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04070049 (2) CITY OF CUPERTINO x` 77 : �p ? PERMIT corrR� T. BUILDING DIVISION 1 issue 4- err„ BUILDING ADDRESS: - ROOFCO OF SILICON VALLEY PERMITN°04070049 OWNER'S NAME: PERMIT ISSUE DAM DANIEL MCE ONE: SANITARY O. CONTROL NO. 408 7 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p 0 0 0 0 LOO LICENSED CONTRACTOR'S DECLARATION I hereby aRtrm that 1 am limned unlet pmvisions of Chapter 9(mmmcncing ascription n� with Section 7000)of DIAi.n3of the B.M.and Professions Code.and my licensee o in full fame and officer. REROOF S � License Clan Lk.d �� °are `on meth` SEP 0-- 2004 ARCHITECTS DECLARATION I understand my plans shall be used as public wands 7yU aG Licensed encs Professional BUILDING I ®I ^ S OWNER-BUILDER DECLARATION D V I hereby of0rm that 1 am exempt fmm the Contractor'&License Law for the Eng 0 following season.(Section 7031.5,Business and Professiuu Code:Any city or county y$ which requires a Permit W construct.elect.improve,demolish,or relnir any ahumum rnn prior W its issuance,also requires Ne applicant for such permit W File a signed statement FF; that he is licensed punuantla Ne previsions of the Conuumr's License Law chapter Sq.F[. Floor Area Valuation as s (commencing with Section 7")of Division 3 of the Business and Profession&Code)or .. Nat he u exempt therefrom and the buts for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit subjects dm applicant W a civil penalty of 3 2*lt&QIfd183et0 0 Occupancy Type not more Nan Om hundred dollars($500). e. ❑1.a owner of the properly,or my employms with wages as their sole compensation, will do the workk,and oe mucture is not inrcnded oroffered for aale(Sec.7044,Business and Professions Code:no Convectors License Law dors not apply W an owner of Required Inspections properly who build&.r improves thereon,and who docs such work him elf or through his own employers,provided that such improvements art notinuended or.ffesA ferule.If. however,Ne building an improvement is mid within one year of completion,Me owner. builder will have Ne burden of proving Nat M did not build or improve for purpose of W.J. .�tJ.i(1,es owner of tis propeny,am ee.la,ivet,convecting with licensed convect..to ,,iux l Ne project(Sec.7(344,Bosinca and Professions Code)The COMo cWrs Li. cense law docs not apply W an owner of property who builds or improves dsson.and. who contracts for such projeca with a mammonist llmnud pu.uant to the Contractors Lumme La7WORiKERS ❑Ism exo .B&PCf.rthis on Data � j2 B COMPENSATION DECLARATI1 he .under penalty of perjury ane of Ne followinglaratiou:Theresaintains Ccnificeta of C.nuntmulf--insure for Worker's Coman- sation,as provided for by Section 37M of Ne Labor Code.for the performance of the work for which this permit is issued. ❑1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of Me labor Code,for the performance of the work for which this permit is issued. My Workers Compensation lmmmna carrier and Policy number me: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (The union road notWcompleted lithe Permit is Intone hundsddollars($100) mf leas.) I certify Net in Ne Performance of the work for which this Permit is issued,I shall not employ any Person in any mannerm as to become subject W the Workers'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject W the Workers Compensation previsions of Ne labor Code,you mum Z forthwith comply with such provisions or this Permit shall be deemed revoked. z O CONSTRUCTION LENDING AGENCY i.4 rte. I hereby affirm that them is a construction lending agency for the Performance of lYi> Ne work for which this Permit is issued(Sec.3097,Cih,C.) V]Q Lender'a Name .a7 z Lender'sAddress I �- I,p comfy the I have read thisapplicationand coon and sink that and shove sus rmAnn is '© Is,0 F COMM.I agree W comply with all city sed county ordinancesve,of and seta laws slating e 0 U abovengenfloned.gand hereby eLtionurcprcsenulims of Nis city to cnsr upon Nc n7 about-(We)a gree to eryave forindemnify a keep h LL caju agree t.dam,indemnify and keep harmless w City of mCupertino against UZ in gratsing expcueamit. may in any way&came against said City - („),Z A consequence of the granting of this permit. v �^' APPLICANT UN ERSTANOSqAND WILL COMPLY WITH AL471r, L N N-POINT Issued by: Date SOURCE RIS ONS f' Re-roofs S use of p1' V .^`rector eta - HAZARDOUSMATERIALSDISCLOSURE Type Of,Roof Willow pplicanl or future building occepantamrc or handle havaNaus material deNmd by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety I .at.,Secti.a 2ss3zean All roofs shall be inspected prior to any roofing material being installed. C3 .a �Nu Will the applicant future building aceupam tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit haxaNnus air conuminants as dMincd by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes CJ u I have mad the haaardous materials squimm ms under Chapter 6.95 of Ne Califor. niaHmlth&Safety Code,S=dnm 5505,25533md25534.1un&m=doatifoeboilJing 7117,& docs not curomt .vc a woml that it is my respomihility an mN'y the aeup n,of the require mcmew mu br 'sumceafaCmificateorOce wig Applicant e Ow &.dant W All roof coverings to be Cla "B"or/better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Dejpartment JOB ADDR PERMIT # /� 16,3(00 r(oa •Meow r f'Iv V 7 OWNER'S N k PHONE # 5 q130 3 GENERAL CONTRACTOR ,5 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 Am 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 er/�wn *�WTCor Signature Date --- - ---- -- -- +' 4$ Community Development 10300 Torre Avenue '~ �;y {` Cupertino CA 95014 „- Telephone(408)7774228; t" > rvCITY OF Fax(408)777-3333 j UPERTINO Building Department JOB ADDRl PERMIT# fD�DD l3(o0 �/(�cn� r r v l OWNER'S N /,� 011 PHONE # jj 3 GENERAL CONTRACFOR5d1 1 FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR c BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation Landscaping Lathin Masonry Ornamental Sheet Metal -`• Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock s Tile ner/c9l 5 or Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 qUPEkTINO 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: Qa& f e/ MC 45A.)ree Job Site Address: 10360 Mmiy&) pr, Roofing Company Name: O e,4 iV le AP Signature: Date: / Gre el g e Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF 7 T CUPERTINO PERMIT APPLICATION FORM APN# 6 41r— O/ Date: 7 O Building Address: / 3 /"INN Owner's Name: Phone#: m ti SDS -9'73 '03 S Contractor: Phone#: License#: of s ve 6336,67 Contact: Phone#: Cupertino Business License#: Ey erer Yo ' 53 S 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# – 9 XTo be Removed �, Provide Mfgr.Installation Specs. •. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: rear ofexiSy-lA/J 5,,AiaN2) 4� )!' GOXPIY re 4-::Xtfr/.v9 PPIX Cenflioiteed o y r P io1evr/a,7 4k*5 7,6 A),e'v d r fri jl-� -Tr8a Residential Commercial , ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning D�ept. if �� there are anrestrictions: 15 Cost of Projec Type of Construction: Occupancy oup: 14S 11r_ ! emo Mppcitle 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 i WG II - z-oy 57-AT( r-u"D 17Co0 �a �