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04030059CITY OF CUPERTINO �` �±'''" BUILDING DIVISION PERMIT /� �`3 % WONTRA�0RA. V6 sRODRIGUEZ A�,'161' BUILDING ADDRESS: APOLONIO AND LOU IITNO04030059 OW NEWS NAME: PERMIT ISSUE DATE RODRI ONE: SANITARY NO. CONTROL NO. ARCHITECDENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 bereby Air. that 1 am licmucd under provisions of Chapter 9 (commencing with Section 70th)) ofDMM.A 3 of the Business and Professions Code, and my license is in fun tone and effect. RERCG F License Class Lm.N Dam Contractor T/O (E) WOOD SHINGLE /REPLACE WITH NEW ARCHITECT'S DECLARATION I understand my plans shall bee used u public records .. Licensed Professional OWNER - BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason. (Section 7031.5. Business and Protcesiuns Cade: Any city or county which esquires a permit to castmcL altar, improve. demolish, or repair any structurd prior to its issuance. also Acquires the applicant for such permit to file a signed stsmmant that he is licensed pursuant o the provisions of the Conmctm'A Limn. taw (Chap. 9 Sq. Ft. Floor Area Valust' (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that M is exempt therefrom and the beau for the alleged exemption. Any violatfon of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the'Plicant to a civil Penalty of not more than five hundred dollars (1500). C] 1, as owner ofthe property, or my employees with wages as encomia compensation, 35922005.00 Required In will do Newark and the sBadum is not intended oratfered forsam (Sec. 70/4. Business and Professions Code: The Contractor's Liceve Law does not apply a an owner of property who buildsorimproves Hereon. and whodassmh work himalfar through his (iC +[1ai 11� r� own employees, provided Nat such improvements art not intended oroEeed forsale.If, i aU^ L19�©. however. lie building ar improvement I. sold within one year of completion, the owner rssa builder will have the twirl n of proving Nat he did not build or improve far purpose of °m' AUG 11 2004 ❑ 1, as owner of the property. am exclusively conducting with licensed contractors be construct the projhcl (Sec. 70,14. Business and Professions Code:) The Contractors Li- cense taw does not apply to an owner of property who builds or improves thereon, and . pB� who mntmcte for such pmjecu with a commaor(s) Imensed pursuant to the Commutes U ®8., emm Law. B1YV� 1 am exempt under Sec. . B Ar P C for this mason owner %" Dam 87 eb 0`7 WORKER'S COMPENSATION DE 1 hereby atoms under penalty of perjury one of the following declsamiam: I haw and will maintain a Certificate of Consent to ml6inmm for Worker's Camped. sation, as pmvidcd for by Section 37011 of me labor Code, for the perfurmanm of the work for which this permit is issued. ❑ I ban and will maintain Worker's Compensation Insurance, es required by Section 37W of the labor Cade. far the crfmmmm of the work for which this permit is issued My Worker's Compensation Inman a carrier and Policy number am: Cartier. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need at be completed if she Permit Is fmrone hundred dolun (Slip) or less.) P certify that in the performance of the work for which this permit is issued, l shall not employan min any same,,. as to b Tame subLul to the Worlacrs 'Compemadon Laws of Ca A. Date o - AP licant / af� N E TO APPLICANT: If, after making this Certificate of Exemption, you should b e subject a the Worker's Compensation provisions of the labor Coda you must foMwith comply with rah provisions or this permit shall W deemed ranked. CONSTRUCTION LENDING AGENCY I hemby affirm that them is a construction lending agency for the performance of the work for which Nu permit Is issued (Sec. 3097. Civ. C.) Lender's Name 1<mer's Address 1 certify Ner 1 haw mad this application and sum that the above information is ' correct I agree to comply with all tidy and county ordinances and sum laws relating to building construction, and hereby autharim feprosemarins of this city to enter upon the above- mentioned properly for inspection purposes. (We) agree to ran, indemnify and keep harmless the City of Cupertino against liabilities, judgments. costs and expenses which may in any way accme against said City a, in of the granting of this rmit. V APPLICANTeUNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. 63 td 6r' Re -roofs , Type of Roof SA of ApplimWCamrutor Debt HAZARDOUS MATERIALS DISCLOSURE WIII the applicant or future building accupantstom or handle havardous material u defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety ode. Section 25532(a).r All roofs shall be inspected prior to an roofing material being Installed. P P Y g ❑ Yes e+ «—. 0 g If a roof is installed without first obtaining an inspection, I agree to remove WAIT the applicant or future building occupant use equipment or devices which it lumoadous air conuminamu as defined by the Bay Area Air Qualily Management all new materials for inspection. District? oyes $fn I ham mad Nmid, Sedates 25505,25533mme5534.I rChapmdthaLitho Wilding spo25534.1 Samtyhaw occu J doHcaWc& a usom that I, i my r art, oring dos not currently ban a mmnt Nat it is my responsibility W notify Nc omupant of Nc w notify t e, — requiremcnu which mum Im= I poor W issuance ofaCenificam ofOccupancy. T SI naturfApplieant Date eo Gi3 06 a°/ All roof coverings to be Class "B" or better Owner or or-two ogees Dam J If cc Community Development \` 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777 -3228 Fax (408) 777 -3333 Building Department JOB ADDRESSNd /0 -';27Y S Srelf iN S 1,Q- edyg7 C,* Ct 5-0 ch( PERMIT # OWNER'S NAME. of i /J t'0 C,4 us ue2 PHONE Cfte GENERAL CONTRACTOR: FAX # I am not using any subcontractors: / %`?- r / 0 d'( Signature V Date Please check annlicable subcontrarfora nncd rmmnlafa flip f�n�U.;,,e ;, f ,, ,,�+ ,,• - Ow ignature D3 lO Ocr'- �, Date 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 - Ow ignature D3 lO Ocr'- �, Date Community Development Department Building Division avtn City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408) 777 -3228 U P E ITT I N O 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. 40 Homeowner's Name: of X � O � C7in^. G ce Z Job Site Address: e/0 31 G% 1-v Roofing Company Name: A plicant's Signature: Greg teel Building Official �"'-- Date: 63�ooY Revised 1 /30/03 Printed on Recycled Paper Q s L 1 I O CUPERTINO CITY OF CUPERTINO �q REROOF C;-� C) PERMIT APPLICATION FORM APN # 3!5 I--[ "2Z -O o S — Dater V1 OZ a Building Address: /09 3 `/ S 57`el�/ �/ 2�% e� C4 9501y Owner's Name: BENERGY Phone #: d 'Al f `0 12 /,,, fi 46 Contractor: Phone #: License #: SeiF Saws oi,• b o 6 2s 3 gg' Contact: u Phone #: (5' ,V, . /f6 Cupertino Business License #: Plan Check Fee Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof • Asphalt Shingles ❑ Asphalt Shingles • Wood Shakes ❑ 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: El_ Job Description- �1 Pao �e fhs.`ST %�g g wC�f? s nt vg t e a QQPfg�� w %{ c New Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Proj `i 3 I p 0 Type of Cb—n iw Occupancy group: IMOT . - FPP M I FPP TlPOnr...r...n 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