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0305003902 Z r 4 W � UCE 0 C U4 U`s CITY OF CUPERTINO C0"NTI2A.0 Uig INFO BUILDING DIVISION PERMIT BUILDING ADDRESS: SECURITY ROOFING AIR SYSTE MIT "D03050039 OWNER'S NAME: 677 KINGS ROW PEJ �U%789/2003 1VIC CENT NE: (408)971-1777 SANITARY NO. CONTROL NO. ARCHITECDENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 MRby affirm sed that 1 am licenunder provisions of Chapter 9 (commencing with Session 70110).17 Division Sol the Business and Professions Code, and my license is m. fu 111. andcff�dr._ LeeCI }a Lk. N �U�,u�O REROOF Dam Connector AR CIm DEC RA ION 1 andCRmnd my plan si be used Bap IC R !d3 ^/DY — Licenmtl Pmfesaianal OWNER -BUILDER DECLARATION I hereby affirm that 11. exempt from the fessin$ License Lew for the following Cc My city or county 7onstr Boniness and Proere, oas ' Ohm a matian which alma Improro, demolish. or any structure permit re cores its iss> n ermttfi e. mg priorbslissuance,alwmquims the Applicant for suchpermittoices Law etstemenl the COntrmmr'n License law 9 q,Tjb, or -Area $16Yp111gtion that he uliccnmA pumdammshe provisions of the (Chapter (commencing with Section 7000) of Division J of the Business and Profeuinm Code) or loop that he is emmpt shemfrom and the basis for tide alleged exemption. Any violeUon a! 3 Oa4K WI Aero 0 Occupancy Type Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of not mart than Eve hun lmd dollars (5500). . ❑ 1, as owner of the property, Or my employees with wages as their sale compensation. RR T d Inspections P willdo Newark, mdthesurcmrchnotlnmndedmoRerrd ImmM(Sec.7044,Business and Prefesalaru Code: The Contmnor'a License Law dors set apply to an Owner of dura himsel f through his 307 - INSULATlmy Property who builds or improves Nercan, end who such work or own employeas, pmlded thmasch improvements AM not attended motional for ale, If. 601 - ROOF TEAR OFF however, the building or improvement is said within Oa you of completion, the owner - builder will hive W burden of proving Nn he did nue build or improve fur purpose of 602 - ROOF PLYWOOD NAIL asks.). 603 - ROOF BATTENS ❑ 1, an owner of the property, am exclusively contracting wish licensed contractors to 604 - ROOF IN -PROGRESS consumer the project (Sec. 7010, Business and Professions Code:) The Contractors Li - came law docs not apply to an owner of property, who builds or improves demon, and who contracts for such projects with a conwculds) licensed pursuant m the ConuBcmh License law. ❑ lamuemptundar Sea ,B&PCfarthisrtme, Owner Dem WORKER'S COMPENSATION DECLARATION 1 hereby aBlrm under penalty of perjury, am: of Ne following deelmtions: 1 have and Will malnsam a Certificate of Consent tomlf-Insure for Wahers Compen- sstion. an provided for by Section 3700 of the labor Code, for the performance of the work for which this permit is issued. 0 1 have and will maintain Workers Compensmion Insurance, as required by Section 3700 of the labor Cade, for the performance of the work for which thin permit is issued. a a TI q Ca Ma"Wok — GI RT FlCCOMPENOATION INSURANCEIO.; (Otis section mod not be completed if the permit is for am hundred dollars (SIM) or Icas.) I certify that in the performance of the work for which this permit is issued,) shall not employ any person In any mmmr an an to become subject to theworkeri Compensation Laws of Califomis. Data Applicant NOTICE TO APPLICANT. If, after making this CcniBeate of Exemption, you should become subject W Ne Workers CompemNon p aviiond of the labor Code, you must ' forthwith comply with inch provisions or Nu permit a hall be deemed mooted. CONSTRUCTION LENDING AGENCY 1 herby affirm that minm Is b a • covwc0on lending agency rorthe performance of ' thework for which this permit is issued (Sm. 7097, Co. C.) Lenders None Landers Address ' 1 certify Net 1 have Rad due application and dune she Ne above inform Wun is cmrceL 1 agrte to comply with all city and county am i umeas and comb laws relating to hetoby authorrepresentatives of this city to enter upon site abovingcnionadw;and prpooms. above -(WA) nreproperly for imnity an keepls m the City of Cupertino against (Wo) agrte s, aro, ind and tech hay in j Ilablllgea,judgmenb, costs andexpenses which may in any way same against mid City expenses In consequence of due granun8 npermit. APPLIC UNDER' ? S ND WILL COMPLY WITH ALL NON -POINT Issued by: Date so UR GULATIONS A—<— Gt ��7 �� Re -roofs Type of Roof Signatum of ApplicanulZontrWror Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or fumrc building Occupanta me, or handle hnsrdous material a deRmd by the Cupertino Municipal Cade. Chapter 9.12. and the Health and Safety ode, Section 25532M)? ❑Yea '6�"o All roofs shall be inspected prior to an roofing material beim installed. P P- Y g g If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building acupent um equipment or devices which MIL hazardous nit conmminen u defined by the Bay Area Air Quality Management all new materials for inspection. istrict? ❑Yea No Id I have met the hamNlms materials requirements underChepter 6.95 of the Califor- c �s .in Health SaferyCom, Section 25 25533 and 25534.1 undemmnd this if the building oes rwt cu ly have a mnan4 1h my respoasihility W notify Ne Occupant tse en facertiMamOroeasocy Signature of Applicant Date S All roof coverings to be Class "B" or better wner or authorized agent vo�";K CITY OF CUPEkT1NO 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 Y4 " 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: e C PCO lob Site Address: - /03S3 \hCte Glyey-ue- Roofing Company Name: S ec,., •= z cwt; ' hp1can sSignature: Date: S_9-03eel Building Official Revised 1/30/03 Printed on Recycled Paper ,S t • f j J CUPEI�TINO CITY OF CUPERTINO v 3 REROOF PERMIT APPLICATION FORM APN # � Gci- C-! 0 �vao BUILDING Date: 5 -�i-o3 Building Address: BUILDING BSEISMICRE /0353 —\0«e- Gl%eh,e. BUILDING Owner's Name: Seismic Commercial Phone #: Contracto : f Phone #: L0,6 11-n-)-) License #: ,5Oa0(�a Contact: Phone #: we Cupertino Business License #: C �JcSs _O� 721 S Type of Roof Covering: Exi TBuilt-Up Proposed: Roof ir'�—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 Polic : ❑ Job ascription: Q trv�JJ < t i h7 L — 1 t �StG � �� ( C sk, uQ Residential ❑ Commercial Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are anrestrictions: LJ Cost of Project:y `� (� I Type of Constrpction: Occupancy group: - Qty. if Avvlio65lt\ Fee M Fna. lloenri nf'nn ❑ve r_.. 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 Zc� 23