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03050040r 07 zC a� CL UC UC }0 Uf�aJ F CITY OF CUPERTINO BUILDING DIVISION PERMIT ^gON'i RAGTURlINFORMN "4 BUILDING ADDRESS: SECURITY ROOFING AIR SYSTE 9MITND03050040 OWNERS NAME: 677 KINGS ROW "R" `seNn9/2003 IVIC CENTER PROFESSIONAL GROU NE: (408)971-1777 SANITARY NO. CONTROL NO. ARCHITECT/ENOINEER: BUILDINO PERMIT INFO PLUMB MECH BO 0 LICENSED CONTRACTOR'S DECLARATION Job Description o 1 barely affirm Met l un licensed under provisions of Chapter 9 (commencing p MN Section 70M) of Division 3 of the Bust. and profaalons Code. aha my license is in null fmrte antic c,. ` Cpl a REROOF License CI^e J N ell Ya'•�' Dem Coni C "Mil LA ATION IjII he 1 undcntsnd mY Plen h1 Mused Ir v � M " Licensed Professional OatNEm BUILDER DECLARATION ..� --� I hereby .(nese Net 1 emmp, from Ne Contractors law for tie :Anse 7031.5. B. aher, and Professions Code: Any fallowing reason. 1. mity structure which requites • pctm0 re cnns,roel, elm. improve, emit h at mash any alrommm requires the rhe h pcmith, prior to its �ensed Sq. F[. Flo _ palm isionofnt Conpermitmfileae Law (Chapsuouneter 9 Division of the exeandmpt omissions Code) or (co me cingwitpumremNOeprovisionsoftheComrmmr'aLimneflaw(,Code) (commencing withSection70W) r Net he ts exempt therefrom and Ne buts for the alleged exemption. Any vlmlNa of the egad 3 (Afta(hMer0 0 Occupancy Type Section 7031.5 by my Applicants for a permit subjects Me applicant or • civil penally of mol mare Nan five hundred dollars (55001. 0 I, a mwmr of Ne pmpetsy or my employees with wage u their sole cmopewdon, g�� d Ins actions will do tiro wo& and the aWCInmY Mt Intended oraRGmd for We (Sec. 7M. Business tad Profmions Code: The Ceumte's License Law Over not appy in an owner of 307 - I NSULAT I'O p properly who builds or Improves thereon. and who does such work himself or thmugh his ownemployeds. provided Net such improvements are notinteMcd oroQesed ferrule. If. 601 - ROOF TEAR OFF however. the building or Improvement u sold within one year of eompladon, the owter- wilda will have de burden of proving that W did Out build or improve for purpose of 602 - ROOF PLYWOOD NAIL We.)- 603 - ROOF BATTENS ❑I. as Omer of the property, me exclusively contracting with licensed conuanms In 604 - ROOF IN -PROGRESS com uet the Irmica(See.7(th, Business and Protons. Cade:)The CommsesYsLI- cense Law doe not apply to an owner of propeny who builds or Improv demon. and who contracts for such projects with a contractor(s) licensed pumuam m Ne ConuacmYe License law. [_]I am ecmpt under Sec. , B k P C for this rcamn Owner Data WORKERS COMPENSATION DEcum--noN I hereby do m under penalty of perjury on of the following declantioe: 1 haw and will maintain a Cam' am OfConsen, m self -insure for Worker'sCampen- .h., m provided for by Section 37011 of the Labor Code. for de performatec of the woA for which this permit is issued. t I I haw and will maintain Worker's Compensation Insurance, u required by Section 3700 of the Labor Cade. for the peKmmana of the wank fun which this permit is issued. My WorimesC ororpeenution Inwrace anis and Policy number art: CaMeT.5 `1e`' L PolicyNo.: 'a3 & 3 7p CERTINCATE OF EMPIUN FROM WORKERS' COMP ATION INSURANCE (Thu section need not be completed If tie Permit Is format hundred dollars (SIM) " m leu.) I terrify dui in Ne performance of de work for which this permit is issued. I sill not employ my person In my mannerm as to he cone subject to de Worked CmmpenLtimt Laws mf Califomi& Dam Applies., NOTICE TO APPLICANT: If, after making this Certificate of Esemp,ion, you should become subject in No Worker's Compensation provisions of the labor Code. you muss forthwith comply with such provisions or this perml, mall tac deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that Vert is sending agency for the performance of s ed (Sm (Sce. 3 3 097, Civ. C.) Me work for which Nu permit Is issued Lender's Name Lender's Add^•• I I certify that I hew mW this application and slow that the show Information is correct. I Kane to comply with all city and county ordinances and sum laws relating w building conduction, and hereby mahorme rcprcaenu,ives of this city to eraser upon Ile above-mentioned prepcny ran Wpecdon purpose& (We) agree in save, indemnify and keep harrnleas the City of Cupertino against j Ilabilidea,Judgments. eau and expenses which may in any any accrue against said City In consequence of Ne gmnli f thio pnntlL ' APPLI NT UNDER NO AND WILL COMPLY WITH ALL NON -POINT Issued by:9 Date SMREGULATIO S. �7'Y/ Re -roofs Type of Roof � �/� � 7 Sngnuu oxppinndcomaewr Date - a HAZARDOUS MATERIALS DISCLOSURE Will Cow applicant on fuuue Wilding Occup om am or handle ha um ous material as defircd by the Cupertino Municipal Code. Chapser 9.13, and the Health and Safety Code, sectionsss3z(.1? C] Ya {�Ne All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove Will the appllcam ser furore building occupant use equipment or devices which It hootmous air contaminants as dcnned by the Bay Arca Air Quality Management all new materials for inspection. Diwict? ❑Yea u I haw mW the hvardtnumuerialstequirtments un1crCM,ga105ofMc Califor- nm Health&SarctyCoh, Strimn25505,33533 u425534. l understand that lfde Wilding does set cunemly have a u n OU a Nary responsibility m mdfy de occupant move mquire whichmuatbcme nem muse.faccrtlnatert pansy. Signature of Applicant Date ./.e Qf�� All roof coverings to be Class "B" or better Owner or authorized agent Dow 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 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: (., V) C Job Site Address: i�3 3 b f qqlJ VA�P ✓� U� Roofing Company Name: Q v 1L OU 4 rn A plicanrs(S�ignature: \�ll�l�OC.X1 Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper Date: S - 9'U 3 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: (., V) C Job Site Address: i�3 3 b f qqlJ VA�P ✓� U� Roofing Company Name: Q v 1L OU 4 rn A plicanrs(S�ignature: \�ll�l�OC.X1 Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper Date: S - 9'U 3 t • • CITY CUPEkTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM 03 6s-Zr-0jjZ APN # Bldg Permit Fees Date: 96 Energy BUILDING Building Address: Seismic Fee Res 0303 �cr� Cue -E - BSEISMICOM Owner's ame: BUILDING Phone #: Contractor: Phone #: License #: Contact: Phone#: �tl I - 17 l Esc. l5 Cupertino Business License #: Type of Roof Covering: Exis�t'/rn�gQ� Propose UV Ifuilt-Up Roof silt -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 Descri tion: Ye,.,,,,, Ll P— rn 5 \Cao Z G keek ?>()a._ Residential ❑ Commercial Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are anrestrictions: LI Cost of Project:R 9 Type of Cons ction: Occupancy group: Qty Anol' ahl& Fee ID Fnu linen.:..♦:.... BPERMFEE Bldg Permit Fees VV V1VY BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING 2( g 23 0.07-P