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04080142 (2) CITY OF CUPERTINO -- '^ BUILDING DIVISION PERMIT CO NTRACTOKINk'ORMATION `•<; BU II.DING ADDRESS: PERMIT NO. CINDY ROOFING CO INC 04080142 OWNER'S NAME: PERMITISSUEDATE ONE: SANITARYN 0 OLNO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH D O ti00iJA LICENSED CONTRACTOR'S DECLARATION Job Descriii w❑ I hereby affirm that I am licensed under provisions or Ch.prer 9(Commencing iW with Sccom.70 sq of Division Sof tW Budneaa ofessions Code,endmyliccnse is rl Li!. n anderrec < REROOF W COMP. Asa? License Lk.N �— p ff__ /yam e F Dale Cunlractor AU V (i al 2004 V ARCHITECTS 0TION ? � tun nil my Plmeahall be used u P=cord, =A. Oo� Licensed Professional BUIL®L N G 3 OWNER-BUILDER DECLARATION f T hereby arm I am exempt frum the Contractors Liccnx Law for the p O following mason.(Section 7031.5.Business and Professions Code:Any city or county K m which mquihes a permit m construct,alter,improve.demolish,or mryvir any structure FIy prior to its issuance.also nounct the applicant for such permit to fie a signed summmn i< that kulicensed pumusnucmrs In roviaionsoftheOm aI.. aw(ChapmsY Sq. F[. Floor Area ValuaU n ce ,FG (commencing with Section 10M)of Division 3 of the Busioear and Prefessiam Code)or y $ that W is eaesopt tbcttfroa and the basis for the alleged exemption.Any violation of i�i Section 1031.5 by arty applimnt for a permit subjects the applictnt a a Civil PMAIV of 3 BB1410t2tieC 0 0 Occupancy Type not more than five hundred dollars(5500). I,As owner of the property,or my employees with wages aa their sok compensation. will do the wai and the structure is not intended or offered Ron].(Site Was.Busims, Required Inspections and Profession,Code:The Confetti License law does ret apply to An owns of q P property who builds or improves thereon,and who does such work himself or through his own employm.provided Nat tech improvements arc not intended or o0ehed for sale.l- however.Ne have the or improvement is sold within oto year of mprove for the owncry builder will love the burden of paving that he did not build or improve for purpose Of Cala.). ❑1,as owner of the property,am exclusively convecting with licensed convectors to construct the project(Sec.70,14,Business and Profession,Code:)The CWUOAC ors Lf- ccnM law does not pply to an owner of property who builds or improves thermn,and who Contracts for such projects wife a eonesictor(s)licensed pursuant to the Coaracari License Law. ❑1 Am Attempt under Sec. B&P C for this mason Owner Data WORKER'S COMPENSATION DECLARATION 1 Mmby affirm under penalty of perjury one of dm following deelaratioos: I haw and will maintain a Ce,ormte of Consent to self-insure for Workce,Coapcn- 7037W.fft udn,as provided for by Section 31W of the Labor Code.for the performance Of the rk for which on.permit is issued. I base and will maintain Worker's Compensation insurance,As required by Section laborCode.far the perfofmanee oftM eh this permit is issued. yWoorker'sCompensation 1 mrriu andion n m:tpfpPolicy Y CE IMC TE OF EXEMPT ON ROMW RKERS' s�OMPENSATION INSURANCE most section needt be completed ifthe,permit is forone hMdmddollam($100) or kss) I ectfify Nal in the performance of the work for which this permit is issued.I shall not Ampl%any prawn in any manecrso as It become subject to the Workers'Compcn,etion Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Cenifteare of Eacmption,you should become subject to the Worker's Compensation provisions of the Labor Code,you muss OfoMwith comply wish such provisions or this Infant shall be decreed masked. Z'-" CONSTRUCTION LENDING AGENCY E.t .N. I Wmby affirm that them iso croswction knding.1hey for fee ,to--Of fY> Ne work for which Nis permit H issued(Sec.301 Civ.C.) W A Linde's Name IL Underi Add., U C) I certify not 1 have head this application and sate that thc above infmmatiun is IL r c0omel.1 agree te comply with all city and county Chi and state laws totaling to O('J building conwuction.and hereby mthorin representatives of this city tocnteru-uruse n above-mentioned property for inspection purposes. 4. (We)agree 10 save,indemnify and keep harmless the City of Cupertino against In lubilitic.,judgments,costs And apaucs which may in any way Accmc.gei Rsaid City / U z in consequence of the granting of this Permit. APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued by: Date 50 RCER CATION i Re-roofs Si awrca A Ka aOaCor atr H DOUS IAISDISCLOSURE Type of Roof Will fee applicant or future Wilding occupant stem of handle havameus material As defacd by ft Cupertino Municipal Code.Chapter 9.11.and the Health and Safety We.5ccdon 15532(.)? t All roofs shall be inspected prior to any roofing material being installed. 0 Ye Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it haran ous air contaminants as dcfincd by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes Nu I have mad on harasdous materials ic,immems under Chapin,6.95 of the noire, nis Hmlut&Safety COM.Sections 25505,25533 and 25534.1 undemtsnd iMl if she Wilding does not currently haw a tenant,Nat it IS my respon,ihincy in notify tM Occupant of the mquimmc ,which at ntprio mramp snanor.a _ nature Of plicant Tate ecr nr anN a agent / Dahe _ All roof coverings to be Class "B or better ,b.} Community Development CuTorre Avenue peOrtino CA 95014 " Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADPERIT# D U �� lo ('011aa v1p Z,7 OWNER'S PHO GENERAL CONTRA O • 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 I � � ontrctor Signature Date i Community Development Department _ Building Division City of Cupertino 4 T ...,..: 10300 Torre Avenue CITY OF' Telephone: (408)777-3228 CUPEkTINO Fax: (408) 7773333 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: Job Site Address: OS'// li/P.yz �/�✓� r Roofing Company Name:' A plicant's Signature: � Date: Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper i CITY OF CUPERTINO J/ o 0Z REROOF T �CUPETINO PERMIT APPLICATION FORM APN# O Date: Building Address: r /GS// CPI�n lii�/r/ �v 2 Owner's Name: Phone #: yof Contractor: Rdo�HS �j Phone License : / Contact: Phone #: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof `1 Asphalt Shingles X 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. [ Have Read, Understand and Will Comply ith Cu ertino's Tear Off Policy: Job Description: -e i�r ed C' 6:-x 1 S � Zc it s 4:1— Residentilil ommercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: U Cost of Project: Type of Construction: Occupancy group: ��5s Qty. if Applic 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