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03090235 (2) CITY OF CUPERTINOA BUILDING DIVISION PERMIT CONTRAtlFOR,IlVF RMATION BUILDING ADDRESS: PERMIT NO.03090235 3090235 OWNER'S NAME: PERMIT ISSUE DATE CHURCH OF THE APOREL OCl/9912nni NE: SANITARY N0, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELF.Ci PLUMB MECH 0 0 0 0 00 LICENSED CONTRACTOR'S DECLARATION IObDDSCTI IIOn I u 1 hereby affirm that 1 am licnnacd under provisions or Chaptcr 9(contmcncing P i� with Simian 7IXM))ofDldakin J of NC Bumincasend Professions Codc.and my license is a in full fortq�o effe0 tr .Lli Llanmcld' - `f Le.• M REROOF Da —v can oar h CONTRACTOR: A VIAT ROOFING l ARCHITECTS—EC{4ATION O I understood my plans shall be used co cel emcnNa a Licensed Professional >a O '0S OWNER-BUILDER DECLARATION <I 1 hereby ofirm that I em eaL from the Commences License Law for the CIO following mason.(section 7031.5.Business and Profession,Code:Any city or county i m which requires a permit to construct,alley,improve,demnliah,or repair any structure prior us its icosoce,aIs.mquirca the applimamr.,such permiuo 0 lc a signed statement Rthat he is licensed pursuant to the provision,of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area ValuO)a 000 2�0 (cncementingwith Section 701X)of Division J ofthe Business and Professions Codc)or V ,'3$ that be is exempt thercfmm and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of - 3AFD1 lhber00 Occupancy Type not more than five hundred dollars(S500), P Y YP ❑1,to owner of the property,or my employees with wages their sole eompenutlon, will do the work.and theswcmm is not intended or offered for sale(SO.7044,Business Required Inspections and Professions Code:The Cornmelor's Licence Law does not apply to an owner of 305 - FRAME q p progeny who builds or improves thereon,and who does such work himself or through his own employees,provided Nat such improwmenta ase not intended or offered for sale.If, 307 — INSULATION however.One building or improvement is mid within one yeas ar completion.the Iranian' builder will hove the burden of proving chat he did not build or improve for purpose of 601 - ROOF TEAR OFF ole.). ❑I,as owner of the property,am eaclusively contracting with licensed convectors to 602 - ROOF PLYWOOD NAIL construct the projem(Sec.7D44,Business and Professions Cole:)The Contractor's U. 603 — ROOF BATTENS, came taw docs not pply to an owner or propeny who Wilds or improves themon.and, 604 — ROOF IN-PROGRESS who contracts for such projects with a conuanor(s)licensed pursuant to the Conuaetob me law. Iem aempt under sec. ,B&PC far this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: I haw and will maintain a Cenifcame of Consent to ulfdnsure for Workers Compare 7:31].00 on,u providW for by Seniors J]W of Nr.labor Code,fm On Performance of the - k for which this permit is issued. 1 have and will maintain Worker's Compensation Imuran",u squired by Section of the labor Cote,for the performance of the work for which this permit is issued. Workers Compensation Insurance carrier and Policy number artrtier. Policy Na.: _ CERTIFICATE OF EX EM PEON FROM WORKERS' COMPENSATION INSURANCE (This section need not hucomplcled If the permit Is furnace hundred dollars(51(XE or less.) I certify Nat in the porforramee of the work for which this permit is issued,1 shall not . McmPlayany person in ymanrX3m last strpjn:r to the WoIkeri Compcnu. . aof CalifoJ' cl —/—��s 7 Applicant •""" NOTII��TO AP ICA NT.If, it,,making this Certificate of Exemption,you should hecotpLhubjc0 to the Worker's Compen-tion provisions of the tabor Curb,you must 7z forthwith comply with such provisions mine permil shall ft deemed cooked. Z CONSTRUCTION LENDING AGENCY 1 hereby affirm Nat there is a comwctinn lending agency rat the performanm of Ya the work for which this permit is issued(Sec.3097.Civ.C.1 Q Lender's Nene Z)z Lender's Address ;)Q 1 certify Nat 1 have read this application and state that the above information is g• f+ correct.I agree to comply withall city and county crdiomces and m¢laws misting to DU Willing construction,and hereby authorim representatives of this city to enter urim the N a "hove-mentioned property,for inspection purposes r (We)agree to save,indemnify and keep harmless the City of Cupenino against h Iiabilidcs,judgments,costs and expenses which may in any way same against mid City J Z in consequence of the granting of this perm it. •"" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date - S URCE RE CATIONS. ?y^U Re-roofs Signatumof Ap IicanUConuacmr Dow HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle hazardous material as dcfincd by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safely Code. Dyed,zssu(a)7 All roofs shall be inspected prior to an roofing material being Installed. ❑Yat AN. P P Y g g Will Ne 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 haaamnn,air contaminants to dcfncd by the Bay Area Air Quality Management all new materials for inspection. uict? a! ❑Ycsr QjJa [how read thc hmmdousmacrialsmquimmenm under Chaper6.95 of thc Colifor- / niaHmlth&Safny Cade Scn.o 505.25533and25534,1undcra ci ddaifthehuilding docs not cumendy haw a enant that it is my mspomibilily m notify the necupmt of the mquimmenu w 'h must be met prior to issumce of a Certificate of Occupancy. IgnatufC Of Applicantate v._ - -" All roof coverings to be Class "B" or better l7goer or authorircd agent Date Community Development Department Building Division City of Cupertino aaattt 10300 Torre Avenue Telephone: (408) 777-3228 CITY OF U n E kT I N 0 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: To AA07(Iirr Job Site Address: olo 1 o h4 c C l'C U u a j Roofing Company Name: A R op.'uu L iP'AicDate: y o3 Jteant' el Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPEII;TINO PERMIT APPLICATION FORM APN # , q� Date: 2�— O Building Address: 1 0924 �C -c I ti Owner's Name: Phone#s IOM tT F of qug 9912— 57/ Contractor: Phone#: License#: -T'w 4) ,ter v8 3 0, '70j6 Contact: Phone#: Cupertino Business License#: T V t K08 390 -701L 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 ❑ Provide I.C.B.O.Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: 7 O EP C C o Residential ❑ Commercial Fire Zone: Yes [9 No ❑ Confirmed with Planning-M t. if there are an re ti c ions: L8p Cost of Project: , Type of Consfruciion: Occupancy I0 Qdo Qty. if Appli4e 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 z3 3 7