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04030246 (2) CITY OF CUPERTWO -- + �rr „yPk. a r ' 'N,y„:._ -- BUILDINCDIVISION PERMIT COTQR. '•, { ,d ' ' fix_ ,._ .. „ ,v.• BUILDING ADDRESS: TEO I S ROOFING PERMIT 1101030246 OWNER'S NAME: PERMIT ISSUE DATE S . M RT ONE: SANITARY nO�. CONTROL NO. ARCHI] IENOINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH t� 0 u00 LICENSED CONTRACTOR'S DECLARATION -- - - -- -- --'- -' - -- F 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description -- - 6y wiNS calors 7W0)of DiAsion3of Ne Businusod Pmfcssians Codc..dmylimnuis in full dery REROOF C w■ 5uip Licen 3 Lt lrumr ■ INALE® 3e Dam RCHI7ECTS D A Y 1 mohnsnnd my plain shall he used c mends M''uAPR 0 6 2004 Q Licenced Pmfcssionel OWNER-BUILDER DECLARATION I hereby affirm that I am exempt tram the Communes License Law for the i pe O following mason.(Sccsun 7031.5,Business and Profession Code:Any city or county �'A 1LD1� M9 which requires a permit to construct,alter,improve,demolish,or repair any structure Y poor In its issuance.aim requires the applicant for such Permit to File a signed smlement Net M is licensed parWant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft. Floor Area Valuation (commencing with Section 7”)of Division S of the Business and Professions Code)or $ that he Is eumpt therefrom and the basis far the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to e civil penalty of - 3.N aro 0 Occupancy Type not mart Nan five hundred dollars($500). ❑I,a owner of the property,in my employees with wages as lheirsele compensation, will do Ne work and the structure is not intended or offered for ale(See.7044,Business and limitations Code:The Conuactar's License Law does not apply b an owner of Required Inspections property who bu Ilds or improves demon,and who does such work himself or through his own employees,provided thattmh improvements art notinunded moffered forsak.IL however,Ne building or improvement is mid within am yeas of compledon,the owner. builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the properly,am exclusively conuaning wit licensed conuacuse,to .neva the project(Sec.7044,Business end Profession Code:)The Conbumra Li. cone Law dors not apply re an owner of property who builds or improves quartan,and who contracts for such projects with a contrectarfs)licensed pursuant in the Comncmt's License Law. ❑1 am exempt under Sec. .B&P C for this reason OwnerDale WORKER'S COMPENSATION DECLARATION 1 hereby aBi,m under Penalty of perjury nem of de fallowing declamions: 1 have and will malnuin a Certificek of Consent to self inaurt fm Warker'scoalition. astion,as provided f c by Section 3700 of de labor Code,far the performance of the work for which this permit is issued. ❑I haw and will maintain Workers Compensation Insuranm,as required by Section 37W of the Labor Code,far the poimmramc of the work fm which this permit Is issued. My Wbrknes Compenastien Insuru¢c cagmiv and Poll number�a�rt^:f / - rtl : 5�rlw e 7<'//aCn1Y/ Pol e.:�7G0 Gr CERTIFICATEOFE� NnnM WORKERS' COMPENSATION INSURANCE (This section need nm M com plate d lithe latest is foram hundred dollars(S I O T) less.) 1 unify Net in the performance of the work for which this permit is issued,I shall not employ any person in any manor an as to become subject to the Workets'Compensation Laws of California DOW Applicant NOTICE TO APPLICANT.If,after making this Certificate of Eacmption,you should become subject an the Worker's Compensation provisions of the Labor Code,you mum Z foMwiqu comply with such provision or this permit shall be domed minions, z0 CONSTRUCTION LENDING AGENCY [-i l hereby affirm that Nem is a Connotation lending agency for se performance of !Yi> do work for which this permit is Issued(Sm.3097,Co,C.) fA 0 Landefs Name zLanders Address U Q 1 certify that I haw read this application and mum that do else.information is I%,P cortacL I agree to comply with all city and county ordinances and state laws Misting m p U building convection,and hereby auNoom representatives of this city in enter upon tho �a above-mcnOmcd property far himatian purposes. F qREONS. .,indemnify and keep homeless the City of Cupertino against rA limiliU. sts and expenses which may in any way accrue against said City („)Zin con ... eeting of this permit. APPLSTANOS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dat SOU Re-roofs s' sere UConommr HAZARDOUS MATERIALS DISCLOSURE Type of ROOF ill lh plicate or tutu.building mCornerstone rehandle Miamians mareoal as fined by the Cupertino ManiC.Pa CC de,Chapter 9.12.and the Health and Safety IdonsSection zss3xar All roofs shall be inspected prior to any roofing material being installed. ❑Yon o Will the applicant or future building occupant use equipment or devices which If a ro stalled without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Amo Air Quality Management all eve mater Is for inspection. mrict7 C1 Yes No Iha ad ehumdousmatcsalsmquimmenlsundcrChapme6.95ofdc Califor- � n .t.Heal Safe Codd.Secdom25505,25S33am1255M.1undcmm�d Nmifh building carte a s tenant,Nat it la my msponsibility m nodly Ne mcupam of Ne me ustbemetpdormissuanceofaccruncaeopf0ccupenc. I Pelican[ Date J was a cows agent Dam All roof coverings to be Class"B"or better • Community Development 10300 Torre Avenue Poor Cupertino CA 95014 Telephone(408) 777-3228 Fax(408)777-3333 UPEI�TINO Building Department JOB A SS: PE T # 0 ( 14v,u AS A 4�J S O 2 OWNER'SNAkAl;, )IalzrV, PHONE # GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontracts com Tete the followin information: ba 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 T' Contractor Signature Date Community Development Department Building Division ttzw, City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 CITY OF Fax: (408)777-3333 qUPEkTINO 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: O c 1,©,t,x9 1-�, 1. f_-� Roofing Company Name: -0015 f CN0i—etc' A plicant's Signature: Date: tGreg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF b CUPEI�TINO PERMIT APPLICATION FORM APN# / D Date: —ZLb Building Address: Owner's Name: Phop #: �l Contractor: Phone#: License#: �,� - - C' - �Slp Contac Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles p"Asphalt Shingles A' Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# U'�To be Removed ❑ Provide Mfgr.Installation Specs. • I Have Read, U_ndersland and Will Comply With Cupertino's Tear Off Policy: Di Job Description: Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed wiDe t. if there are M strictions: Cost of Project: Type of Constru ti Oc p6cy gro : JvCD �� C-F9GU Qty. i AppWAPle 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