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04020078
CITY OF CUPERTINO ',r,�«. „ s.Iy�y� 'g n ,� '��'»y > . y. a BUILDING DIVISION PERMIT ct� rxxA.Coyt°y �yAy BuLONG ADDRESS: CONLEY ROOFING PERMll"0.04020078 OW NER'S NAME: PERMIT ISSUE DATE VE ONE: SANITARY NO. CONTROLNO. ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p 0 0 0 0 LlLICENSED CONTRACTOR'S DECLARATION ,y��w� 1 Wrathy affirm Well sm limnscd under provisions of Chapter 9(commencing Job Deseri'uMu��pI YALE gD witb Secti 7")of Dimdm3ofthe Bua Prolesaom Code.and my license i5 ■ ■ n. m sen�am°e��,arca L a= see aaa c-3`I 5'(03002 REROOF -- Da , iia Gan um �- FEB 2 4 2004 Imo' AR HTfECI-S DEC LA N �a 1 undersand my plane shall W used u puhl m rands �� 5 30 Lmen dPmfsuan.l BUILDING OWN ER-BUILDER DECLARATION +�<f 1 hereby affirm that I em exempt from me Contremw'A License taw for the 00 fallowing reason.(Section 7031.5,Business and Professions Code:Any city at county $T which rtqulrrs a permit in construct,site,ImPmw,demolish,or repair any smmcture prior to its issuance.also raqulms the applicant for such pormiuo rile a signed worment < that he Law S Ft. Floor Area o q- Valuation (cat he Is(commencingwithSimian 70nd basiso.3nf allegehe ineacrass don.Any CMe)of — Net he U exempt tWrefrom and de aura forit s the alleged exempdm.Any violation of Semon 7031.5 by my red dollars lafor•Permit subjects Ne applicant to a civil family of Om more Nan Ow hundred dation($500). 3MIClM1fAt'irOO Occupancy Type O L as Owner of the Property.Or my moployees with wages as Weir sole eomposin lon, will da she work.and the aWmurt isnotumniftd orafferad forsak wa (Sm. Buas and Profession de:CaThe Ca.uae.rlars A License w donot apply m an Owner of Required Inspections Property who Wllcismimpraws theseon.and whodmi,.h work himself Or though his Own employers,provided that such Imprammentsue not intended woReand for We.If, however,the building or improvement is sold within am yeu of completion,the owner. builder will have We burden of proving that W did an,Wild at Improve for purpose of We.). ❑1.as owner of the property,am escluively im usecti.,with licensed convacton to contract the pmject(Sec.7044,Business and Professions Code;)The Corner-s U. cease Law does not apply is in owner of property who Wilds or improvrs thereon,and, who can Tech,for Such projects with a canuacto ls)licensed pursuant to the Convector's License Ls- C3 I som a.empt under Sec aw.❑IsmeaemptunderSea ,B A,P C far this residua Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury am of the following declarations: ave and will maintain a Cer00cute of Conant W self-imam for WorkcYS Compen. souse,as provi&d for by Section 3700 of do,labor Code,foe the Performance of the for which this permit is issued. ve and will maintain Wwkels Compensation Imuran.,u required by Section the labor Code,for the Pmfor.umof the work foe which this Permit Is y orkeY Compensation in j time n(erand Palicy...theism: Ca l 1`-V PoJ�sfy/J{�o.: —�06 CERTIFICATE OFEX PGON FROMWORKERS' COMPENSATION INSURANCE or kis.)(Thb seNm need not W completed if the permit is intent,hundred dollars IS 100) I unify that in the performance of the work for which this Permit Is issued,I shall nut employ any Person in any merman u in become subject to We Workeri Compechadon Laws of California,Date Applicant NOTICE TO APPLICANT:If.after making this Cenilleste of Eacmption,you should - hmome subjm ha the Workers COmpemeuun provision of tie tabor Code,you must .J,Z forthwith comply with such proviciom or this permil shall be decmad rtvokcd. Z0 CONSTRUCTION LENDING AGENCY ' .� E+ l ha irahYwhichithi Netmercis ecorutmcdnn lendi,,C.) for dm perfurmenm of ' �i the work foe which this Permit it issued(Sec.]097,Civ.C.) 0.Q LendcYs Name .7. z Lender's Address U Q I certify that 1 have read this application and state that the aWw:Information Is W6 F coronet I Agra m comply with all city and county ordinances and Attie laws relating in Q U building construction,and hereby euthorne repruenutives of this city ro enter upon the W atmve-mentioned propc n for espouses peNan which may �„gy (Wt,)agree ro vee,indemnify And keep harmless the City of Cupcnim af,W, liabh inciliicpteneOfthees,Judgments.emuandOf this pAmit. may in any way acme against aid City U 2 in consegmnce of the gaming Of this permit m.. SAPPLICANT OURCE GUNDT R NTA DS AND WILL COMPLY WITH All NON-POINT Issued by: Date / Re-roofs ovum of Applicarmonaractor Date HAZARDOUS TERIAIS DISCLO RE Type of ROOF Will the applicant or future Wilding Occupant stem or handle huaNaus material u defined by the Cupertino Municipal Cade,Chapter 9.13,and time Hcahlb and Safety Code.Sectim 35532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or furore building=upon,use equipment ordcvices which If a roof is installed without first obtaining an inspection,I agree to remove 11 it huardaus air contaminants u defined by the Bay Area Air Quality Management all ne District? w Is for inspecti n ❑YCS �j NU f Ihavemat the hxsardd 25505,s 5333 d nts 25Su,derChapterd.95 ofdeWildi g it..Out currently how that 311 ISSBJ am175534.1urrdcntaM muifthc Wilding dma not cunen0y h mnan4 Nat it ie my rtspo sihilimy w notify me occupant of me requi cots wpieh Mine pro,m ivmncc of Ccnifcam of Occupancy. 9,J/lGL( IXI l/r'w Z -/p..U(....r ignature of Applicant Date OwnOwn O�ed ascm V Date All roof coverin to be Class"B" or better ' Community Development 10300 Torre Avenue Cupertino CA 95014 It PiTy Telephone(408)777-3228 F Fax(408)777-3333 UPEkTINO Building De artment JOB ADDS: PERMIT# v �� OWNER'S NAME: C PHONE # 54119 6 P 3 Z GENERAL CONTRACTOR: I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following ' ormation: 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/Contractor Signature Date 10/28/03 j Community Development Department Building Division r :Or City of Cupertino 10300 Torre Avenue CITY OF (408)777-3228 OUPE k1 '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 " 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: V C* Job Site Address: �7 5 11�-V ,✓n�iCQ Roofing Company Name: 0 h A plicant's Signature: Date: Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOFo " LD CUPEkTINO PERMIT APPLICATION FORM APN# Date: C7 Building_Address: v✓z � ✓ Owner's Name: I� Phone#: _ s �/ � s Contractor < Phon #: License#: mICm 5ef 0 k 3Z 2-� 6330Dz- Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles so Asphalt Shingles />P Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings h ❑ 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 an restrictions: LJ Cost of Proje ©\ Type of C structioq: Occupancy group: 11 �,L, s' , r, r 5tRBSEISMICOM Fee ID Fee Descri tion Fee GrouPERMFEE Bld Permit Fees BUILDING ENERGY Ener BUILDING SEISMICRE Seismic Fee Res BUILDING Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING a�