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05070032 (2) CITY OF CUPEWFINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION BUILDING ADDRESS: PERMIT N00 5 0 7 0 0 3 2 OW NER'S NAME: PERMIT ISSUE DATE .-DENNIS HARRIS ONE: SANITARYNO. CONTROLNO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 boa LICENSED CONTRACTOR'S DECLARATION Job Description e C I hcuby affirm dor,I am li¢nuoesP d under provisions of Chapter 9(commencing - <n with Sutbn90(lU)uf Diviaian3of the no aIoCM and P.rgrn..Cpdc,.Nnd my Iiccnm is ^may in ton torte and c(fsA17� r6J/Cq ✓Q.J( � REROOF W/TILE �r- �1p1 v�Z Liccnm hers_ ;1_i_—o Dat Convector CONTRACTOR: B R ROOFING (06/d3O/jO'5/) 1+I ARCHITECTSDECLARATION ` w1 undemm�J my plans shall be used u public records < s �p ;ow Licensed Pmfcsxinnel G�3 COo9 [ 3 OWNER-BUILDER DECLARATION dd ' I h[mhy vrcrm that 1 oto exempt from he Contractors License Law or the mm.. D O following mason.(Section 7031.5.Business and Pmfessiuns Code:Any city or county 11.'iYl �I p fin{ �{�� p p ra x m which mqui.s a permit m Construct,shot,improve,demolish..,.pair any suremm �a aspoor to its issuance,also acquires the applicant for such permit to file aligned statement C L < that heisliccnsedpursuant tothe provisionsU of Sq.Ft.Floor Area vLValu�gE�ri1;O67 E'Fo Commencing with Section 7000)of Division 3 of the Business and Professions Cona)or 'y that he is exempt hcmfrom and the baso for the alleged exemption.Any violation of Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not mom Nan five hundred dollars(5300). ❑1,uowneroftMpmpcny,mmyemploycuwithwaguazhchmlewmpenudon, 32616003 . 00 will do the wor and the structure is not intended.(offered Inside(Sec.'/Od4.Business Required Inspections and Profession Code:Thw e Contractors License ladoes tot apply to an owner of q P property who builds ori arrows nhemon,and who does such workhimselfor through his ownemployees,provided Natsuchimpro mcnuarenotinmWd crone.dfmsale.If. however.the building or improvement u sold within am year of compmmn,thc owne, harder win have the Wrdcn of proving that he did not build or improve for purpose of sale.). ❑1.as owner of the propxrr,am exclusively contracting with licensed contractors to construct the pmjcct(Sec.1044,Business and Probations Code!)The Contractor's Li. tonne Law dose not apply to an owner of property who builds or improves themon,and who contracts for such projects with a eamractor(s)licensed pursuant m the Conmuars Liccnm law. ❑I am exempt under Sec. B&P C far this mason Owner Dam WORKER'S COMPENSATION DECLARATION 1 hereby affum under pemi of perjury one of Ne fallowing doo aur lions: Iia ve and will maintain a Corsicana of Consent to self-insure for Worker's Compere sation,as provided for by Section 37W of the Labor Cade,for she performance of the work for which Nis pornin is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3900 of the labor Code,for the performance of she work for which this permit is issued. My Workers Com intention Insurance Gamer and Policy number am: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This unionrecd not Chetan toed iris,permit is fomite hundred dollars(SIM) or Isis. 1 eenlN that in the performance of the work for which this .it a issued.I shall not employ any person in any. arm sew be c 6e a ho Workeri6omprrialum Laws of California.n ^•'?"yNL u..).°'"/i31�. Applicant l NOTICE TO APPLICANT. M mg ba Omiricate or Exemption,you ahouW bocomc subject in he Worker's Compeuntion provisions of he Utter Code,you no u .JQ foMwih comply with such provisions of this Permit shall he deemed revoked. Z� CONSTRUCTION LENDING AGENCY [-. I h rchy alE.n that here I,.comasnima Rading agency for the perfomancc of :L> he work for which this permit u issued(Sec.3(191,Civ.C.) Iz]Q lender's Name z lendcri Addmss U O 1 certify that 1 have tend hie application arta sum that die above information is IL F norma 1 S.In comply with all city and county ordinances and sum[aws.]arng to 0O Wilding construction,and hereby emhoriu mpresenutives Of his city to Cour upon he r above-mentioned pmperty for inXcbon purposes. t1 (We)agme to save,indcmni fy and keep harmless tho City of Capron.against F' p) liabilities judgments,Cosa and cxpcnses which may in any way accmo against mid City /�r U in cansequcncc of the granting of this permit. lJ'U APPLICANT DERST D WILL COMPLY WITH ALL NON-POINr Issued by: Date U SOURCE ATI JC94 b Re-roofs C7 �f r Signature of ApplicaHAZ tar na HAZARDOUS MATERIALS DMore or U Type of Roof Will the applicant or future Willing occupant erre or handle ha moue mamnal as defined by the Cupertino Municipal Code-.Chapter 9.12,and he Health and Safety Calc,So❑Non25532(Yes i a)? OleAll roofs shall be inspected prior to any roofing material being installed. Will he applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it havrdous air contaminants as defined by he Bay Area Air Quality Management all new materials for inspection. 4111CO El Yes I have mail the hmerdtws materials nqui.menu under Chapter 6.95 of the Califor O�qut lth&Safety Code,Savona 25505,25533 and 25534.1 undross nd hu if do Wilding t[umcndY haw a mnanL WI it a y mibilitY m noufY Uc oaupmt of the l n hi be methCeNfieamar theoercy. Signature of Applicant Date Owner ar anhorra gent Date All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue {1 Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408) 777-3333 �UPEkTINO Building De artment JOB ADDRESS: PERMIT# /; �D o G c� rx l b,5-V O o3 2, OWNER'S NAME: r PHONE # GENERAL CONTRA OR: iN FAX # / I am not using any subcontractors: /%/ AP4 Signature Da e Please check applicable subcontractors and complete the followinginformation: 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 Owner/Contractor Signature Date Community Development Department Building Division i City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 �'�� Fax: (408)777-3333 �J 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. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. 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: Mk ALM �.IJ H IqIC�I S Job Site Address: _01 4o [),a C k r., / Tb c W to1 r"o Roofing Company Name: TO ©d FVU G Ap plicant's Signature: Date:J0Ly� tGreg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO �` REROOFTy CUPEI�TINO PERMIT APPLICATION FORM APN # 7� � / � OO � Date: � c Building Address: J l LL �5fv - - Ol Owner's Name: Phone #: tr r: P one#: License#: ( cc�C�i iU 6 o c( a �2 5 S Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑,/ Asphalt Shingles ❑ Asphalt Shingles Rr 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 Mfg. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic Job Description: Residential Ea Commercial ❑ _ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are any restrictions: i5 C st of Projec : ype Construction: Occupancy group: o©F SlN LFulrv� I t, Qty. i f Applicable 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