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03090211 (2) ' CITY OF CUPERTINO BUILDING DIVISION PERMIT J;CONTRACTOR INFORMATION- 1 k BUILDING ADDRESS: MORAZAN ROOFING INC PERMIT N0133090211 1 0539 ESQUIRE PT OWNERS NAME: 740 SHAWNEE LN PERMIT ISSUE DATE AdMI 41F"` (408) 224-5785 SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLS MO ±ore LICENSED CONTRACTOR'S DECLARATION IOb Description w 1 hereby art,,. bar I am licem<d um nder pvisions of Chapter 9(commencing p ?6W with Section 7M))of Division 3 of the Busfncax and Professions Code and myliccnu ix union' n full force and effec{, License Lte.M REROOF ®®'vpp® �a��aa11 ® F,W Do. Y— -nth Cunlracln ��Y�T��Y ARCHITECTS A f e 1 understand my plans shall w used as public records 0„1", Licensed Prorcssional FEB 3 2004 S OWNER BUILDER DECLARATION <q 1 hereby affirm that I am exempt from the Contractors Licenu Law for the �rra1 00 following mason.(Section 7031.5.Business and Profession Code:Any city or county Y�'�\N� <m which requires a pemm rit to ennstrum.alter,improve,demolish.or repair any structure dZ) p G S1 0800 Her In or issuarte,aIs.m,.rc,the n,,lmamfnr3uch pCto,,nl Me a.il6nCd SmlCrrlCnl �za that he is licensed pursuant o the provisions of the Contractor's Lieenea Law(Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7")of Division 3 or the Business and Professions Code)or that he E exempt therefrom and the basisfor She alleged cacmption.Any vmladnO ser 32644027 . 00 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty Of APN Number Occupancy Type not more Nan five hundred dollars($500). -- P Y - 0I,u owner of the propcny,or my employees with wages as their Sale(nothu aidon, will do the work,and the stmcmre is not intended or offered for sale(Sec.7044,Business I J Ub — and Professions Code:The Contractor's Lieense Law docs or apply to as owner of11�@d Inspections progeny who bui Ids or improves thereon.and who does such work himself or through his 307 - INSULATT own employees,provided Nat such improvements are not immnded or offered for Sale.IL 601 — ROOF TEAR OFF however,the building pr improvement is to within one year of completion,the mvncr- bu0der will have the burden of proving that W did not wild or improve for purpose or 602 — ROOF PLYWOOD NAIL Salt')' 7 603 — ROOF BATTENS 0 1,as owner of the propcny,am exclusively contracting with licensed contractors to ._. consumer the pmjecl(Sec.7044.Business and Professions Code:)The Contractor'a 604 — ROOF IN—.PROGRESS wse law docs not apply to an owner of properly who wilds or improves thereon,and ho contracts for such projects with a contractor(a)licensed pursuant m the Contractor's License Law. 0 l son emm"antler Scc. ,B h P C for Nis reason Ownr Date WORKER'S COMPENSATION DECLARATION I hereby afrnn under penalty of perjury one of the following declarations: I have and will maintain a Ccnificam of Consent to self-insure ror Worker's CumPcn. cation,as provided for by Section 3700 of Iw Labor Code,for the performance of the - work for which this hermit is iuucd. Vfbavc and will maintain Worker's Compensation Insurance,ss required by Section 17q of the Labor Code,for the performance of She work for which this Permit is issued. My Worker's Compensat n Insurance carrier and Policy numbs am: Canner. v. .s Policy No.: CERTIFICAT, OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not w completed if the Permit is for one hundred dollars n 10.3) r Mss.? I certify Nat in the performance of the work for which this Permit is issued.I shall nut employ any person in any manner sur a of wcome subject to the Worken•Cmmgcnsation Laws of California.pale Applicant NOTICE TO APPLICANT:If,after making this CeniGcate of Exemption,you should become subject to the Worker's Compensation provisions Of the Lahor Code,you must z fonhwi th comply with such provisions or this Permit shall w deemed revoked, zO CONSTRUCTION LENDING AGENCY I hereby affirm Nat there is a commotion lending agency for Iw performance of Y the work fur which this pcmnt is issued(Set.3(197,Civ.C.) 'JJ Under Name 1 Lcndcr'x Atldress Z) z J O 1 certify that 1 have read This city and coup and sure that and above information Mining is 1. Fr building I agree m comply with all city and county ordinances and state taws mooring 7 V mvc-gcpastrucdmentioncit orrich for inspection ctio oriny n aemoses. ivcs ser Nis city mcnmr upon the uj a1 gy (We)agreeto save,indemnify ad keep hay in an Um Cityru Cogent id City Z inconsegjude of ts,the craning expenses which may in anyway accmc against aid City J Z A APPLICANT ofDERSTANofthis permit. ^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ' SOURCE REGULATIONS. Re-roofs HAZARDOUS Signamrc of APPlicagam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Inc applieam ser forum building occuganl snow or handle ha�ous mamrial as de0ned by Oe Cupertino Municipal,Code.Chapter 9.12,and de Health and Safety Cone.Section 25s 321e)? ` All roofs shall be inspected prior to an roofing material beim ❑res �fNu P P � Y g g installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without firs[ob g an inspection, I agree to remove it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materia pecti uic" ❑Yes ,1<Nu IhaveteaJ Ochilrialsre oder Chapter 6.95 or:Calif., ria HcalthS Safcry 505 wilding, 3 534.1 understand that if ding docs am dune u 1 e N S r oaiibillily m mok,the txsupam or the requiremc mu orto'so rc sCcmrca¢uf a'cupancy. Signature o Applicant Date owner oraumorive sent Date All roof coverings to be Class "B"or bette Community Development Department Building Division City of Cupertino CVV� 10300 Torre Avenue CITY OF Telephone: (408) 777-3228 4UPEkTINO 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: S J ll' w2 �/ 17tratrtiC� / Job Site Address: g)S a d C .S00 l lCnE I( 4c e Roofing Company Name: c t` Aplicant's Signature Date: eel 3'v 3 Greg t Building Official Revised 1/30/03 Printed on Recycled Paper t Zia CITY OF CUPERTINO 0 2- 11 REROOFCITY OF l CUPERTINO PERMIT APPLICATION FORM APN # " q e4 o2— Date: Building Address: IDS3,;1 Owner's Name: Phone#: Contractor: Ph e#: License #: o I'c� .J- z z -J Y5 7 T` Con t: Iflione #: Cupertino Business License#: Me- ZZ - S2 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles `R Asphalt Shingles P, Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings t ❑ Provide I.C.B.O.Report# Js[ To be Removed ❑ Provide Mfgr.Installation Specs. ® I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: rrD , Residential E Commercial ❑ Fire Zone: Yes ❑ No`Q Confirmed with Planni et. if there are any restric . n : LJ Cost of Pro'ect: Type of CootructiIo Occupcy group: _10 Qty. if A l; ab 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, 3 z6� `l6�