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03100022 (2) Cl"rY OF CUPEWUNO CON PERMIT TRACTOR,INF�\ORMATION: BUILDING DIVISION s a BUILDING ADDRESS: _ SHEM THOMAS D PE11ITN003100022 799 E RRTIA�IRR pg. OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MP.CH 0 +op LICENSED CONTRACTOR'S DECLARATION F 1 hereby arum that I am licensed under provisions of Chapter 9(commencing Job Description ;Zw with Section 7IXM))of Division 3 of the Business and Profesxinm Code,and my liven.is fulrce and effect. License ue.x REROOF �a�t �i��tYP9rlC �pA t-O Da¢ Contractor 4e� ARCHITECTS DECLARATION i nU 1 undersand my plans sM1all be used as public recnNs c.In LicensedPndcssinnal nEr. 1 s M03 01 OWNER-BUILDER DECLARATION 1 a y 1 hereby affirm that I am exempt from the Contractor's License Law for the :0 O following reason.(Section 7131.5.Business and Professions Code:Any city or county BUILOIN m� which requires a permit in construct,alter,improve,demolish,or repair any structure ,Y 1 i y prior to its issuance.also m4oires the applicant Inflect permit to Glc a signedstatement az< that he is licensed mum=tothe pmvisimoofthe Caotsanorsueen.Law(Chapter 9 Sq. Ft.Floor Area Valuation dF0 (commencing with Section 70(1 Division 3 idiom Busineesmd Professions Code)Or `<$ that he is exempt therefrom and the basis for the alleged exemption.Any violation of 36922016 . 00 Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy Type nut m.,a roan five hundred Will...S500). P Y YP ❑ I.as owner of the property,or my employees with wages as their sole compensation, will do the work and hies"nun:is not intended or offered for sale(Sec.7014.Business 305 — FRAME and Professions Code:The Confucian's License Law does not apply to an owner of Required Inspections propmrty who builds or improves thereon,and who does such work himself or through his 307 — INSULATION awn employees.provided that such improveme.0 are not intended or offered for sale.if, 601 — ROOF TEAR OFF however,the building or improvement is sold within one year of completion.the owncr- milder ,will have the burden or proving that he did not wild or improve for purpose of 602 — ROOF PLYWOOD NAIL sale.). ❑ 1.as owner of me property.am exclusively contracting with licensed contractors m 603 — ROOF BATTENS .sumer the project(Sec.70Pl,Business and Professions code:)The Contractor's Li. 604 — ROOF IN—PROGRESS carom taw does not apply to an owner of property who builds or improves Woman.and who contracts for such projects with a continuants)licensed pursuant to We Confacmr's Liesuse Law, 0 lamemm (under See. B&P C for this rcazon Das WORKER'S COMPENSATION eEC RATION 1 hereby affirm under penalty of pc jury one or the following declarations: --� I have and wil l mai main a Cenificam of Consent o sole-insure for Worker's Campion. .alio.,as provided for by Section 37W of the labor Code.for the performance of the ark for which this permit is issued. ❑ 1 have and will maintain Workers Compensation Insurance,az required by Sectino 3700 of the labor Code.for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number aa: Canter: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not bccomplkmd if the permit is for one hundred dmllars(Elfk)) or less.) 1 ccnify that in the performance or the work for which this permit is issued,l shall not employ any pc ymafm�ras3ro p�cumc subject to the Workcrs'Compensatinn Laws of Calf ny(Lntc ZZJJ 3 Applicant :apo NOtICE TO APPLICANT:If,after making this comhi use,of Exemption,you should w subject to the Worker's Compensation provisions of the labor Code,you must z forthwith comply with such provisions of this permit shall he deemed revoked. ZO CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of L' > the work for which this peonit is issued(Sec.3097,Civ,C.) Q Lender's Name Z, z Lender's Address ;J p 1 comfy that 1 have read this application and sate that the above information is y F officer.I agree to comply with all city and county ordinances and state laws relating to �U building construction.and hereby authorize representatives of this city to enter upon the N above-mentioned property for inspersion purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against h liabilities,Fragments.costs and expenses which may in any way acerm against said City J z in consequence or the grand ng of this perm it. (b*�7 ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE R ULATIONS. �"a' � z 0 Re-roofs 5' nature of ApplicanVComra' arc HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will We applicant er future building occupant stem or handle mormous material az defined by the Cupenino Municipal Code,Chapter 9.12.and the Health and Safety Code,secaea 25532(a)7 All roofs shall be inspected prior to an roofing material beim C]Yea )Q NO P P Y g g installed. Will the applicant or future building Occupant use equipments devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. snict? ❑Yes 'fikNo 1 have mad thc hvardnus materials requirements under Chapter 6.95 alum Califor- nia Healthe,Safoy Code,Seedons 25505,25533 and 25534.1 understand that if the building does not cwsently have a tenam,We,it is my responsibility as n.uty We Occupant alum requi¢mems which mustwmetpfi rt Iissuancn ars Coreflcate of Occupxm:y. Signature of Applicant Date nerorsumofindagent •���u All roof coverings to be Class "B"or better Community Development Department ,Lwt Building Division ` City of Cupertino 10300 Torre Avenue C Telephone: (408)777-3228 ITY 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: 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: /&_c)1 7/9r Job Site Address: /d 7 9 y mfrs,— �s rg rPs /O� Roofing Company Name: '/Hv- xi A plicant'sSignature: ��-� �-. Date: /o —L -0 Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO i � REROOF Z Z CITY OF CUPERTINO PERMIT APPLICATION FORM APN# / �/ Z Z 0/ Date: b l /0 - 2 - 03 Building Address: 99 - AST fsrATe ./7it Owner's Na e: Phone#: Contractor: Phone#: License#: Contact: Phone#: 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: X /Za._...>-•--- Z`J�.s.�.- O 4- Li9-G e `-`� e Residential ® Commercial ❑ Fire Zone: Yes ❑ NO Confirmed with Planning Dept. if there are an re t c ons:. LJ Cost of Pro' D p27�e of Const n Occupancy cu Qty. if Arckle 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 4- 23 3S / 07, S .