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04080114 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTR°ACTOR�INFORMATION x4 BUILDING ADDRESS: PERMIT N0. JNSJ ROOFING INC 04080114 OW NER'S NAME: PERMIT ISSUE DATE NE: SANITARY 4:3O OL NO. ARIHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 +n+Op LICENSED CONTRACTOR'S DECLARATION Job Description a W C w I hereby affirm that I am liecnxd under provisions of Chapter 9(commencing P !!�®fes b illi Senion7W))o(Division 3 oftim Busineuand Professions Code.and my license is /B`p in full fore and aff `� p n Hz License � Lie.N REROOF �5�� a Date Contractor f� xrrEcrs DEct fmr., AUG 1' 20p4 s< 1 an not m shall W used u public records �yU mLicacndPssn p 5 OWNER-BUILDER DECLARATION cr y affirm that I ore exempt from the Conuannr'a License Law for the no fallnwi easnn.(Section 703 1.5,Business and Pfffeatlons Code:Any city or county • � m which reyuiru a permit to construct,altar.improw.demolish.or repair any structure prior to its issuance,also mquims the applicant for such Permit to file a signed statement �r< that he is licensed Pursuant to the provislom of he Conlrecumf license Law(Chapter 9 Sq.Ft. Floor Area Valuation FFG (commencing with Section 1000)of Division 3 of the Business and Profusions Codc)or i that he is exempt therefrom and On,men for Ne alleged exemption.Any violation of Section 1031.5 by any applicant four a permit subjects the applicant to a civil Penally of 3 Mhl fgtgbJPr 0 0 Occupancy Type not mom Nan five hundred dollars(S50% I, the worof the pffpmty, re is with wages r Nei(sole campenvdan, W311 dodrwork endthe ha Comisnotintendedorawd far sale(Sec.tfled,Business and property who Calc:The Contractors and res aces not apply to an owns is Required Inspections Own eny who buildsvided 6oms thereon,and who ams such work or sefforoffered ed for ughWe his ownemployee,providedthanSuch.t is Wd wi artnot earfOofahem..for We.If. huilder.will Wilding orimprovementis Bald withinore Wild of mpromfrNe owned builder will have dr When of pffving that he did nal Wild or improve far purpose of ukJ. ❑1,as owner of the progeny,am exclusively contracting with licensed mntmetors to construct the project(Sec.1064.Business and Professions Code:)The Contractor's Li corse Law does not apply to an owner of property who Wilda or improves daemon,and. who contracts for such officers with a contrxc or(s)licensed pursuant to the Contractors License Law. I am exempt under Sec .B k P C for this rcssan Owner Dat WORKER'S COMPENSATION DECLARATION 1 hereby alarm under penalty of perjury one of the following declarations: I have and will maintain a Certifier,of Consent to elf-insure for Work s's Camper- extio t,as provided for by Section 3700 of the ISWf Code.for the perfarmatre of the work for which this permit is issued. ❑I love and will maintain Workers Confirmation Insmmce,as mqui(ed by Section 3100 of the,labor Code,for the performance of the work(of which this Permit is issued. My Workers Compensation Insurance carts rand Policy number art: Carrier.af* aldP grog , {(5_ CE MCA OFEXEM MWORKERS' COMPENSATIO INSURANCE (This merino need not becomplered if dr permit isforone hundred dollars(SIM) or It..) 1 certify Nat in the perfonnum.of the work rot which this Permit is issued.I shall nut employ any person in any manner sn ax to become subject to the Workers Compewtion Laws of California.Dale Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should meomc subject to the Worker's Compensation previsions of Ne Labor Code,you must .,0 foMwith comply with such provisions or this permit shall b=deemrewired, ed rered. Z CONSTRUCTION LENDING AGENCY (r .N. Ikmby affirm that there is a construction lending agency for dr performance of a' the work for which this permit is issoed(Sec.3041,Civ.C.) D] Alender's Namc ZP. Lenders Address V Q 1 certify that I haw,read this application and sale Nal the aWm information is [S. f"' conca.l agree to comply with all city and county ordinances and stale laws relating w 0C.) building construction.and hereby auNome¢Pmxxrutisea of this city to enter upon the W shove-mentioned pffpeny for impaction purlwsea (We)agree to save,indemnify and keep harmless the City of Cupenino against pap liabilides4udgmcrrs.casts and expenses which may in any way scenic against said City . U 2 iAnPCPLntseMc' DERSTANDS AnND WILL COMPLY WITH ALL NON-POINT Issued by: Date ' SOURCE R ATIONS. J Iov Re-roofs at of Applicam/Comractor De HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or rumrc building oeeuPam store or handle haurdeus material defined by Nr.Cupertino Municipal Code.Chapter 9.12,and Nr.Health and Safety Coale,Soon.2553$4)t All roofs shall be inspected prior to any roofing material being Installed.❑Yes gNa Will the applicant or future building occupant use cgaimuni m Eewieu whuen If a roof is installed without first obtaining an inspection,I agree to remove it haaardous air contaminants as dcfincd by the Bay Area Air Quality Management all new materi or inspection. District? Dyes &INo I have mad the WaaNuusmaterials nquiremens under Chapter 6.95 of the Califor. rasa Health6 Safcty Cadcriccdons 25505.25533 and 25534.1 understnr-0 Thar ifthc Wilding V✓/ `� doe non eurmoll ha ¢nam Nal h ea my mamnsibilky w madly tha mcuP t of mquirtmenrsw abcmet Poor heis&are=rfaC=mfiese ra=e y Si re Applicant Date n b .,a ager, „! All roof coverings to be Class"B" or better =t Community Development 10300 Tone Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRESS: ,, PERMIT # FVaw-o Q . $� [iC © YD$O ll OWNER'S NAME: of PHONE # tgvg_ 2:1,J ^(o l GENERAL CONTRACTOR: �/ e�i c FAX # I am not using any subcontracto Signature Date Please check applicable subcontractors o owing information: 60 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 er/Con actr Sign otore Date Community Development Department Building Division ' City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 OUPEkTINO CITY OF 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,�Nlzi D!fe-NQ-� job Site Address: ( 880 FY°pp�LL C�. r C_ ' r Roofing Company Name: Aplicant'sSig—nature: Date: 8 0� I JR.e II�N Greg teel DDCC�c1� 1 Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO 01TYOF REROOF ° op o d CUPERTINO PERMIT APPLICATION FORM APN# 326— L O — O S S Date: /1-240 Building Address: O �Q O `o C nG V Owner's Name:^� /� ( Phone #: YQ /titZ'1 YO GS Qr�t"o Sc�� Contractor: Ph ne#: License#: JNSJ —+c . a• 21a-6/7r 73g98Q Contact: Phone#: t t Cupertino Business License#: Type of Roof Covering: Exise r ting Propos p�Built-Up Roof Wk,'Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Nu 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: ti kkwA C, toK 1j (4— w�{ Residential ❑ Commercial Fire Zone: Yes ❑ No Confirmed with Planning Det. if there are any restrictions: LJ Cost of Project: .0 Type of Construction: Occupancy group: OQ — Qty. if/- A li a gni 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 • z� -77