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04080254 mini 10haTr CITY OF CUPERTINO - coN "ch �o�At ABUILDING DIVISION PERMIT DUFLIUMIr- BmL.DIrvc ADDRESS: _ - WESTERN ROOFING COMPANY PEaMrr rv'04080254 OWNER'S NAME: rppq DR PERMIT ISSUE DATE STANLEY L ONE: SANITARYONT SANITARY NO. CROL NO. ' 4 ARCIAMCDENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 400 LICENSED CONTRACTOR'S DECLARATION V 1 hereby affirm Nat 1 am limmcd Motor pmvisimesof Chapter 9(commencing Job DesCrlptin with Sermon 7000)of Division 3 ofthe Busineavand Professions Code,and my license is ? a in roll foreamd cffmt. REROOF j tgi License Class Lie.g SEP ✓� n Dam CS DEC 2004 1c3'y` ARCHI'IECPDECLARATION �i I understand my plans shall Mused as public .,its p BUILDING Gh LiccnutlerebyPrumsdomil affirm OWNER-BUILDER DECLARATION d 0 @ I hereby (Sem That 1 1. exempt from the Convenor's e:Any c law for the o O following Mason.(Section]o L5,Business and Ro,demolish. oaz Cote:Any tiny or county X22 which its requires a Permit re construct,allot improve, pamim repair any structure Fly priorm its issuance,also requires the applicant forsuch permiuo file aligned auloment 5220 £ thatheisliecasedpuni anlmthepmvisionsofthcContraat'il-ccarclsw(Charting Sq. Ft.Floor Area Valuation y $ (commencingwith Section?"oof Division 3 ofthe Burincoand Professions Cods)or that he is exempt themfrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects We applicant to a civil poowy of not ream than five hundred dollars(Ssw). - 3 rxrmr wx.nxCLO O Occupancy Type ]'Pe ❑1,az owner of the pMperty,or my employcad with wages u their sole[ompensmion, will do the work and theaweture isnotinlonded.off red formle(Sec.7044,Business and Pmfessioad Cade:The Commencer License Law docs not apply to an owner of Required Inspections property who builds or improves thereon,and who does such wart himself or through his own employees,provided that such improvements are nolintended oroResed forsale.If, however,the building or improvement is sold within one year of completion,We owner. builder will have the burden of proving Net he did act build or improve for purpose of ale.). I,as Owner of We property,am exclusively contracting with licensed contrsctors to construct the project(Sec.7064.Business and Professions Code:)The Contractor's Li- Made Taw does not apply to an owner of property who Wilds or improves thereon,and who contacla for such projects with a contractions)licensed pursuant in We Contractors License law. ❑l am exempt under Sea .B&P C for this mason Owner Dale WORKERS COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury ore of We following declarations: 1 hers and will maintain aCcrBOMlo of Consent m self-insure for Workcr'sCompen- 7C373��'fflmfdh. tan,as provided for by Section 3700 of the labm Code,for We performance of the rt for which Nis permit is issued. 1 have and will maintain Worker's Compensation Insurance,az required by Section Labor Code.for Ne perfotmaceof the work for which Nis permit is issued. y Worker's Compensation Imumllce carrier and Polley number am: rver. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not bo completed if the permit is inranc hundred dollars(glrlol or less.) 1 cattily that in the performance of the work for which this permit is issued,I ahall oat employ any person in any manner so as m become subject o the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must .JO foMwidt comply with such provisions or this permit shall M deemed invoked. zCONSTRUCTION LENDING AGENCY I hereby affirm that them is acoadvectinn lending agency for Ne performance or aniNe work for which this permit is issued(Sec.309'i,Cih,C.) Lender's Name 0.z Lender's Address V 0 1 cemlfy Nat 1 have mad this application and stare Net the shove information is [L F correct.I agree to comply with all city ad county oNinances and sole laws relating to DU building convection,and hereby suthonse represenmlivm of this city to color upon the above-mentioned property for impaction purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against o-F.r fA liabilities.judgments,casts and expenses which may in any way ammo eSolns(said City L)z in consequence of We grating of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signnurc ofApplicaanor Delo HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will We applicant or forum building Occupant store ar handle Health and Safer l az defined by the Cupertino Municipal Code.Charter 9.13,and We Health and Safety oda,station zss3z(an All roofs shall be inspected prior to any roofing material being installed. ❑rad ❑rvM Will the applicant or future building Occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove mit haasrdous air contaminants az defined by the Bay Arta Air Quality Management all new materials for inspection. isuict? ❑Yes ON. I have mad the hvardmrs materials requimmcros mok,CMpmr6.95 ar Ne Califor- Ionia Health th&SufelyCode.Sections 75505.25533 and 25534.1 understand thalifthe building oes molcumenlly haw a tomo,Nat it is my reapamihilily to notify the..,amof Ne quirensmr which must Im met prior to iazaucc or a Ccrurmalo ofoccupacy. Signature of Applicant Date wner or authormed agent Dam All roof coverings to be Class"B"or better • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDR PERM1W/# O Of 0 2 5 y 0 - C91- Cv G , n OWNER'S NAIS45i. PHONE # GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting A Linoleum / Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing y Septic Tank Sheet Metal Sheet Rock Tile 1 6 - S 31 r/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Tone Avenue Telephone: (408)777-3228 CITY OF Fax:.(408)777-3333 4UPEkTINO 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. P g 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 m/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 Nam 1AMIK 5-a'/cayi.A }Y LES Job Site Address: ��3�5 WC�Tt7 CKCS pR C.UP&Nz /azo Roofing Company Nam W65 C/�/V Ro o (,tv 6/' �O . AplicanYs Signatre: _ e c10 o C r'6uYL-n Greg eel Building Official Revised 1/30/03 ' Printed an Recycled Paper CITY OF CUPERTINO REROOF � � v ZS CUPEkTINO PERMIT APPLICATION FORM APN# J J D Z Date: Building Address: D v E i o Owner's Name: Phone#: I/OX 25JV- 7 7-y 9. Contractor: IV Roo F114 Phone#: y6 f 25p-77_y9 License#: k,955 38 6 7 Contact: Phone#: �6� 66 �7 Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ 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 Policy: Job Description,)d C h o g f 6 576 Reside tia Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Plannin t. if there are any restri s: Cost of Project: 15,326 Type of Cons Occupancy gro Qty i A Fee ID Fee Description Fee Grou BPERMFEE Bldg Permit Fees BUILDING -ENERGY Energy BUILDING SEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BLUDING 2, 235 ' �