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03040119CITY OF CUPERTINO " '"a1"�Tr"g.R'""(°"k"`(�"''""ay1 L'`��'��, ,kiy'�'`a`- �., Q.,�RT�IZI,l\xWl?.I� BUILDING DIVISION PERMIT BUILOINO ADDRESS: 3 T e tie �r r � L�- �/ PQM p C, Cf O kR'3 NAME: L / CIo 3 SANITARY NO. CONTROL Nit. /' I ARCHITECf/HNGiNEER: y/,/� ♦ naU B BUILDING PERPLU L� LICENSED CONTRACTOR'S DECLARATION Io c ptlo 1 hereby affirm that I am Ilern under providom of Chepmr 9 (cammOndng withS 7 pofDivdlon Sof dwO nusend Profculana Code.and am On is LU' mmnM aert - �0.2U�j0 '" �e Llan. s Lk.N a Date — nladon r AR CH__ RATION plans,mll W undo u puhllc mrorde L seder ma oust OWNER- BUILDER DECLARATION 1 hereby Affirm Net 1 am exempt from IW Convector's License Lew for the j following reason. (Section 7031b, Business and Professions Code: Any city or coumy which inquires a permit to cOn,=, alter, rumm demolish, m mpAlr any awdurc prior in its tauonce. also mqultea lM applicentfmlit permiuo file esigOld nammrnt ' thathe is licensed pursuant to the Provisions or the Comrsemri License Law (Chapmr9 3 Budnessand Professlmts Codc)m S q• Ft. Floor Area VValuation 1 (commencing with Section 7000) or Dlvislon affle that he is exempt therefrom and the bub rot the alleged exemption. Any violation of APN Number Occuparicy Type Section 7031.5 by any applicant fm a permit subjects the applicant to a Civil Penalty of not mom than five hundred dollars (S500). () V ❑ I, u owner of thus property, ormy employers with wages u their sale compensa0on, wllldo On work and the structure Isnotintendsci or offered Russia (See. 7044, Business Required Inspections and Professions Code: The Communes License law does not apply to a owner of property who builds or improve ounces, and who does such work Mussel f or through his own employees, provided that such improvements are, not intended m offered for sets. Ir. however, the building or Impmvemat Is sold within ane Year of completion, the want' builder will he" the Wrda of proving that he did rot Wild or Improve for purpose of am.). ❑ 1, as owner of the property am exclusively contracting with licensed contractors to comtrmt the project (Sec. 70", Business and Professions Code:) The Communes LI - ave law docs not apply to an owner or property who Wilds or Impmms Ihemen, and. who contracts for such pmjcm with aeoom eor(0licensed pursuant to the Contractors Lianm law. ❑ lamexemptunder See. ,BkPCforthIlmxwn ner Data WORKERS COMPENSATION DECLARATION 1 hereby sinus under penalty of perjury one of the following deeluadas: I have and will maintain a Cerifieste of Consent to self -imam for Wof e#ComPen- an, u provided for by Section 3700 of the labor Code, for the Pmformenm of the k for which this permit is issued. 1t3]71W1 1 have and will maintain workers Compensation Insurance, a required by Section of the labor Code, for tiro performance of the work for which this permit is Issued. Werke a n eneetl9n Insoma carim end Polity numbem�maPoliryNa: Ri?_ // CERTIFICATE . COMPENSATION INSURANCE (This section wed notbecompletedlf lW permit is foronthumbr ddellats(SIW) or less.) I certify that in the performance or the work rot which this permit Is issued, I shall not employ any person in any manner an u to become subject to the Warken'Compensatlun Law, of California. Date Applicant NOTICE TO APPLICANT If, area making this Ccslficam or Exemption, YOU should become subject to the Worker's Compoundon provisions of the labor Code, you mull Z forthwith comply with such provisions or this permit shell W deemed mvoked. 7 CONSTRUCTION LENDING AGENCY y 1hornyichthi met them Iss constructionlending agency for Ne Performance of ed(S... > the work for which thio permit b boned (Ser. 3097. Civ. CJ Lender's Name Lenders Address jI is edify that I haw read this application ad stem that the shout Information ounce, I agree m comply with all city and county ordinances and sum law, misting to r upon building construction, J representatives or this city to cmm�o agame tone, Inde nifyanauthorim above-memtuned pmpeny for inspection purposes. (we) agree m outs indemnify hoep hamin a tits City of Cupertino lma e, ld City Ilabllilles,judgments. costs andexpenses which may in any way acme sgalnstuld City in conwgmnm of the grating of this permit. APPLISANT UNDER S AND WILL COMPLY WITH A NON -POINT Issued by: Date ALO SO/{aR[\H REGUL(1 Ns. �' �3 �' Re -roofs Type of Roof Sign of Applicamuchintoactor Dste HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building Occupant norm or handle h4cmdous material as defined by Om Cupertino Municipal Code. Chapter 9.11, and for Health and Safety otic, Section 15532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes Ile—N. If a roof is installed without firs[ obtaining an inspection, I agree to remove Will the applicant or future building Occupant use equipment or devices which mit haunted, air c ummalmms u defined by me Bay Ares Air QuWly Management all new materials for inspection. Diurict? ❑Yes Rf& Ihavercel meWudasro5505.5333ame 55341 rChapmr6.95ofthe Califon. hummed he Woodcut mriai25533Am1 n5 un 1adcatantlthu time Wining �f } /l .• _ L _ ole Hed dal not oily have non L that It b my respooslM'I m notify dm nccupal of me !//LJI/t/�'N-`v ��L '9 Date dim9whknm W Iplot rm haeme ofs Cc maroce�py�ry. Signature of Applicant t � �H All roof coverings to be Class "B" or better Owner unuthorimd a col DAm / %;iu1, CITY OF CUPEkJ1N0 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 A " 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: 10 r'/ e Cfyi -CS 5" 0 c Job Site Address: l (D r( e CCJ l Roofing Company Name: � U�)erS A plicant'J@ , Signature: Greg eel Building Official �� Date: 6 3 Revised 1/30/03 Printed on Recycled Paper 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 A " 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: 10 r'/ e Cfyi -CS 5" 0 c Job Site Address: l (D r( e CCJ l Roofing Company Name: � U�)erS A plicant'J@ , Signature: Greg eel Building Official �� Date: 6 3 Revised 1/30/03 Printed on Recycled Paper i • CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN# ` 3%q — Bid Permit Fees Building Address: BENERGY %0383 io(re �e�-e,��e Owner's Name: t�<'cC- Coes Jar`a C'P u Phone #: �-lo qjt,/5/l Contractor: Sea)C.A Un �(UtAun Phone #: SC(U)CCS yv� �1-1717 License #: S Oci-0 0 Cont t: c(c•,` cls Phone #: v 1-177?Y, Cupertino Business License #: BUILDING Type of Roof Covering: ExiVg: o/ Built Roof Proposgd: -Up e�Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ . Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Nuq*er of existing coverings ❑ Provide I.C.B.O. Report # tY To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job DescriFFtion: ILe ,eon 1, �� I sh& ASW y I c SV1 S�, Residential ❑ Commercial ©� No ❑ Confirmed with Plarm t. if nFireYes there are anres _ect: Type of Ction` Occupancy gro p 2e -M • Qty. if Aonlicalfe---� Fee m .�- FPA r 1Ael Apt;( . BPERMFEE Bid Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING z16�3 �76. 7Z i�