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04090056
•. CITY OF CUPERTINO e$t�* 3K�e +a� = �' "'�" -'_� " `" BUILDING DIVISION PERMIT C,(SNTRAGT R 1�FFOR TATIUN; BUILDING ADDRESS: PERMIT NO. LEGACY ROOFING & WATERPROOFING 04090056 AM PERMIT ISSUE DATE -l;q?q1hhA if 860 PAULSTIeff ONE: SANITARY OL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO l� 0 LOU aLECTPLUM L0 286 LICENSED CONTRACTOR'S DECLARATION Id I Mrcby affirm Nat I am licensed under provialwu of Claimer 9 ware m sac ng Job Description Z�� with Sado ) )of Dwialon 3af the Business ad Prmfe ®Code,and my license is ^ Z Li m.C erten./•3 Lie.N 8 to 5 Dara l• canlraemr 'sae REROOF W/HEAVY SELECT SHAKES ygn ARCHITECT'S DECLARA N wale t omrdgrygnm lalll IJM fl u pis Licensed Pmfeuional IA OWNER-BUILDER OECI.xRAT10N +� I I herchy affirm that I am exempt from the Contractor)Licanm Law for the I� O O following moan.(section 7(01.5,Business and Pmfessiom Cade:MY city or county I $ which requires a permit to construct,aloe,improve,demolish,or mites any awemm 1-Z�e pram to its issuance,also requires the applicant for such permit ro file a aignctiMme , - NatheislicensedpursuantrotheprovisionsoftheCommunesLkenmlaw(CMpmr9 So. Ft'jFlodd a Val ,Sets (commenciagwithgmYon7ODO)of Divisim3ofthe Busimuend Rafedou Cmk)ur 3 that he u Ma exempt teform bole and the for the alleged exemption.My violation of Secdan 703LS by any applicant fora permit subjects Ne applicant ro a civil penalty ofa coat mom than Ron hundred dollars(M5 er00•� T; Occupancy Type ❑I,uowneroftMpmpdy.mmyemploymswlihvnguuthehmlccompcnudon, will do thewnh,ad tl a ammum Is mtinended aro@red fonele(See.7OµBualnus and Professions Cade:The Contractors License law dram Out apply an an awrcr of IIEd I spections ownproper,wyms.Wild,arimpmt such Impn, rod heweans daeesuchwmkhimmlredNr ughsale If. / ,f awnomployeWipmvidd met such Improwmatsin not intended on,leered the ow er. v boil.d)u the Wilding carimprowmmtlamid within oro yam of completion.the owmn builder will have the burden of proving Net k did not Wild or improve for purpose of uk.). ❑1,u owner of the property,me exclusively committing with licensed contractors to construct the Proles(See.7044.Business and Profauiou Code:)Tac Contrumrs Lt. mean Law dna not apply to an owner of property who Wilde or Improv women,and. who contracts for such pmjeeu with acontrmer(s)licensed pur aunt to tie Conwactors License Law. ❑I am exempt underSec. .B&P C fm thismann Owner Date WORKERS COMPENSATION DECLARATION 1 Mmby.M.under penalty of perjury am of the following declardom: 1 hers and will maintain aCeNOate of Commot IoselGWue far Waren Compen. udon,as provided for by Section 3700 of the LAWr Cade.fon the performance of de work for which this permit is laced. ❑1 haw and will maintain Workers Compensadon Insurance,u required by Section 37M of the labor Code,for the performance of the work fm which this permit is issued. My Workers CCoLmpewdore Tnaursmm a artier and Policy number am: Cartier: +'I Q& C M1 Poliry No.: Za�2215D` CERTIFICA OF E%PMPnON FROM KERS' COMPENSATION INSUBAN ( tlesmtlon need not bocoreplekd If1M Penult Is Corona hundred dollars($1011) or kis) 1 comfy that in the pe,fmmance of the work for which this permit is istmd.I shall not emplry,any person in any Insurer an as in became subject to the Worsen Compensation Laws of California.Dae Applicant NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should become subject k the Workar's Compcavtion provisions of the talar Code,you mew 0z forthwith comply with such Provisions or this permit Mall be deemed rewked. ZCONSTRUCTION LENDING AGENCY y 1'w (hereby affirm that Owns is a mnstractinn kndingagenry for the NoNnmemm of C'7 the wish for which this permit u issued(Sec.3097,Ch,C.) QLenders Name 7 z 1<nkh Addmu U O I c rely that I haw mad this application ad now that the same Informdm Is ' Ig.H comma I agree to comply with all city and county omtwems end sum law.reining to O U Wilding twnsWctlon.and hereby uthonre repmsenutiws of this city w corer upon me Liz aWw-mentiamd property for Inspection purposes. 4 (We)agree to taw,indemnify and keep harmless the City of Cupertino against Cn Uabtlides,judgments,ants and expenses which may in my way new,Mitimt said City U 7 in consequence of the granting of this permit. \/ G APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO POINT Issued by: Date SOURCE ON s II ../Ir(,...,C 4C5// ? 14n Re-roofs Signerom ofof AppllnNAZA nc r Dam XA2AR USMATgoccum Dnowor URE Type of Roof Will the applicant or future Wilding mcupmt r 9.1 or Mdlc haumom maedal C kOned io the Cupertino Municipal Car.Chapter 9.11,and the Health W Safety Com.pvm 3ss3z(a)7 ON. All roofs shall be inspected prior to any roofing material being installed. Will Oe applicant or future Wilding occupant tax equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove it haysmous air commune u defined by the Bay Area Atr Quality Management all new materials for inspection. iatric'? ❑Yon Nu Iswretl ehuamauamatdatsroquimmenuunkrCMpw6.95ofthe Califor. nig Hcolth&SalciyCok,Smtiom25505.15533ad25534.lunkmmdthuifde Wilding I O� dons not currently hew a moanis u m,thit my responsibility ndfy we occupant of No / s RRRis�I 1 Wi1�/1 m immenu ichmuaMmet 'ormtuusoMDf.cnifmatcorom 'y. SiatureofApplican Date t All roof coverings to be Cls"B" or better Owncr bonxed nt Dom Community Development 1' 10300 Torre Avenue " Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRB PERMTT# � 939� Sgk�r0. way oyo°toosb OWNER'S NAME: i c PHO yoll °l Rb GENERAL CO OR: AMM Le ac (. 4i FAX #i I am not using any subcontractors: S ature Date Please check applicable subcontractors and complete the following information 64 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 v Roofing Septic Tank Sheet Metal Sheet Rock Tile _ M==- } gll3�oy .,�7 /Contractor Signature Date Community Development Department Building Division r •City of Cupertino 10300 Torre Avenue % e Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 OUPEkTINO 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: Job Site Address: f9�z6 5n6uock Wo-A Roofing Company Name: LC 0.c R ;(\q £ Wcc�E CbcA (� A ph c" Signature: � Date: Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO q Sb GC. REROOF U / CUPEkTINO PERMIT APPLICATION FORM APN# © Date: 9 13 o Building Address. 19 388 Owner's Name: TPhone#:cti� � G 446 -Z41Z Contractor: r r Phone#: License#: 134aJcy �QnoTrnT ° (A/a.fegi-aMrn Nolj-4bl -oIS'o 802(osb Contact: J J Sob Rini 409 -ybl -olso Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: O Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes Wood Shakes ❑/ Wood Shingles t ❑ Wood Shingles i Other(Specify) CeMWiod ❑ Other(Specify) Tmberp� of existing coverings I ❑ 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: jew- A cer4\�06 roof ins+a.11 I 1 a�eC Zi` 30� (elf i�s 4a\\ Neon Se\ect S4 a\cesl Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are anrestrictions: IJ Cost of Project: m ,500 Type of Construction: Occupancy group: Re-fooF y. if /Apg1i4able Fee ID Fee Description Fee Group BPERMFEE Bld Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING