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04120138CITY OF CUPERTINO /�-��:�7?�r^{{�n.a« �v ,� ^•r{k 7y�t�ttdy p° ''�'�eA,�� I` �-'��+y a ' L3 r�R1YlATl:11\ ' BUILDING DIVISION, PERMITc'Vt'L�V�vL� " BUILDING ADDRESS: _ - )1731 STEVENS rRRRY ATAM ANTHONY ROOF SERVICE " PEt`MITNO04120138 OWNER'S NAME: PERMD'IS6UEDATE URI FREELAND ONE: SANITARY NO. CONTROL NO. ' ' 408 265-51 ARCHITECT/ENGINEER:.. ;.'• •. - .., , • - -' BUILDING PERMIT INFO . '. BLDG - ELECT PLUMB "• MECH LICENSED CONTRACTOR'S DECLARATION mmewing _ Job Description affirm deet ram lion n pmviaan, of chapter 9 (or 0(10) of Divirion 3 Orionis PrefeWuas Code.and my It.. I.d`tLm./4/ Aiby REROOF- - ARCNOECI'SD _.—ON - /. 1 undersand my plans alWl ba used u public records - Licensed Professional OWNER-BUIIDER�DECLARATION - - — '1 hereby Affirm that I am exempt'From the Commoner License Law for the - - - following rtuon. (Section 7031.5. Business and Pmftessiuu Code: Any city ser county - which acquires a Inner,to contact, alcor, improve, demolish, or repair my structure - prior in its issuance, also requires the applicant for such Permit to rile s signed statement that heialicensed pursuaminthe provisiduoftheContrmw,aueanmLaw (Chapter 9 . .- Sq. Ft. Floor Area . luauon (commenting wide Sectio" 7000) of Division 3 of the Business and Professions Code) or dot he Is uempt thetefmm and the basis far die alleged exemption. Any vloladou of _ .. 3 WMGIbfter0 0 .cFtlpancy Type--_—, Section 7031.5 by any applicant for a permit mbkcla the applicant to a civil penalty of nm moil them, five hundred doll. ($SM. JJ rte. ❑ 1, u owner of the property. Or my employee. with nW u theb ale compemation, Required Inspections " - will do Ne work and da sweum u wt i.=dcd w oRemd far ask (sm. 70 . BuW w or and ProfeWam code: The Coubmors Lima law doe. rot Apply w an owns of Propa ny who buildsea Improve,; dwseon, andwhadoe.amh work himae fmlNough his .. . . awn employees. provided Nn such improvements am but intended oroQemd feature. if. - however, the building or impmvemml is mid within one year of completion. the Owner. - Wilder will have that burden of Paving that he did not build or Improve for purpose of • . ... - -. sale.). ❑ 1, ea canner of the property am emlusively contracting with licensed conswum in ser construct the pmject (Sm. 7014; Business and Professions Code:) The Contractor's Li. - cousin Law docs not apply to in owner of property who builds or improves thereon. and, who common for such projects with a commucor(a) licensed pursuant w the Cameramen - License Law. Iamuemptunder Sec..- .B&PCror Msreuor Owner - Dme WORKERSCOMPENSATIONDECLARAT00N- IherbyafNmunderpcnALYofperjuryowofrixfollowingd it me: I have and will maintain aCerdfiwaefCamwit to self -loom for Workers Compere Winn, u provided for by Station 3700 of the Later Cade, fm the pert... of the work for which this penal is issued. Workers Compensation Insurance• as acquired by Station ❑ 1 an and will me noon Workpe 3 fthe Tamm Code• far the perfermanm of We work far which this permit is Wood. .. —... ' orno's Cc emus. nncgeeni n cY nu�}b jptr4O/D P C CE TIFICATE OF EXEDS ONI- COMPENSA76NINSURANCE - (Thlssection wed notbecompleted inhe prate taforam, hundmeddollam (SIM) w lefa) 1 sanity that in the Performance or the work for which this permit is Owed, I Snail am employ any pcnan in my mmwrm u at become abject an the Workeri CompuNan Lawlor CAlifthooL Dam- Applicent - NOTICE 70 APPLICAM: IE afar mrting this Cenifials of Exemption, you should become subject w the Workout Compensation provisions of that Lahr Code, you ata foMwith comply with such pmviuma or this Permit shall be dcemed revel CONSTRUCTION LENDING AGENCY I hemnyahfin that then It a construction lending agency for the performma of .. . the work for which this permit is issued (Sec:3097, Civ. C.) Lender's Nme Lender's Address I certify that I have mud this application and also that the above Information is conncL 1 Agree to comply with all city and county oN namxnnd sea len minting to building conswclion, and hereby authanne representatives of this city to cmenr upon the unove- ee ny fm inspection^n Purpura (We) agree to ;am, indemnify and keep the Jac of Cupertino againstIiabilitie..judgmenu. cam mdexpe"••which may in my nyacme against saidCity in consequence of the grmtln µ ptlmll. APPLICA WILL COMPLY WITH ALL NON -POINT - - Issued by: Date RE Re -roofs Type of Roof a lican onaacor De ' HAZARDOUS MATERIALS DISCLOSURE WIII the applicant or future building accupAm sore or handle hrardous maarial u dc0ned by the Cupertinounicipal Code. Chapter 9.11. and tis Hulth and Safely oda. Section ss31(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes u If a roof is installed without first obtaining an inspection, I agree to remove von nc appnaant ser, nue building o upem use cyulpmcnt or devi es which It hesrdnus air comaainemt a defined by Nat Bay Aro Air Quality Menagenanl all new materials for inspection. Oiuricl7 ❑Yo I have rod the toward. maarfals requirements under Chapter 6.95 of the Cali ea- 'mu nu Holth&SafctyCo s. 15505.25533 and 25534. I undersand that ifthe build. d rot cur and sol. il4 my resWmlbility w wafy dC occupant of the P laBob, thetmtpnarwiaaumceofacenifwamofOccuptwy. u Applicant ate / gnu All roof coverings to be Class " " or better u thonvcd agent pk Community Development 10300 Torre Avenue aClOF Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 �UPEkTINO Building Department C` JOB ADDRESS: PE OWNER'S NAME: I and PHONE # 66S GENERAL CONTRACTOR: FAX # 1 n I am not using any subcontractor ignature , \� Date Please check applicable subcontractors and complete the following informatioi� Date 60 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 Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408) 777-3228 UPEkTIN0 Fax: (408)777-3333 Building Department Subject: Re -roofing policy for the City of Cupertino Prior to permit issuance, you must agree to comply with 1997 UBC Standards and manufacturers specifications on re -roofing. 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. All roofs shall be inspected prior to any roofing installation. 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. If plywood is installed, a plywood nail inspection is required. 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. - 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 anotherinspection 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 Nab f- /��-�e�as1 C%� / Job Site Address: .7'113 I (/ l Aln-i 5 C !& Roofing Company e: /—T'? Applicant's Si re: 1Datefe� �dDy I Greg Casteel Building Official Revised 11/2/04 Printed on. Recycled Paper r - C OF CUPERJINO CITY OF CUPERTINO REROOF (Z° PERMIT APPLICATION FORM APN #3z / U Bldg Permit Fees BUILDING Date:2,0 /� O Building Address: �� Yah Ctoee 16c) Owner's Name: Seismic Fee Res BUILDING Phone #: ZIf el ,7' BPLANCHK so �s S-3�-_ Contracto •Phone #: Business License License #: mss- �� Contact: Phone #:Cupertino Business License #: Type of Roof Covering: Existing: Proposed: p� Built -Up Roof jV 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: ❑ Job Description:r�//////,��klo Residential ❑ Commercial. Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictio s Cost of Project- 60-J-4 Type of Con c o Occupancy grow Qt f Adnli6ahl4R" Fee 1D Fee Descrintion Fee GrouD 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 7"?r �2, 6Z