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04050020 FICOF CUPERTINO Ru1L HNG DIVIs1oN PERMIT i CAL_UILDING ADDRESS: PRO ROOFING PERMIT Nfl 4'050020 WNER'S NAME: PERIXT ISSUE DATEROMO SALVADOR F ANT) ANDREA M 12135 PRICE WAY nrin4-,L9.nn4INE: SANITARY NO. CONTROL NO. 408 377-024RCHII'ECf/EIJGINEER: BUILDING PERMIT INFO BO EO PLO MEOCH >✓o'z LICENSED CONTRACTOR'S DECLARATION 7obDescri von i 1 hereby affirm that 1 em licensed under previsions of Chapter 9(commencing p n< "Issued. i )of Dlvialon3of Ne BusiasssmdPwfcsnonaC de.andmylicenmis <� onffl fore d ren o V 77$o TEAR OFF SHAKES y 8 g License Cl a -� LI0.N Dams COmator REPLACE WITH PLYWOOD--30 LB„/ , ARCH IIWwcTECTSDECLA o FELT & 30-YR. ELK 1 untl nJ my plain shell be used a Public Oki5 G t; CrProfessional 3 OWNER-BUILDER DECLARATION <� 1 hereby affirm that I am attempt from me Contractor's License Law for the / O O following reason.(Section](131.5,Business and Pmfesnons Cale:Any city or County s�$ which requires a permit to construct,alter.improve.demolish.Or repair any struclum rZi priorm i%iasuance,.Im requires the spittoon for such permit lm file salgn.dustarac l ss< that he is licensed pursuant to Me provisions of the Connector's License Law(chapter 9 Sq.Ft. Floor Area 37 Valuation F� (commencing with Section?")of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged eumpOOn.Any violation of $7000 Section 7ML5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type not mom than fivo hundred dollars(55007. p y '7 p 0 1,w owner of the property,Or my employees with wages as their sale compensation. will do thework and dm structure is not intended oroifemd Tonne(Sec.7044,Business and Professions Code:The Conumcmr's License Law does not apply m an Owner of Required IDSpeCIIOUS property who builds a r improves;Memon,a nd who does a uch work himself Or through his own employees,provided Nat such improvements arc not intended orDfRoad forsale.If. however,Ne building or Imprevement is sold within one year of completion.Ne owner- builder will have Ne burden of proving Nat W did not Wild or improve for purpose of aleJ, ❑1.as owner of the property.am exclusively connoting with licensed contractors to construct the pmjecl(Sec.7044,Business and Professions Code:)The Contrecmr's Lt. Came Law does not apply in an owner of property who Wilds or improves Mereon,and who contracts for such projects wish a can assefor(a)licensed pursuant in the Conaacmfs License Law. 0 1 are exempt under Sec. .B k P C for this mason Owner Date WORKER'S COMPENSA71ON DECLARATION I hereby aRmn under penalty of perjury one of Ne following decimations: I have and will maintain a Card tate of Consent to self-insum for Worker's Compen. 7031('W on,ss provided for by Section 3700 of the labor Code,for the performance of the rk for which this permit is Issued. I have and will maintain Worker's Compensation Insurance,v required by Section of the Labor Code,for the per(mmanec of the work for which this permit is issued. y Workers Compensation Insurance ember and Policy number am: CKCERTIFICATE OF EKEMPf1 6'hi WORKERS' COMPENSATION INSURANCE (Thlssection wed notbecompleted if lW Permit is foram,hundred dollars($IN) or less.) 1 certify that in the performance of Ne work for which do.permit is issued,1 shall not employ any person in any manner an as to became subject to the Workers*Compensation Laws of California.Data Applicant NGnCE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of Ne Labor Code.you mum ,J O forthwith comply with such provinces at this permit snail be deemed invoked. z a CONSTRUCTION LENDING AGENCY [r 1 hereby affirm that there is a construction lending agency for the Performance of (Yi > Ne work for which Nis Permit is issued(Sec.3097,Civ.C.) t7 Lender's Name z Lcnder's Address V 0 1 certify that 1 have mad this application and seem Net Ne above infomutlou is IT, fr Carmel.I agree to comply with all city and county ordinances and mule laws reining to O V building Construction.and hemby authorize ropmeentadviu;of this city to enter upon the t3.1 ahovcros,judgdprogeny for impaction purpowhich may (We)agree m Cave.indemnify and keep harmless the City of Cupertino against „y Z in othecraningof thisexpenses pcmit. may In any way seem,against said City C)z in conarquene,of the grantinC of this permit. I"t //APPLICANT UNDERSTANDS pAND l)WILL COMPLY WITH ALL N144N-POINT Issued by: Date <P16L_J SO I/I CE I J 4 2aoy Re-roofs qm of Applic HAZARDOUS MATERIALS LOSURE� Type Of Roof Will the apPlicam or (inure building occupant srorc or handle hazardous material Id,sm by the Cupertino Municipal Code,Chapter 9.13,and Me Health and Safety oJc,Section 25533(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes �NoWill the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. istrict? OYcs 1I NuIh&Sect the Wrardouamamrlals 5,255 3wd2ts 4.lunder Chapter dcmm6 alifthc WildingimHcalth@Safclyhave 4Sccdonshat iti my respd25534.1unJcrsmndNall(the Wilding not curtently hove a mnel.shat it u my respovihiliry m notify the acupant of Ne ��immcntswIt In st tdctpdo tui a cc.(accrifcateofOccu rete L Signatu of Applicant Date Ow r alhorizcd.,art J/ LII am All roof coverings to be Class "B" or better x Community Development j 4 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 UPEkTINO Building Department JOB ADD : C I V ' T # ' 3 `T9 S , 6 a � OWNER'SN p o PHO d -377oay GENERAL CO CTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 137 Roofing YC f RIO n o , Septic Tank Sheet Metal Sheet Rock Tile /Contractor Signature ate Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY Of Telephone: (408)777-3228 4UPEkTINO 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 " 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•ihe time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: -�O FAO Job Site Address: la p I Roofing Company Name: Aplicant's Signature: Date: 4 l� Greg teel Building Official Revised 1/30/03 Primed on Recycled Paper CITY OF CUPERTINO GGl50a� REROOF CUPERTINO PERMIT APPLICATION FORM APN# DS. Ll © a Building 6 ,3 re N ( C Owne 'sN e: ph one 2 S3 7 g Contractor: Phone#: License#: C — f fo 0o N 6 g a Contac : Phone#: Cupertino Business License#: J � S yd ? -3770 a. L11 I Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt ShinglesAsphalt Shingles D4 Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings�_ ❑ Provide I.C.B.O.Report# IR To be Removed ❑ Provide Mfgr. Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic ❑ Job Description: +e AP, o 1 _ 1A ;res 11 0Residential Commercial ❑Fire Zone: Yes ❑ No ❑ Confirmed wng Deptthere are anCost of Project: Type of Cons c Occupancy g 7050 - v r Qty. . A i Fee ID Fee Description Fee Group BPERMFEE BldgPermit Fees BUILDING NERGY Ener BUILDING SEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING