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04090073 (2) CITY OF CUPERTINOu>rnna,ye � dPs, BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ,, . . . _ eU1LDINGADD[i MARTINEZ ROOFING INC 1111NOD4090073 OWNER'S NAME: PERMIT ISSUE DATE DNE: SANITARY O. N OL NO. ARCHITEC(ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 400 LICENSED CONTRACTOR'S DECLARATION F❑ 1 hembYY,�aafli� Net I am limed under provisions of Chapxr 9(commencing Job Description iW with Smdmn]0dry'of Division3ofthe Do4nevyll Pmfrssiom Codc.endmYlicenu is Zc. h r.0 retro some ys'a / l REROOF W/ COMP . Lice C Lic.M It ^o Dem Comrx �; ARCHITECTS DEC ION m Tun,moth my phns shallWuxdaspu crtcnNIt /^ G 3 C H Licensed Pmtcssionel / g OW NERr exempt ER DECLARATION (� 3�M I hereby alErm I I em exempt from We Contractors License Law for rW p O fallowingso man.(Seeman 703 .5,Business and Professions Cade:Any city or county V K m which requires a,smut m construct,altar.improve,demolish.or repair any strucum 6490 ,nm mils Lcsuenm.alw mquime thetapplicrat forsueh pe.iuo fileasigned summons Nat he is licensed,....at to the provisions of Ne Commoners Limme law(Chapter 9 Sq.Ft. Floor Area Valuation mH" (commencing with Section 7")of Division J of the Business and Professions Cook)or Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by Say applicant for a permit subjects tha applicant to a civil penalty of 35CPN6`1M*Qr00 Occupancy Type not mom Nan firs hundred tonin($500). C3 I,as owner of the property,or my employees with wages as Nair sole compensation, - will do dta work end the aumcwte is not intended or offered fatale(Sec.]U64,Business and Professions Cote:The Contractors Licenu Law it=not apply in So owner of Required Inspections property who builds or impmws Nemon,and whodoessuch wart himself ormuough his Own employees,provided that such imprommenu art not intended oraRered for ale If. however,the building or impmvemens is Sold who.m¢year of completion.be ownm. builder will ban the W.den of proving Nat W did not Wild or improve for purpose of okJ. Q 1,as Owner of to property,am exclusively contracting with licensed contactors to consumer du praiser(Sec.74364,Business and protections Code:)The Comracwr's Li come law does not apply as So owner of propany who Wilds or improves themmn,and who contracts for such projects with a conmcter(s)licensed pursuant to the Convenors License Law. I am exempt under Sec. B&P C for Nis reason OwnerDau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under Penalty of perjury one of Ne following dxlarations: 7�cl I hasand will mainuin aCeniOmm of Consent m self-insum far Wmkers Comperelian,re provided for by Section 3700 of Ne Inbar Cade,for Na perfam race of the for which Nis perm it iS issued. ave and will me.norm Workar s Compcnumon hummu s.as mquimd by Section of Ne LaWr Code.far the pcfamormof Ne work for which Nis permit is issued. Workers Cov,cnemion m mac amu rad Policy num ame u Pahccyy��o:A -ERS 2/ CERT( CATS OF EKEMPTIQMFI40M WORKERS' COMPENSATION NSURANCE (this section need nothecomplc¢ ftW Permit is for one hundred dollars(SIIX) at kit) I certify Nat in Ne performance of On,wart for which this Permit is issued,I shell not employ any Person in any mother an as in become subject to the Workers Compensation Laws.(Calif mla.Dam Als,Bcam NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject to the Worker's Com pcnsmimn provisions of the labor Codc.you must Z foMwith comply with such provisions or Nis Permit shall be deemed moment. Z O CONSTRUCTION LENDING AGENCY H� I hereby aRrm Out there is a commandant lending agency Or the perfombrom of C4the work fur which Nu permit is issued(Sec.3097.Civ.C.) CQ Lenders Namc z lender's Address U 0 1 certify Nat I have mad this application and sure Nat the above infoonatiun is P coned 1 agree to comply with all city and mUrLy ordinances and sure laws relating to 0U building construction.and hereby authanae mpmumutives of Nis city in enter upon NC above-mentioned initially for intimation purposes (We)agree to save,indemnify and hep harmless the City of Cupcnino against .F.V1 liabilidea,judgments,costs and mapcnses which may in any way acme against said City in cissOccuters.of On ai Of s pormit. U? APPLIICCAN-OsUNDENSTANDS AtND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. Re-roofs Signazurc of AppliwDau HAZARDOUS US MATE RIALS DISCLOSURE Type of Roof Will Nc applicant or future building mcupem start or handle haaardaus material u tafimd by are Cupertino Mumvi al Code,Chatter 9.12,and the Health and Safety gi�rdur de.secyO25532(tr, No All roofs shall be inspected prior to any roofing material being installed. pplicant or fuwm building Occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove conummarms as dcGned by dm Bay Area Air Quality Management all new materials for inspection. District, If ❑Yes /f N. I have mad the bar ndn/us materials raquimmcnu under Chapter 6.95 of the Califor. .is Health&Safety Code,Sectors 25505.25533 and 25534.1 urmersrand Nat if the With, dna not currently have a mnan at it is my msponsihility to num 1,mat occupant of Ne mq.imA,htswn J pnmrmias. aamncenrea or cap y. S ature•ofApptcan Date n onxedagatnt G � �oam7y—" / All roof coveringS_t e Class "B"or better a1 Community Development ( N 10300 Torre Avenue Lr' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building De artment JOB AD SS: PERMIT # 21831 /7.e�r4 OYO C00 73 OWNER'S N Rlle-E- —1!5e14,c C . PHONU GENERAL CONTRACTOR 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 JeMit�TisVzZ ..✓G Septic Tank Sheet Metal Sheet Rock Tile i v /Con c or Signature Date Community Development Department Building Division ��t fr ':' City of Cupertino 10300 Torre Avenue OzCITY 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 wild comply with the above stated policy on re-roofing. Homeowner's Name:' //,�2 Cr` Job Site Address: ���i Roofing Company Nam 1-16e-% eJ V L AA9:— A plicant's SignaturesAIA- Date: 3 Cis f Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF O bCITY OF � CUPERTINO PERMIT APPLICATION FORM ! APN# Date: a 9 Building Address: / Owner's Name: Phone#: Contractor: Phone#: License# Contact: Phone#: Cupertino Business License #: t06. G 7 - i?ar- Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ 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. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: / L �/� AMo Oj1� �JIr/S C r2 / P4 I jl Ye C Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with PI e t. if there are ans rictions: Costf Pr,t jt Type of Co t Occup y gr Qty. if A 1' e I 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 J