applicant or future building =upon, use equipment ar Jcvi whim If a roo s installed without first obtaining an inspection, I agree to remove it hazardnm air canuminanu u Jcfmctl by Ne Bay Arta Air Quality nagcmcm I new m CI for inspection. S Distrin? (:]Y. IhaveroaJ the huardnusmateriolsmquimmcnu unJcrCepmr6.95x( Califon nuH it &SafctyCW,S dons25505,25533ad25534. runderstadlhu ifthe 'ding curmmly have A moat tel it u m mArAmAz ility m notify tW occupant of time- _ req' pdo m a r.eemreaor an Signat reofApplican Date All roof coverings to be Class "B" or better owner amoriza rat Da CITY Of UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 IveltM;�� HIM,, I "' jt� t" �e� ,.l b i l l t" i l k JOB ADDRESS: l l�q �ife�ti TL. PERMIT # 64 - 6 � 0 �0 b OWNER'S NAME: -5C-V9_ V-Tlh kL PHONE # 21 ,4 GENERAL CONTRACTOR: -T-,v- -ob�t N i FAX # L_ 2(0 - 1 l 6 I I am not using any subcontractors: Signature Date Please check applicable subcontractors and com Tete the followino, information: b � 6 ate 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 'e b � 6 ate CITY OF UPEI�TINO 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: Job Site Address: k9q -RICJC_ FL. l Roofing Company Ne: L_ -Ro QY � N I� C61J J�TK U1 C l 61'' \ l I C App]ican(Signatur, : �� Date: �� 3 J aAi •. J UAL Greg C,4Aeel Building Official Revised 1/30/03 Printed on Recycled Paper L C CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN # -� t / �,/ v S� Bldg Permit Fees Date: G I I Building Address: I Energy Owner's Name: BSEISMICRE Phone M. Contractor�I�IdJ � Phone � #: License #: Contact: ui�l�, Phone #: Cupertino Business License #: BUILDING BUSLIC 2G61S BUILDING Type of Roof Covering: Existing: Proposed: ❑. Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles � Asphalt Shingles j� Wood Shakes ❑ Wood Shakes d 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 Cu ertino's Tear Off Policy: Job Description: FCl�TN1 �_A-W� r)F V,)06I) 5l kyr l JSTM l2" CP � Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with PlanningDept. if there are any restrictions: E Cost of Project: VU Type of Construction: Occupancy group: 101006 .- Qty. if Aunlicable .Fee 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 4k` 70,5