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04040167 (2) CITY OF CUPERTIN'O .'y^" a rk✓ %°,I BUILDING DIVISION PTRMI'I' CONTRACTOR INFORMATION:' Lia • �: .� "��.f��pw.. a, BUILDING ADDRISS: H & W ROOFING PERMITNOO 4040167 10480 J H OWNER'S NAME: PERMIT ISSUC DATE PAM CAPANA 1890 CREWE CT 04/27/2004 ONE: SANITARY NO. CONTROL NO. (415) 964-4945 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 .0, LICENSED CONTRACIDR'S DECLARATION Job Description [U C I hereby affirm that 1 am licead under provisions of Chapter 9(commencing p U wi lh Section 90gq of Division 3 of the Businex%and Professions Code.and my license is n mu force and erfeck —/�a— RER00 F n�A {� Low Licimea class ate _.17_ '3l Lir.#mor q1 LC 4 c' F•nff t 0 N L ARCIIITECTS DECLARATION 1 understand my plans shall M used as Public reenms >itu MAY fir 2004 tN Licensed Pmfcesion.l iOWNER-BUILDER DECLARATION <Z I hereby affirm'hal 1 am exempt from'W Common's License Law for the Sfl �"9eAn OLM nq_ es o following reason.(Section 91131.5,Business and Profezxions Code:Any city Or county U K m which requires a permit it)construe',alter,improve.demolish m repair any structure 86200 oma" prior In its iumnce,atm requires the applicant forsuch permit to Glc asigned statement -�a that he is licensed p...amI.(be Imvrsmunflh.Cnntmcmr's License law(Chapter 9 Sq. Ft. Floor Area Valuation yFD (commencing with Section)W()of Division 3 ofthe Busincasand ProfcesionsCNe)or i Nat he is exempt therefrom and Ne basis for the alleged exemption.Any violation of Section 7031.5 by any applicant forapermh subjects thc.PPlicam loo civil pcwl'y of 37431X6•Qt&kBer00 -Occupancy Type not more than f hundred dollars(SLA). O I,u owner of the property,or my employees with wages u their sole compensation, will do the work,and the strunum isnot intended or offered forsale(Sec.7 4.Business and Professions Code:The Cmimoror's License Law dues not apply to an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that such impro em rens are not intended or offered for sale.If. however.the building or improvement is sold within one year of completion.the owner builder will have the burden of proving drat he did not Wild or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed convectors m convect the pmjcct(See.7044,Business and Professions Code:)The Contnctms Li "rise Law does not apply to an owner of property who builds or improves thereon,and who commeor for such projects with a commulor(s)licensed pursuam to the COOOCIOT's Lianas Law. ❑1 am exempt under See .B h P C for this noon Owner Date _ WORKER'S COMPENSATION DECLARATION 1 hereby.firm undo penalty of perjury one pf the following decluatimoc 1 have and will maintain a Cenificatc of Consent to self-insure for Worker'seompen- satiun.a provided for by Section 37M of the labor Code,for the performance of the work for which this Permit is issued. �I have and will maintain Worker's Compensation Tomorrow,as required by Section 39114 of thc labor Cade,for the performance of Ne work for which this permit is issued. My Worker's Crimpy vtion Insurance/cartier.nd Polley number ate: S7� came[ SELLIT FJ A/d Policy Na: MI R A3 CERTIFI ATE OF EXEM PfION FROM WORKERS' COMPENSATION INSURANCE Oma section need not k completed if the permit is for one hundred dollars(SI W) or Icss.7 I Canty that in the performance of me work for which this permit is issued.I shall not employ any person in any manner an u in become object m(be Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Cumfieam of Exemption,you skald become eubjea I.the Worker's Comp round on previsions of tW Tabor CMB,you mum Z forthwith comply with such pro Ismns or this Permit shall he deemed revoked. ZO CONSTRUCTION LENDING AGENCY �-. 1 hereby affirm that there is a construction lending agency for performance of a 7 the work for which this permit is issued(Sec.309].Civ.C.) W Q Lender's Name Z Lenders Address U C) 1 Certify that 1 ban read this application and aunt that the above information is W F ummi 1 agree to comply with all city and county Ordinances and auto laws mla'ing to CU building convection,and hereby authorim rcprescnuGsca of this city to enter upon the r W above mentioned property for inspection purposes, j t1 (WcI agree to ve,indemnify and keep harmless the City of Cupertino against liabRitics,judgmen. and cxpcnsea which may in any way acme against said City Uz in consequence aft c gnrning o(this Perrty( ^^ APPLICANT L)VDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date $O{!)tCE REC IATIONS Re-roofs �ignamrc Of ppmanVComOfmr Date / HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will4he applicant or Boom building Occupant store or handle hoard..,material a defined by the Cupeninn Municipal,Code,Chapter 9.12,and the Health and Safety 'MlIcndc.Seotion 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Ya FIN. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove 7nis it harardoua air contaminants as defined by dm Bay Arca Ain Quality Management all new materials for inspection. strict? F1 Yes M1 Nu I have read the hmardoyr o mcrials mquimmcnu under Chapter 6,95 of the Cali for ---ass H"Ith KrentlSafety COMsreadyotts255115.255J3 an)✓155J4.1 undcrsunJ thmifdm Wilding _ /7— �� cs trot curtendy have a Iet(ank that it us my m�saihility to nndfy IW ocupant Of the L • +� quiremenu wkm mbanfcordcemrw.Icofocmpacy. Signature of/Applicant Date "' /�'�`2All roof coverings to be Class"B" or better wri ag m Date Community Development ' 10300 Torre Avenue i � Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 �UPE(�TINO Building De artment JOB ADDRESS: PE;MI1T# Q (G��o Sk .so OWNER'S NAME: RS cagoadd. PHONE # GENERAL CONTRACTOR cJ oa i FAX # I am not using any subcontrac Signature Date Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing A44xi 42 or,^,` Septic Tank Sheet Metal Sheet Rock Tile boy } ontractor Signature Date Community Development Department ' ���$ Building Division City of Cupertino 10300 Torre Avenue 4 CITY OF Telephone: (408)777-3228 U PEQ I NO 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: �l4 �-#7 Rs C&aQ Nu Job Site Address: -O /S ai Roofing Company Name: o A plicant'sSignature: G� Date: -6 • Greg teel Building Official Revised 1/30/03 Printed an Recycled Paper CITY OF CUPERTINO REROOF • CUPERTINO PERMIT APPLICATION FORM APN# J 7S `� Date: Building Address: T JO SC IA/ Owner's Name: Pim 61 It Phone - 70 A Contractor: Phone .. LSO License#: u >C G - 3 0 Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: Af Built-Up Roof X' 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# 18. To be Removed ❑ Provide Mfgr. Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: to Job Description: Rcnlovc /Qe/�(�cc F(RT QooF Residential X Commercial ❑ Fire Zone: Yes ❑ No ,W Confirmed with Planning Det. if ere are any restrictions: LJ Cost of Project Type of Construe ' n:� ccupancy groin 1 GD l Qty. 4- A P14WFee ID Fee Description Fee Group BPER.MFEE 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 7, .