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04060219
CITY OF CUPERTINO BUILDING DIVISION PERMIT .CONTRACTOR INFORMATIQN - M afi. - BUILDINGADORESS: _ OLD COUNTRY ROOFING PE ""04060219 OWNER'S NAME: PERMIT ISSUE DATE JAMES OBER ONE: SANITARY O. CONTROL NO. 707 864- ARCHITECrfENGINEER: BUILDING PERMIT INFO \ BO EO PLUMB MEOCH u00 LICENSED CONTRACR3R'SDECLARATION Job Description ' u p I hemby oban Nail I am licensed under provisions of Chapter 9(commencing n¢ wit Section 7")Offfivision 3afta Business mad proliessionsCade,and my liCene,is ^n jam<< mmnrameandR (_ Li9-31 _ REROOF W/50 YR. COMP . �0t1�11A�,E® Llanse Clue Z c.N Conlractor C ARCHITECTS DECLARATION JUL 'y9 I understand my plans shall M used as public records JUL 3 p Licensed Profcssioml OWNER-BUILDER DECLARATION BUILDING m I masa affirm tail 1 aim exempt from the Contractor's License Lew for the INL y 0ounty 9 followwhich guires a Permit i 7(81.5.Business*hwt.Improve, ve,demolish, h,or minor y or conte u�3�i whirh its requires u a person to a fires ow alter lmpmve,demolish,nr c a sig any atructum poor In is issuance.rsurequires twvision of such permitmfilensigned sutemem ��ss< tai he is licensed pursuant to to provisions of We Contractor's lJcense hw(CNpmr9 Sq.FL Floor Area ValUatlO❑ s kg (commencing wit Sttdon]a00)ofDivisionJaf the Businwand Prafeuians Code)ur `i.. to he Is exempt tamfrom and we basis for the alleged caempdon.Any violation of Section 7031.5 by any Applicant for a permit subjects he applicant to a civil penally of 3 SkBE Idrtbal0 0 Occupancy Type not mom tan five hundred dollars(S500).,. 0 I,As owner of to property,ar my employees with wages As deur salt campenallon, will do do work.and the soucame is not intended oroffered foram(Sec.7044,Business end Porfcaelans Code:The Contractor's Llcemo Law data wt apply an an owner of Required Inspections property who buil ds or im prover thereon.and who doessuch work himsel f or Uuough his own employ=.provided that such improvements art notima dad oroRered for eels.If. however.to building or improvement is sold within ant year of complconn,to Owner. builder will have the burden of proving tat k did nm build or improve for purpose of tela). ❑1, .own,of the propeny,am exclusively canuating with licensed comra.mrs in construct the pmjea(Sec.7044.Business and Professions Cade:)The Contracwes Li. come Law dans not apply w an owner of property who builds ler improve renew.and. who conaccu for such pmjecu wit AconuacmKU licensed Pursuant in to Contractor's Lice"m Law, ❑l Am exempt under Sec. ,B&P C for Ile reason OwnerDate WORKER'S COMPENSATION DECLARATION I herebyaR,.under penalty of perjury ane of to following declansit": 1 have and will maintain a Can foam of Consent to self-insure for Workers Compere sm.a.u provided far by Section 3700 of the Law,Code,for he performance of du work for which tis permit is issued. I have and will maintain WOrkcrs Compensation Insurance,As Acquired by Section ] of NC lobos Code.fw to pcAormance of the work for which to permit is issued. My Worke�krjf�Caompenadory Insumnm;c nicr end Poliry number am: Cartier:/ (TTL (//11/0.ej r?ze lwy No.:4✓C— 7"16� > CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thissec0an nand not w completed If the permit Is for onchundmd dn11m($I W) ar leas.) 1 certify tet in tt performance of de work for which a,BJ�eJy}}it k¢�Issued.I shall not m employ any rmad ya ymanne se tbec ubj td4NWo(keri COmpenallon Iowa of Califomi(. YY�U� LLLL Applicant NOTIC. O,A (CANT:IL after making hisaCeniffcate of Exemption,you should become ser t b de Workeh Campenation provision of he 1.wr Code,You most OQ fanhwit NOTICE; with such provisions or this Permit shall be deemed revoked. z^' CONSTRUCTION LENDING AGENCY [—m Fon l hereby affirm to dem is A construction lending agency for tt performance of ' Ge> to work fur which this permit is issued(Sec.3W7,Civ.C.) aQ Loweri Nam. Z Lender's Address V 0 I minify Na 1 have read Lids application and sale do we above information Is Ecored 1 agree to comply suit all city and county ordinances and mule laws relating an building construction.and herebyaudoos mpresmadvu of his city an enter upon he Walaw-memianed property far insfac on purposes. /Date(We)agree m ase,indemnify and keep harmlessto City of Cupertino agairmIlaibilides.judgments.cats ....and eapawhich may inany way acctu.gslmt aid CityZ In consequence Of de granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs HAZARDOUS SignamrcOf ApplicaDat HAZARDODO US MATERIALS DISCLOSURE Type of Roof WIII he Applicant w future building occupam strt or herdic ha'rudom metetisi As lclZd by to Cupertino Municipal Code.Chapter 9.12,and we Heald and Safety Codes coca 2ss32can \ / All roofs shall be inspected prior to any roofing material being installed. ❑sen $Na Will to applicant or future wilding Occupant tea equipment ler devices which If a roof is installed without first obtaining an inspection,I agree to remove mit haixodnn air contaminants as defined by the Bay AMA Air Quality Management all new ma asitia for inspection. District? �� ❑Yrs ypna Ihave Mail he bmardo.emocrialarequirements under Clwpar A95afhc Califar ria Heelt&Salm Code.Scetions25505,25 3 12 34.1 ndcnund detiftc Wilding , 6 a4s Joos mMy hew a Noon tel'l'er r hili o notll'y dmsup I ofpc Y x BVici9hmmufbcme o I A Ce mca orotcupen Si lure of ApplicantDate g — All roof coverings to be Class "B" or better msd agent D m Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: I PHONE 6 OM P3 m GENERALCONTRACTOR:OL� CouNr f:16o FAX oF� 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 Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing 0J) Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino "- - 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E kT 1 N O 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) h1-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 1/4" 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: �I n'1 0✓5r✓/t i I� OY060Z1y Job Site Address: J y 6 w 0� l L� �• Roofing Company Name: OLS C () L4Ar—1 ' L>Oi- 6_ A plicanYs Signature: �� L o _ Date:6- Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF�CUPERTINO REROOF 6 o z t CUPEkTINO PERMIT APPLICATION FORM I APN # D Z66 SS © yam (D o?5 - O`f Building Address: 11 � y6 oc�l-SILL c. t� � z-- O er's Name: Phone #: T e77 03&j,_1.+ o -yt 410 F aSS 6�a Contractor: Phone#: License #: vu-P C OunJ r ,2001F1/lJG /OF FS(YD & �a 6 Co tact: hone#: Cupertino Business License#: i S I0�-, bL 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 Com 1 With Cu ertino's Teaz Off Policy: JobDescription: t�{��i�ro✓� 4xI� � l�C7 L� 1cK, ter- 11yfiK,�� I!VS P �' zc2-r d- ,0 mac.. CA — Residential Commercial ❑ Fire Z Yes ❑ No ❑ Confirmed with Planning Dept. if there are restrictions: 8 Co t of Projec : Type of Construction: ccup c grou C) p K< C% O(c)r— Qty. if Apvf4ble 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 2, (7-V e - 6/a 9/ 7,