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04090058 CITY OF CUPERTINO ('� •� ^� - yyyyyy,,, . BUILDING DIVISION PERT �^ �A O r x; BUILDING ADDRESS: PERMIT NO. RESPONSIBLE ROOFING INC 04090058 R NA PERMITISSUE DATE 17VATWV V�NTgj4pb;DRAN 2882 SPRING ST U SANITARY N OL N0. ONE: RCHITECDENGINEER: BUILDING PERMRINFO BLDG ELECT PLUMB MECH p 0 0 tl00 LICENSHOCONT(ACOR'SDECLARATION lob De t tWiF 1 hereby ar0rm that 1 am limned unJeDpovisiona of Chapter Y(commencing at¢ with Seo;o 7 )o(Division3ofthe Bu' sand Professions Code,and my license is << in full forte act. 5'qz Laena, Lie.« REROOF W/COMP. Dem ll ' -^�>u Co. scmr �-� NOV 9 - 2004 1 undera➢«Emy plans shall ARCHITEand u public rrecorrd Y'� D�° BUILDING 3 G In Licensed Professional y: ' OWNER-BUILDER DECLARATION F 1 herchy arcrm thel 1 I exempt from the Contractor's Cattle: License Law for she X 0 0 whichfollowout...(cation TIBIA Business,Shotland ve.predicationsdli Code:Anyrepair y lir county X22 which rcquirn n eesmR re quires the applicant improve,demolish,lire.sig my suucmm w–'^ prior in issuance.also roquimslheepplicanl for such permiva fleaaigneJ smmmem that he is licensed pursuant to the prevision of the Commutes Lia (Clops tag Sq.Ft.Floor Area VaIU IOn C (commencing with Section?")nf Division 3nf the Business and Professions Cmm)or that he is exempt Murefmou and the basis for the alleged cumpti on.Any violation or Section 7031.5 by any applicant for a permit subjects the applicnu0 a civil penalty of 3l�giy�er00 Occupancy Type nos mom Nun five hundred dollars(E500). do the nerof Mm pmpuny,armycmployceawhhwagous.l.(Sec.co ,Business will dothework,and the he CGtisnot iamiMed Lawdo(orale(Sec.toan,Business and Pro(wh obs Cade:The Contrac(or.Licensendwho law docs not apply lf an owner of Required Inspections property who builds vi ed prem Ih improvements andwho,arcssuch work himself er through his ownemployees,provided provehimprovementsin not intended ma@red for sak.IL however,Ne building or improvement is aid within one war or completion.the owrcr- h le.). will have Ne buNen of proving that he tlitl not build or improve for purpose of ale.). g 1,as owner of the progeny,am exclusively contracting with licensed contndan to consumer the project(Sec.7000,Business and Professions Code:)The Contnemr's Li. came law does not apply to an owner of property who builds or improve Mutton,and who contracts for such project,with a comnemr(s)licensed pursuant to the Contractor's Uccnw Law. I am tempt underSec. .B&P C fm Nis moon Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following decluatl0m: 1 have and will maintains Ccrdficem of Conwnl to self-insure for Workcr.Compen- tion,as provided for by Section 3700 of Me labor Code,for the performance of Ne W for which this permit is issued. Fl 1 have and will maintain Workers Compensation Insurnce,u required by Section 110 of the labor Code,far Ne performance or Ne work for which this permit is issued. y Wmkcra cann'tsan n lnsuraa^artier and Policy number am: rrie' / Hey No.:�37s�+�� CERTIFlCATEOFE7 P130N FROM WORKERS' COMPENSATION INSURANCE (Thlssectlon need not becomplemd ifthe permit lefaroac hundred dollars(SIM) lir test.) 1 unify that in the performance of the work for which this permit is issued.l shall not employ any person in any manners at m become subject to the Workeri Compenatlon Laws of California.Dau APPlicnl NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions of Ne Labor Cade,you must .JO forthwith comply with men provision or this permit shall he duemM malted.Zy CONSTRUCTION LENDING AGENCY [–i I hereby affirm that there is a construction lending agency for Me performance of Cid in.work for which this Permit is named(So,.3097.Civ.C.) ALender.Name Z) z Lender'sAddress U C I comfy that 1 have read this application and scale that the above information is I7. H concct.l agree to comply with all city and county ordinances and stem laws minting to O U building construction.and hereby athonne representations of this city to enter upon the above-mentioned property for inspection purposes. W h (We)agree to save,indemnify and keep humlus the City of Cupertino against / iliabilities,judgments,costs and expenses which may In any way same against wad City V 7 in consequence of the graining of this Permit. •^+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. ///�,ff �'-�• -© Re-roofs SiBpsowYjo(ApPhanUConasmo Data `� HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building accupnutore or handle havardous material u defined by Ne Cala nano Municipal Code.Chapter 9.12,and the Health and Safety g CoJc.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ums P° Will the applicant or[plum building occupant use equipment or devises which If a roof is installed without first obtaining an inspection,I agree to remove It hoardaus air contaminants u ned by the Bay Arca Air Quality Management all new materials for inspection. r'T min? p E]Yet Nu I have wad the havamousmamrials requirements under Chapurfi.95 afthe Caliur- I}�6�aRw- nuHealth&Safmy Cade,Sm omn5M5.25533=d2530.lundcnwdthmirthe building ./// ���_.. / —/3•–V Jos not comedy haw a vont Mut it u my responibility to unity M e oecupat of the rcyuimmc MmmCan amt miaaanq raceni0gamarOccepnay.. Signature of Applicant ate Owrcr ar amar;ned�age t ­7�'3 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 UPERTINO Building Department JOB ADDRESS: // PERMIT# p O cI r 7 9 os� Sh - OWNER'S NAME: ,[ PHO 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 Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile /Contractor Signature Date Community Development Department AMCIA Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E TIN 0 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) 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 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"u.�rL9�diQn Job Site Address: /79,1 Jo r k - Or Roofing Company Name: t iplAicanYDate:,eel Building Official Revised 1/30/03 Printed on Recycled Paper- CITY OF CUPERTINO s- REROOF CUPERTINO PERMIT APPLICATION FORM APN# Date: 3Loz- ii- 010 Building Address: Owner's Name: Df FPhone#: Y• v 12_5 - - 53ti Contractor: Phone#: License#: (co-so)S - 31$9 o Contact: Phone#: Cupertino Business License#: E Pr�cl laso 5(o�-S`l iU5 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Wr'�Asphalt Shingles Wood Shakes ❑ Wood Shakes W-'Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings Z ❑ Provide I.C.B.O.Report# 3'�To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: iear04 rnX i5- inoa V-00-C. Appkt Kt tv 60 "v . corn osrhbyi VA Ito os rd Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if ere are any restrictions: LJ Cost of Project: Type of Cons ctio Occupancy group: I 10-00 (�—YOv S F IZ Qt . t lic ble Fee ID Fee Description Fee Group BPERMFEE BldgPermit Fees BUILDING ENERGY Ener BUILDING / SEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING X27 �