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03110139 (2) CITY OR CUPERTINO bM*;s '''?� � W BUILDING DIVISION PERMIT ¢CONTRACTnR INFURMATI�ON . BUILDING ADDRESS: A L RESIDENTIAL/COMMERCIAL PERMIT"°03110139 OWNER'S NAME: PERMIT ISSUE DATE V NE: SANITARY NO. CONTROL NO, (408) 729-6100 ARCHITECTfliNGINEER 08 729- ARCHITECffliNGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECII t� � t� 0 !00 LICENSED CONTRACOR'S DECLARATION lob Description I u 1 hereby affirm that I am limned under provisions of Chapter 9(commencing p with Section 1001)of Division 3 of the Business end Professions Code,and my license is in full(oreo anacf FINALED Locnse Class LIC.N 7 Z 34 REROOF f Dam Contractor `QQ ARCHITECTS DECLARATIO q q G oZ 1 understand ni plans shall W useJ a public records FEB 2 O LOOP )a s0G Licensed Pmin (cunal _ 1 5 Oat I am exeLDER mpt DECLARATION BUILDING 2 a I 1 naso .Sec that 1 tum exempt from Ne Contractor's License Law for the V ILD' ❑O which re reason.(Section]1131.5,Business and Professions Cod,:Any city m county 5$ which requires issuance,permit to mnawcL palus,plie imfor su demolish,nr e a sig ed tUuntum 000 thathe itscosedalso torches the for suchremitmBln.Law(atammcm pp < (commencingudfosstion7or the Sq. Ft. Floor Area Valuation 2 3 (cat he is (commencing Section and M basis rth the Busalleged andmpt Profieson.Any Code)or Nat he is exempt therefrom m0 the buffs for the alleged exemption.Any violmion of Section 7011.5 by any applicant for apermit subjects the applicant to a civil penalty of 32sFNNMcr00 Occupancy Type not mom Nan five hundred dollars(SSOE) ❑L o the work,r the properly, re my,mploym or o wages u Nei(vole?am,Buss ass will Pr Noshmsands: oto Comisnoinunmderaw do fs ntapplytoin Owner Required Inspections and arty wh obis Com:The Comment's License law docs not apply to an owner of q p properly who builds orimpmves thereon,and who dmssuch woe himself or edlhruu le his f, ownemployees,providedinorPHsuchimpomid within oatintended reoffered parole. r. however,Ne building or improvement is sold within am year of completion.Ne owner builder will have Ne burden of provin6 that he did not Wild or improve for purpose of ole J. I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Profcasions Cade:)The Contractors Li. _ cense law docs not apply to an owner of property who Wilds or improves thereon,and who contracts for such projects with a comm cmr(s)liansed Putnam to use Conmeoes License Law. El nn exempt under Sec. Bk PC for Nis... . Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affim under penally of perjury tum of the following declarations: 1 haw and will maintain a Cenificateof Consent m selGinsurt for Worhrs Camfem nation,as provided for by Section 3700 of Ne Labor Code.for the performan¢of the work for which this permit is issued. I have and will maintain Worker'sCompensnlon insurance,as required by Section _ of the labor Cod,.for Ne performance of the work for which Nis permit is issued. My Workers Compensation Insurance rticr and Policy numbonrt: Cartier. _ MON O�_� �.A� CERTIFIC ON FROM WORKERS' ' COMPENSATION INSURANCE (This section need not W completed if the permit is foram hundred dollars pH00 or less) 1 certify that in he perforumne.of Ne work for which thio permit Is issmtl,l sha11 not employ any person in any manner u as to Wcome subject to the Worker'Compensation Laws of California.Doc Applicant NOTICE TO APPLICANT:If,after making this Ccnificue of Excm prion,you should become object In he Worker's Comp canon Provisions of the Laft,Cmc,you mml .,�Z forthwith comply with such provisions or Nis form it shall W doomed revoked. OCONSTRUCTION LENDING AGENCY I hereby option Nat then its convection lending agency lot the performance of x 7 Me work for which this permit Is issmd(Sec.3097.Civ.C.) yQ I<mcrs Name = Z Landers Address J Q I certify that I have read this application and sum that Me above information is I, F correct.I agree to comply with all city and county ordinances and state laws relating to 0building construction,and hereby authorim representatives of NN is city enter upon Ne V ab rU ove-mentioned property for impaction purposes. (We)agree to saw,indemnify and hep hamless Ne City 9f Cupertino agaiw F h liabiliues.judgrecou.eon and expenses which may in any way accrue against said CityI C.3 in consequence ofthe granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:3 Date ) / CLATH 'It's.RE LAT �S. � l 4 LN 13 i�3 Re-roofs SignaturefApplicM en mor Dao HAZA OU ATERIALSDISCLOSURE Type of Roof Will the applicant or fumes building viceupant nom or handle haafduus material u defined by the Cupeninn Municipal.Code,Chapter 9.11,and the Health and Safety cram,pve.2ss32(an No All roofs shall be inspected prior to any roofing material being installed. Will the applicant or Room,building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,l agree to remove 7d= haoamnus air contaminants u defined by the Bay Area Air Quality Management all new materials for inspe Ion. ❑YesI hawmadNehvaNnuimaterial5requirementsunderChafmr695oftheCali(or IcalN&Safety Code,Sxdom25105.25533m M534.1undcrnand NatiftM Wilding not currently hoc a tenant,that it is my map rouniity m nodly the mcupare of the' mvwhic seat metprucluissumccnfaccnifcaoorD, panty. Signa ur of pplicant Date 03 All roof co n [o be Class"B"or better er or authorized agent I LlDa i Community Development Department Building Division i City of Cupertino 10300 Torre Avenue CITY 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 I/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 QeA W U Job Site Address:-A 'Z© Co oO V1ilo. (ci k i C-4- Roofing Company Name: v 4.. I- . �e s C w-• 1 'AP'plicanYs Signature: Date: 2'[/0 3 Greg eel Building Official Revised 1/39%03 Printed on Recycled Paper CITY OF CUPERTINO D 13 1 aTo REROOF o_3 l l CUPERTiNA�ERMI�APP ICATION FORM Date: Building Add s v ( ek_yk, ' wner's Name: Phone#: Q Contractor: Phone #: icense#: CaDe., jqb —C /00 _ 2!J2314:7 Con act: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ­:-. {Built-Up Roof Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings OHF ❑ Provide I.C.B.O.Report# / 1�r- To be Removed ❑ Provide Mfgr. Installation Specs. (\• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: Residential I Commercial? S e� Fire Zone: Yes ❑ No ❑ Confirmed with Planning De f there are any restriction Cost of Project: Type of C Occupancy group: 000 �o ! Qty. if A lic ice 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 S . �� ��`I l�� . � �� . �� `� �' • � � .