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03060156 CITY OF CUPESIONNO Pl CQ RACTOR4INFORMATION-tf BUILDING DIVISION P1✓RMTl �;� , BDaDINC ADDRESS: WOODS ROOFING PERMIT No.03060156 OWNERS NAME: 2179 STONE AVENUE STE 22 PERMITISSUEDATE L (831) 637-5576 NE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Q = (� +00 LICENSED CONTRACTOR'S DECLARATION JobDescription. 1 lumby affirm that 1 am licensed under provimim,or Chepmr 9lcommcneing with Section? M))of Division Sof the Business and Prorcnteus Cedc,end my license is ^M„ L ease ana�r�'q y 31+ x`/3/ T/O SHAKES AND W/SHINGLE, ADD�DEC�RA STEEL TILE 'M License Cp,y Lic.a Q ee Dam fU gitCHnECPS DECLARATION - JUL 3 0 2003 E Iundcraumdmy plansahall krecdapuhllemcnNa paddd BUILDING'N LicensedPmfeninnai BUILDING OatNEm BUILDER DECLARATION IOO 1 hereby moo of Brm on I em exempt from the Contractor's License law for the 0 0 followwhich moon,Permit t VD L4 Business, tar.ire r ve d a oli Code;Any tiny er county S m which rats issuan Permit re construct,t,trine,improve,demoliit t fi relish any structure Z i that he nno its issuance,six. in the thovisio s offm inch permiuo fide s eLaw(Chapter t Ip (commencingwJpu.utrn7")ofDivisionoftheBffic uinessandPrselaonsCodcr9 Sq.F[.Floor Area Valuation $ (commencing he I,xempth Sectiw.fo rn it O basis r of the Alleged coca old Professions vi Coale)or Y Nn he is exempt Ncm(rom end Ne buts far dr alleged cnmption.Any violation of 36226010 . 00 Section 7071.5 by any applicant for a Permit objects the applicant to a civil penalty of APN Number Occupancy Type not mom Nan five hundred della.IS500). 0 1,As owner of the pmpeny,or my employees with wages u their sole mmpcnsation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Customs — Re mired Ins eCIiOHS and Profusions Cade:The Contractor's License Law docs not apply m an owner of 307 - I NSUL R I ON P pmimprove sh peny who buildsor emon.and who deesauch work himselfor through his . . . . own employees,provided that such improvements are not intended or offered for sale.If. 601 — ROOF TEAR OFF however,the building or improvement is wild within one yew of completion,Ne owner. builder will have the burden of proving at k did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL f1C.). 603 - ROOF BATTENS ❑1,as owner of the property,am exclusively convecting with licensed contractors to construct the project(Sec.7W,Business and Professions Code:)The Contracwts Li. 604 — ROOF IN-PROGRESS cense law dors not apply m an owner of property who Wilds or improves Norton.and, who contracts for such projects wish a contractor(s)licensed pursuant to the Commences License Law. ❑I am exempt under Sec. .B B P C for this rcamn O1371M ner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty,of Perjury ate of dr following delwstions: I haw and will mainuin a Ccohicate of Consent eel Ginsum for Worker'.Compere on,as provided for by Section 571M]of the Ichor Code.fen dr performance of Nc rk for which Nis Permit to issued. I have end will maintain Worker's Compemeadom Insurance,as required by Section of the labor Cede,for Ne performre of the work for which Nis Permit is issued. Wrirke,Cn penudon lruunna artier and Policy.n�uumyybee�r wa:rier. gr� Policy No.;rjC CERTIF CATS OF E%EMPTION FROM WORKERS' COMPENSATION INSURANCE (The section need not kcnmplcted true paomin Is for one hundred dollen all00) or less) I cenify shat in the perromunce or the work for which this Permit is issued,I shall not employ any person in any manner an As m become subject to tk Workeri Compensation Laws of CMlirornia.Date Applicant NOTICE TO APPLICANT:IL atter making this Cenireate of Exemption,you should become subject to the Workers Cmmpacomm on provisions of the labor Code.you mum .J O renhwilh complyus m with such pow,inthis permit shall k domedev roked. Z n CONSTRUCTION LENDING AGENCY H Iherehy affirm than there is a construcninn lending agency fon tbe Performance or Clithe work for which this permit Is Issued(Sec.5097,Civ.C.) GQ Under's Name =z Lenders Address U 0 1..try that 1 have end this aprolmom and satecshat she above information is la. P correct l agree to comply with all city and county ordinances and sum laws misting to C U building construction,and hereby authorize representatives of this city to enter upon the fbl ahow-mentioned prolixity for inspection purposes. (We)ogre.to eve,indemnify and keep harmless the City of Cupertino against ti N liabilities,judgment,crisis and expmves which may to any way accrue against said City U z in consequence of she granting or this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON OI NT Issued by: Date SOURCE REGULA NS. L Re-roofs Signmum of am HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant of forum building occupant mesa or handle heordo is mamaat As defined by the Cu mo Municipal Code,Chapter 9.12,and the Health and Safety endo,Sctmm.zssyxm)? All roofs shall be inspected Prior to an roofing material bei. installed. ❑Ye �Nri P P Y 8 g win th spline n1 er mlare building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove in ict, us tie con inane ss Jefincd by Nc Bry Arta Air Quality Management all new materials for inspection. it lct? ❑Yes Nu [have mad she huuNnm mamrlab rtyvirtmcnu under Chapmr6.95 of she Giifory ria HcalshG Sntlyhow a umannwhat It is rormowhilitl AsAmorn t thmiDk Wilding docs not currently how a tenenq Net 0 is my mspousihility m nndl'y nM occupant f Nc tcyuimmcros which mum mel pdoru iuu fa Ccnifi mof Occupant Signature of Applicant Date ower or aushort n 7 Dale All roof coverings to be Class "B" or better Community Development Department Building Division City of Cupertino 10300 Torre Avenue a"� 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 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: 1.aM, 14-L Job Site Address: /// -- Roofing Company Name: Lo LS A plicant's Signature: Date: \�l/a61/OD�X� Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper 030(0 'o CITY OF CUPERTINO OREROOF CUPEkTINO PERMIT APPLICATION FORM APN# .� � 2 2 � a / © Date: Building Address: Owner's Name: Phone#t9 9 6 —/ 9 5 9 Contra or: Phone#: 03 License#: c, ,r�-z� 6 L/0- o� Contac : Phone#: (o a S — S/ (S Cupertino Business License#: a f'/ D Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles ❑ Asphalt Shingles Wood Shakes ❑ Wood Shakes `¢ Wood Shingles Cl Wood Shingles (� ❑ Other(Specify) $ Other(Specify) �o� Number of existing coverings 2 13 Provide I.C.B.O.Report#� To be Removed ❑ Provide Mfgr. Installation Specs. :mlI Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job esc ' ti Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost o Project: Type of Construction: Occupancy group: /� 6ou . Qty. if Applicable Fee ID Fee Description Fee'Grou 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 T w 2 2S" � 6g - In