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03100119 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION•�•Q BUI LDING ADDRESS: JNSJ ROOFING INC PERMIT NO.0.3100119 OWNER'S NAME: 691 W SAN CARLOS ST PERMIT LSSUE DATE NE: 4082796171 SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH !O o LICENSED CONTRACTOR DECLARATION MF 1 nerve"y" 'm that 1 am Emitted under p ons of Chapter 9(commencing Job Description �J :Ziy with Scaion nyyo rDi inion Jof Ne Businc.s�yrpP,rofcci sCodc.and my license is In mu mMe «e 3R p REROOF i yq? License lke Cha .. dm D Convector �o/z�/` ARCHITECTS DEC N cu BsunJ my plans shall be used as pontic tern( x °Dy Licensed PMfeaaimil S OWNER-BUILDER DECLARATION <y 1 hereby affirm that I am exempt from the Contractor's License Law for the 00 following mason.(Section 7031.5.Business and Pmrcxsiom Cole:Any city nr county 5 m which requires a permit to consumer,alter,improve.demolish,or repair any nructurc .¢i prior u,is issuance.also requires the applicant for such permit to File a signed statement :r< that he isliermadpursuant to(be provisions ofthe eonnaiLib<nscLaw(Chapter 9 Sq.Ft. Floor Area Valuation 21-0 (commencing with Section 70()[7a]Division 3 of the Business and Professions Code)or that he is exempt dremfrom and Inc bmh rot in.alleged eaco,ohn.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally,of APN Number Occupancy Type not ream than five hundred cultists P Y YP 1,as Owner of the proper,,or my employees with wages as Weir sole co rlsmolion, will do the work.and the swemm is not intended or offered for sale(Sec.7014,Business and Professions Code:The Convectors License Law does not apply to an owner or Required Inspections property who builds or improves thereon.and who does such work himself or through his own employma.provided that such improsementa are not intended Oro«ercd forsale.IL however.the building or improvement is sold within am:year or completion.rhe owner builder will have the burden of proving that he did not build or improve for purpose or sate.). ❑1,as owner of Ne proper,.em exclusively contracting with licensed conmetors to construct the roamer(See.7064,Business and Professions Code:)Tic Convaetor's Li case law does not apply tri as owner,of property who Wilds or improves themon,and . . who contras for such projects with a convactorts)licensed pursuant to the Contractor's Licatch Law. ❑l am exempt under Ses. ,B&P C for this Masan Owner --Did — WORKER'S a WORKER'S COMPENSATION DECLARATION 1 hereby ABren under penalty of perjury ane of the following declarations: J I have and will maintain a Cenlficme of Consent M self-mine for Workers Compen- wion,u provided for by Section 3700 of the tabor Code.for Ne performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,u required by Section 3700 or the lahor Code,for she perfarmancc of she w as for which Nis permit is issued. My Wniker Cm sationlougacceanierindP cy number aM: (�JVlrra(r/ .�- - Pa CERTIFICATEOFEXEM FROM WORK ERS' COMPENSATION INSURANCE (Dissection aced not be comple¢d if the permit is for one hundred dollars($100) Icss.) 1 certify that in Inc performance of the work for which this permit is ishacd.I shall not employ any pawn in any manner so Is sea became subjavo[be Workeri Comparvdom Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making Nis Ceniricme of Exemption,you should become subject to the Worker'a COMPeuation provisions of dm Labor Code,you moat D z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY I bemby affirm that Vert its en dmandon lending agency for Ne performance of Ya the walk far which this permit is issued(Sec.3W7,Civ.C.) i1 Q Lender's Name z Lender's Address � Q 1 certify that 1 have(cad this application and sate thn thoabove informationto L H borne 1 time m comply with all city and county oNinanmf andnd sure lawswsreading e V building construction.and hereby auNriae oru cprcnuw liof Nre is city to enter upon Nc Na arow<-menudgmenmmul ropcny for matmoscs purpose:. (Wc)agree to sacs,indemnify and keep harmless Ne City of Cupertino against Z inconso,tainc of do, of this Permit. may in anyway accmc against mid City ,z A consequence of NC Framing of this permit. P .. PR OU ICAREGULATI S. SAND WILL COMPLY WITH ALL NON-POINT Issued by: Date S eorAvpheanvcontraemr am Re-roofs HAZARDOU MATERIALS DISC SURE Type of Roof Wi applicant or future building Occupant or handle haairdous material as th river 9.12,and the Health and Safety code. 0Yes 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Yes Will the applicant or future building Occupant use equipment of d vloes whim If a roof is installed without first obtaining an inspection,I agree to remove it haaardous air contaminants u defined by the Bay Area Air Quality Management istriall new materialsafor inspection. n? �u�� ❑Yes "� 1 have mad thehmardous materials 5533 me55under Chapter6.95of ifthe Califor isrinochil that Mild255J4.1undcrsmnd thaifthe building y � tires nor emly nes a Imam Wes it is my rcxpominility r lily IM cupant of Nc �l C/1✓S act s which reW he priono�uanec of a certifi am pf 1 Can y� ---j o J � Sig ore oFAp licant Dale o u Mind...or D„e a' nngs to be Class "B”or better M Community Development Department CBuilding Division f lCity of Cupertino 10300 Torre Avenue qCITY OF Telephone: (408)777-3228 UPEkTINO 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: U tl Job Site Address: 0$ EY-z-1co Roofing Company Name: J/)S f r5i,c. A plicant's Signature: Date: O if WC) Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper ,1 CITY OF CUPERTINO o 3 REROOF CRY OF CUPERTINO PERMIT APPLICATION FORM APN# Date: I b_I S a Building Address: b b8D d..c o c , Bld . " Y Owner's Name: e#s Z Contractor: P one : License#: � NSJ Root s.c. s �-74-b17( �3Y`l8g Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Propose , r 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: B Job Description: �zwv�n cP) vao , 1'kr�ll tom,,,, 4P w�J�A.aI C3 UR Residential ❑ Commercial Fire Zone: Yes ❑ No ❑ Confirmed with Plan e t. if there are anrestr' tons: Cost of Project: 00 O Type of Con on: Occupancy gro p: r Qty. i A 1 a ]e 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 • -Pl- 1° 7. s�°