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05050014 CITY OF CUPERTINO " �` * BUILDING DIVISION PERMIT Cd�l;l'RACT'l7RT1 'VRMA'TIO ' BUILDING ADDRESS: PERMIT NO. R A CONSTRUCTION 05050014 OWNER'S NAME: PERMTf ISSUE DATE INE: SANITARY OL NO. RCHI (ENGINEER: BUIIDINO PERMIT INFO BLDG ELECT PLUMB MECH �oij LICENSED CONTRACTOR'S DECLARATION Job I hereby affirm Wt l am Remand under provisions of Chapter 9(commencing VINALED tj Wth Snetbn]IXXB of DlvWon3oflN Businm and Profradaes Codc.and rslicaen in full ram and cf( o romChums o cvector a REROOF W/COMP. �ARCHI'IECTS DECLARATION -��- 2005 �i I understand my plana shell N umtl u public records �s/]F��- c Licensed donne,Orin BUIL I I� @fes OWNER-BUILDER DECLARATION I Proles ional that I em exempt from On Canmectora License Lew for the 0 o following mason.(Section 7031.5,Business and Professions Code:Any city at county $ which requires a panelt in construct,altar,improve.demolish,or repair any structure !nprior to its Warned,also requires the applicant for such Permit to file asigned uamment < than,m is licensed pumanuo the provisions of the Connector's Umm Law(Chapter 9 Sq.Ft. Floor Area Valera on a (commencing with Section 700,1)of Division 3 of the Business and Professions Code)or .. Net he m exempt therefrom and de basis fm the alleged cumpdan.My violation of Section 7031.5 by any appllan,for a permit subjects the i ppllanl to a civil penalty of �.�7,��,��,5,, not mom than five hundred dollars(M). 3ek_1'N v4*t r00 Occupancy�I�'pe ❑I,u owner of tN pmpmy.army employm with wgex a rich solo ampenudon. will do the work atl Ne strocten u no,immumded moRertd forasa(Sec.7016.Business and Pmfimdm,Cade:TN Ce nusemea Lams,Law dm not apply In an owner of Required Inspections propenywho Wilda orlmprovethereon,and whadmssmh wort himself or0uough his own cmploym.provided that much Improvements art not intended reoffered forage.If. however.the Wilding or improvement Is sold within arc year of impletion.the owner. Wilder will lave the WNcn of proving that he did not build m improve In purpose of u1e.). ❑1,es Owner of the property,am exclusively contracting with licensed aotrctms ro construct the project(Sec.7044.Business and Fmfessioas Code*The Commandoes Li- cc=law dm not apply b an down Of property who Wilds dor improve Berton,and, who contracts for such pm)mm with a contracmr(0 licensed pursuant m the Cannanore License Law. ❑I em exempt antler See .B&P C far this rtuov Owner Dna WORKER'S COMPENSATION DECLARATION 1 hereby a 5, antler penally of perjury ane of rime following dilvalions: 1 Nva end will milnuln acmdaate of Coasem a self-insure fm Workers Compan- ion,as provided for by Section 3700 of the labor Code,fm On Performance of the work for which this Permit is issued. ❑I have and will maintain Workers Compensation Insoraa,as audited by Section 3700 of the labor Code,far the performmec of the work for which this permit is issued. My Workers C.nommadat,livausum canter and Policy number am: Cartier. :57 61A4 Pellry,No.: CERTIFICATE OF EXEMPTION FROM R ERS COMPENSATION INSURANCE (ThmseNa need not becompleted If,be Permit Is forone,hundred dollw($100) m lemma) 1 codify Nat in the perfmmawe of the work for which this permit u issued.I shall not employ any person in any Mannar an u e become subject in On Worbas'Compemuadon Law of Califomla Data Applicant NOTICE TO APPLICANT:IL afar making this CeniOata of Exemption,you should lawar a subject W the Workers Compensation provisions of the Labor Cade.you muss ' ,J O forthwith comply with such provisions or this permit Mall be damrd ranked. Z ti CONSMUCI7ON LENDING AGENCY [.r I hereby allies thatthert Iso command.loading agony for the wrfanesoa Of Qi > the work for which this Permit m Issued(Sec.3097,CO.C.) YQ Iandcr's Nanta z Latrines Add. L)Q I certify that 1 Nva mad this application and state that f above information is {74 ;"! ones 1 agree a comply with all city and county ordinances and sera law mladng to p St.^J building conurucdon,and hereby auderim representatives afthis city to cnar upon IN {27 abovcmendonad property fm inspection purposes. (Wes)agree to ave,indemnify and keep harmless the City of Cupertino against IAA liabllides,judgmenta,cam and expenses which may in any way accom against mid City V 7 in consequence of Ne gaming of this Permit F7 APPLICANT UNDERSTAI D WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEREGYr3 Ig� —Z _d S' Re-roofs Signature ofVContracmr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant score m Nndlc hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety coda,Secdan 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yeso Will da applicant or future building occupant um cquipmal or device which If a roof is installed without first obtaining an inspection,I agree to remove it huardo s air eomamlnants defined by the Bay Area Air Quality Management all new materials for inspection. 7M. ric" ❑Yea Nu I haverttl thehafudrus maarialmmrtquirtments under Mpar6.95 of the Califon- / ✓D� odcWilding Out currently hew I tht1,hmynaixonhilitya andfy temowemofdeuire ntwhich met priors Num of.CcrtrfwloOfOcavpicy. S nes of Applicant Date All roof coverings to be Class"B"or better wner or mixed.gent Dow Community Development 10300 Torre Avenue iCupertino CA 95014 'f Telephone(408)777-3228 &COF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: PERMIT# /1' OS oDl OWNER'S NAME: IPHONE # GENERAL CONTRACTOR < # I am not using any subcontractors: Z—�✓� 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 Roofing Septic Tank Sheet Metal Sheet Rock • Tile Owner/C actor Signature Date Community Development Department Building Division e�I City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408) 777-3333 UPEkTINO 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 thesheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. 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: Sr�Iiv,O � � Job Site Address: Roofing Company Name: J� Applicant's Signature: Date: -z--O 5� Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper 1 a CITY OF CUPERTINO U S S REROOF CUPET IIINO PERMIT APPLICATION FORM APN # 3 �f 3 f D 7 D0 / Date: S 2 O� Building Address: Z � t:O Owner's Name: Sv2Fr�ir�2,� � Phone#: N;_ Contractor: ,y CS� Phone#*fg, License#:633y� Contact: (/1 Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Cl Asphalt Shingles Asphalt Shingles Wood Shakes X Wood Shakes ❑ 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: IV Job Description: W 1 WaoO(0 S 6) /�S'T✓�� ' Residential C mmercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are any restrictions: IJ Cost of Project: `7� Type of Construction: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group 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