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04060127CITY OF CUPERTINO BUILDING DIVISION PERMITO.Rl�adi:>, BUILDING ADDRESS:" SECURITY ROOFING AIR SYSTE A91TN"04060127 20813 STEVENS CREEK BLVD WNER'S NAME: PERMIT ISSUE DATE J VOLCKMAN & ASSOCIATES, I C677 KINGS ROW 06/15/2004 ONE: SANITARY NO. CONTROL NO. (408)971-1777 ARCHITEC (ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 p LICENSED CONTRACTOR'S DECLARATION o JbDeac p `�6�p P F I h by affirm that 1 am licensed under provisions of Chapter 9 [commencing `� withSectio 7 )ufDIAslan3oftec Business ofcaaiuns Codc.aMm license is in rdl a cared. jL ^' �o REROOF �Ufl' em z Lice Lic.x 'Y ^ 20p^4 Dam Coal. ARCHITECTS DECLA TION I undwittund my plans shall be reed u p m record, A� aAiFOYQ p®� p f� ®iIV Licensed Professional OWNER -exempt frDECLARATION i L hereby .(Sere that 11. exempt from alt Contractors License Law for the O (Section RD LA Buainesa and Professions Code: Any city or county whichrcama h, structure which rcyuircs a permit re eomwcL pNr, improve, demolish, ri repair $16168 �n itscansed c, also ed for such Conourrmiuoiensele a Lsw haptc,l eco WConuecnoaandPrmLionsCopwr9 Sq. FL Floor Area Valuation that onor pursuant previsions epmvisision3 IhnWuncin with ofDivisionbasison 3 ed e and Code) or announcingexempth Sereiourn $ (comic the al eg e on. Any vi .. Nat he is exempt themlrom and Ne bask for Ne alleged exemption. Any vlola0on of is and a Occupancy Type Section 7031.5 by any applicant for a permit subjects the applkanu0 a civil penalty of nut mom than Ran hundred dollars f$Soo). ❑ L ownd of the ar n, atimmulea with wages u Nei( cW. Required Inspections os the mny, Bushman privateapply 70a4. us m is (Sec. will the wons and the aWdurc i.not nal apply lf an owner of s License Law wrier Of and Professions Code: The Contractors Licenx Law Pr property uch his enywha Wildeided esch intendeddmpleded for .a thatimin,aMwho.neu<tendeworcantered awome,, wtsarcne Ne owe teees,p buildingOr improvement wan, however, the building or improvement ts old within one year of console for of Wilder will Nva the burden of preying that N did not build or improv for purpose of ask.). ❑ 1, u owner of the property, am exclusively contracting with licensed contractors to contract the pmjed (Sec. 70x4, Business and Proftedom Cade:) The Contractors U came Law does not apply 0 an owner of property who Wilda or improves thereon, and who comma s for such pmjec0 with a commetor(s) licensed pursuant a the Conlnctor's License Law. ❑ 1 am exempt under Sec. , B & P C for this reason wrier Data WORKER'S COMPENSATION DECLARATION I hereby aRrm under penalty of perjury ane of the fallowing declarations: ❑ 1 have and will malnuln a CmtiRcaw ofConsenuo calf -Insure forworkerS Compm- nuan, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Permit is issued. ❑ I have and will maintain Worker's Cam ration Insurance, u required by Section 37W.fuccubm Code,forthe domain Ne w.rkfor which Nis permit is issued. My Worker' noon In camlr dprdiry number are: Ce 'e . my CERTIFICATE OF EXEMPfI OM WORKERS' COMPENSATION INSURANCE milasection need not becompleted dust rennin is fmone Wndrcddo]lan (SIM) or leas.) 1 certify that in the perfmm uran of the work for which Nis permit la issued, l Noll nut employ any person in any mannerm as to become subject to the Workers' Compensation Law. of California. Date Applicant NOTICE TO APPLICANT: If, after making this Cenifica a of Exemption, you should become subject in the Workers Compensation previsions of Ne Labor Cade, you must z, faMwith comply with such provisions or this permit shall be deemed rcvokho. CONSTRUCTION LENDLNGAGENCY y affirm hereby athi that there is a construction lending agency lar the performance of > the work for which this permit is issued (Sec. 3097, Civ, C.) Lenders Nam. Lender's Andres; z I cenlfy dial L have read this application and show that the shout information Is comtc'L 1 agree to comply with all city and county ordinances and sot, laws relating to building constriction. and hereby authmim representatives of this city to enter upon the shove -mentioned props ty far impetus. purpose. (We) agree to a , indemnify and keep Nnnless the City of Carnation against nliabilides,judgments, std said expenses which may in anyway came igalnsl mid City Zin c aerate of Nc ran ing of this permil. AP ANT U S NDS AND WILL COMPLY WIT L NO 0INT Issued by: Date O E GU A ON . Re -roofs Type of Roof 1. 0�igr4Xr3ofApaIicmaOcomMtor Data HAZARDOUS MATERIALS DISCLOSURE Will Ne applicant or future ]ding accupmumrc or handle hmardoua nuumod u defined by the Cupertino Muui Code, Cle 9.13, eM tW Health and Safety opal ads, section 25533(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑ Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant ar anding «cupnnl arc equipment or devices which mit hmardoua air conuminents atoned by the Bay Arca Air Quality Managm em. all new mat i is for •nspection. i.cot7 _W ❑ Yes ❑ o 1niaHcxlur&SaJr1yC �— I have mad the ha>ardnus materielsoequlremcnu underCNpterii.95 of the Califon ,Sectio M505.35533am12553a. l onrkrs Na fat Wildig at It is my responsibility w nou IW the rc cnswhich be tai rwiasuanccofa 'Ream tic p at OfA locant ate All roof coverings to be Class "B" or better owner a aamaria<a ant Daw CITY OF �UPERTINO • • GENERAL CONTRACTOR: 0 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 !•. IT4 IV= isOW03,51off M��,PVWW `7 R m I am not using any subcontractors: I "` 04\-1 Signature Please check applicable subcontractors and complete the following' ormation: Nhl Owner/ Contractor Signature bate 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 f Til Nhl Owner/ Contractor Signature bate is Is, J; CITY OF UPE TINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 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 j withthe above stated policy on re -roofing. Hnm' eo marLs Name: j Cv�l D,, Job Site Address: apll� fl Q)�__ I & Roofing Company A plicant's Signat� Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper • CLf.F.f�Tr kT IPINO • CITY OF CUPERTINO O g 04 p 1 2 REROOF PERMIT APPLICATION FORM APN #3 2- 6 �� Bldg -Permit Fees Date: BENERGY Energy BUILDING Buildin Address Seismic Fee Res BUILDING BSEISMICOM O er's me: BUILDING one #: Plan Check Fee BUILDING BUSLIC Contractor: BUILDING 'cen #: tact: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles '-B,,AsphaltShingles -'9, 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: Job Description: Residential ❑ Commercial Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Pro'ect:tractio Occupancy group: Qty. if AaKmAe Fee ID Fee Descrintion Fee Cirnun 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 z3 S7