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03050041f CITY OF CUPERTINO ha��,'yy'yg.. "��'wfv Y*yy'ip" "'y`�y,i� �' ��R BUILDING DIVISION PERMIT a -OXT" , x=`�' �`AY�� . `"�lya •" . BUILDING ADDRESS: SECURITY ROOFING AIR SYSTE g""'03050041 OWNER'S NAME: 677 KINGS ROW P"'b'9 u9/2003 IVIG CENTER PROFESSIONAL rROTI NE: (408)971-1777 SANITARY NO. CONTROL NO. ARCHnECTIENGINEM: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH -- LICENSED CONTRACTOWSDECLARATION - t ' eSC �p 1 Wroby aairm that 1 am licensed under provistmts of Chapter 9 (commencing -- with Section 70W)ofDivision 3Of the antl Profcsslons Cule.aMmylicenscis inOmOfoe deG 3e w��j Lica r REROO, Da on CH' • S DEC TION IYndC Jmy pla119a IhC IP N 4. _ Licensed Professional OW Kit ALDER DECLARATION 1 hereby atom that I am exempt from the Conlnce,rs License Law for IM following won. (Schon 7031.5. Business and Profession Cade: My city or county which requires a permit to construct. all improve, demolish, at repair any structure prior in its issuance, nice requires the applicant for such permit in rite asigned 13mcou m Sq. Ft. Floor Area that he is licensed pursuant to 0m provisions of the Conmcmr's License law(Clupter 9 $714ky4tion (commencing with Section 7") of Division 3 of the Business and Professions Code) or that W is exempt Bterehom and the basis for the alleged eaempuon. My violation of 3 G&M-O' crO 0 Occupancy TI pe Section 7031.5 by arty, applicant for a permit subjects the applicant in a civil penalty of not mon dean Ove hundred dollar ($500} 0 1, as owmer of the property, or my employed with wages u Noir sole compensation. —RR Ired Ins ections 1C p .111 do the wort,and the ahuccn is not innMed arortered for am. (S". 7044, Busimss and Prefesuoes Code: The Conerano's LieeMe Law does, trot apply m an owner of himself nth ough his 307 - INSULA N property who builds or improver thucon,and whodocstuuch work own employees. provided Nu such improvements aro mKinnnded oroRered funk. If, 601 — ROOF TEAR OFF however, the building or improvement is mid within aro year of completion. the owner. Wilder will have the burden of proving that he did not Wild Or improve for purpose of 602 - ROOF PLYWOOD NAIL sale'). 603 - ROOF BATTENS 0 1, as owner of the property, me exclusively contracting with licensed conn mm, in 604 — ROOF IN -PROGRESS consuocl the project (Sec.7oaa. Business and Preeminent Code:) The Connacmra Li. cane, Law dean not apply to an Owner Of Property who Wilda of Improves OtCRron, and, who contracts for such projects with a conicou r(U licensed pursuant in the Contraction Lice. law. 0 l un exempt under See . B A P C for this mason Owner Dan WORKERS COMPENSATION DECLARATION 1 hereby salon under penalty of perjury ane of the following deck ubmar. I low and will maintain a Cervaan of Couaenuo seINUUM for WOhors Compan. neon, as provided for by Section 37M of Jr. labor Code. for the performance of the wants for which this permit u issued. 0 1 have send will maintain Workers Compensation Insurance. as acquire by Section 3700 of the labor Code. for the performance of the wank for which this permit is issued. My Worke a oropgLmall O/ ,�uoa,�ce... and Policy numberart: L Carej�r. G\ CVs" PolicyN • CERTIFICATE OFIEXEMPTTON FRO KERS' COMPENSATION INSU CE (This secud Med not W completed if the remit Is (mono hundlecdollsn(SI00) or less) 1 cannily Nat in the performance of dee work for which this permit is issued, I Nail not employ any person In my manlier an n to become subject in OC Workers' Cceopermaket Laws of California Dam Applicant NOTICE TO APPLICANT: IL after making this Comfecam of Exemption, you should become subject to the Workers Compensation provisions of the labra Code. you most foriwiN comply with such provisions or this permit Nail W deemed revoked. CONSTRUCTION LENDING AGENCY 1 herby aRirm that Nen is • eowMNm king agency for the performance of the wort for which this permit is Need (Sec ]09'/,. Civ. C.) Lenders Name lender's Addw j 1 certify that 1 law mad this application w son that the above information IS ' cora 1 ague is comply with all city and county ondinaMes and state laws miNng m Wilding construction. and hereby authorim mpresenutives of this city m enter upon Ne ahovcmentioned for impectiM properly purposes (We) I me m ave. indemnify sod keep hammer the City o Cupertino s against rata and eapetaswhich may in any wayamue against said City j l.cmu'unec oft I. PLICACMC o(IM grand ix D WILL ' APPLICA UNDER ST ills ND WILL COMPLY WITH NON -POINT Issued by:qjtQ� Date SOURGULATIO Q Re -roofs Type of Roof Si pp humi/C.-rilystfor Dam HAZARDOUS MATERIALS DISCLOSURE Willy m (Mun Wilding mind huWous mamriai e. Chaptsmm th u OefiMd by the Cupertino Municipal Code. Chapter 9.13. and the Health and Safely the,Cupertino out, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. OYd No If a roof is installed without first obtaining an inspection, I agree to remove Will den applicant Or ulum Wilding Occupant use equipment m devices which II hvardous air contaminants as defined by the Bay Aid Air Quality Management all new materials for inspection. District? 0Yd u Ihawmad umhevatdMarl 5.uequimmn534. ii Chreasidnifthe Willfon Seed 5Ni nusmoc eery milyCade, .2533aM hillityw ft up tfWilding JOd MIC mealy haw a m nL N t it u my msponsihiliry m maty do aceupm of Ne mqu rn;:Iiy, a metprwWun ofaCmuRdmar cap ;'G/��l CDan� Signature of Applicant Date 't✓" All roof coverings to be Class "B" or better OwnermauNon'vedagem c M -CITY OF CUPS TING Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Telephone: (408) 777-3228 Fax: (408) 777-3333 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: � uv 'Ic 1... e %." r Py'(e S.5, 01\�a l 6 iwp Job Site Address: 10313 —0((e-1 Q U CAUG Roofing Company Name: S QWrkn qalVl4 Applicant's Signature: Date: _,I_J -53 Greg eel Building Official Revised 1/30/03 Printed an Recycled Paper t I 01a CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN Date: -o 3 Address:0313 Fee Group ; v tfc. 6Lue1wc- er's Name: �t)a e.tt BENERGY Phone #: Contractor: Phone I License #: ntact: Phone #: Cupertino Business License #: gas '- Lxa BPLANCHK Plan Check Fee Type of Roof Covering: Exi VtBlt-Up Roof Propose BUILDING uilt-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 Descr' tion: vrzo r L — ; c\5VrLk ) yleel 3AC Residential ❑ Commercial Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project:S CI Type of Const ction: Occupancy group: ((� Qty. if A lic e Fee ID Fee Description Fee Group 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 F - I Z a 26 0-31. PO