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05040182 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTORINk'ORMATIQN I"fi PBUILDING ADDRESS: DADDARIO ROOFING PF ""05O4O182 OWD-11 C1 Mr KT-INT09K IN NER'S NAME: PERMIT ISSUE DATE NE: SANITARY qftOL NO. CHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uoo LICENSED CONTRACTOR'S DECLARATION II��Tpy��rS ttt��'...�� 0 0 0 1 hereby af0rm dust 1 am of the licensed under provisions umt Code. 9(rnmmensi is J�e n� with Section Imcb, ffl, dust on IA lithe Business ar�PfofLSsillttshapter 9 my monarnmouts I n0s.eclass force de `1 Lji6a ••jy REROOF W/ -COMP. j' Teale clue fect. � Lm.e LED L Dam cru_ ns q, 0,` Common, C. " tti,dc•..- ARCHDECTS DECURATIA [ zI understand my plans shall W used u public recmds - _ _ 2005 Dau 0� ; Licensed Professional 3 OWNER-BUILDER DECLARATION kFU�' <F I hereby affirm that 1 am exempt from N LDIN O o reason. Contractor's License Law for the p®y followingreason.(Sadao]SOLS.Guiness and Professions Calc:Any city or county m which requires a permit to construct,altar,improve,demolish,or repair any structure iy prim to its issuance.also mquinx the applicant for such Permit to rile a signed ammment s< that he is licensed pursuant to the Provisions of due Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuat on yf-g (commencing with Section VOW)of Division 3 of the Business and Professions Code)Or ;k than W is exempt thcmfmm and the basis fm the alleged exemption.Any violation of Ssedon 7031.5 by any applicant for a permit subjects the applicant to.,ml penalty of 3 4�Nero 0 Occupancy not mom than Ove hundred dollars(5500). P Y Type ❑I,As owner ofthe property,Or my employes with wages As their mk compensation, will do the work and the awcture is not intended molfe.d forxek(Sec.7040,Business and Profesdons cods:The Contractors License law docs not apply to an owner of Required Inspections property who builds or improves themon,and who does such work himalf or through his awn employes,provided Nm such improvements are natimended moOelm for We.If. however,the building or improvement is sold within one year of completion,the owner. builder will have the burden of proving that W did trot Wild or improve for purpose of .to). ❑1,As owner of the property,am exclusively contracting with licensed contractors to construct the project(See.70x4,Business and Professions Code)The Contractors U. cense law docs not apply to an owner of property who Wilds or improv thereon and who commets for such projects with a contractor(s)licensed pursuant to the Contractor's License law. ❑I am exempt under Sec. ,B&P C for this moon Owner Date 73701WORKER'S COMPENSATION DECLARATION T hereby affsrm under penalty of perjury one of the following dedantions: 1 have and will maintain a Ccni0rne of Consent to self-insum for Workcr'sCompen- ion,u provided for by Section 37W of the labor Code,for the performance of the W rk for which this permit is issued. I have and will maintain Workers Comportssdon Insurance,u required by Section of the labor Codc,for the performance of the work for which this Permit is issued. yWorkers Commmudon Wer.c or and Policy number are: rrier: ..5 A " r eti Policy No.: CElmFICA OTt FA ER F'. FROMWORKERS' COMPENSATION INSURANCE (This section need not W completed If the Permit is for one hundred dollars($m1) or ices) I eenifv that in the pmforrumcc of Ne work for which this Permit B issued,I shall not cmPky any person in any mannerso u to Wcomc subject o Ne Workers Compensation Lawa of California.Dam Applicant NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of Ne labs Code,you most 0 O forthwith comply with such provisiam or this permit shall W deemed mwRcd. zVy CONSTRUCTION LENDING AGENCY [r Ihc.byaffirm that Nem iso emouncdon lending agency,for tW performaae of C' dm work for which Nis peonit is issued(Sec.309],Co.C.) A Lender's Nam, IL =z Lenders Address . U C) I anify that I have mad this application arta sure that the shove tar..U.is COMM I agree to comply with all city and county on inarmes and Aute laws.].list m 0O Wilding cortstruction,and hereby mrhorim mprOMMILtives of this city m enter upon the r 4 shove-memid,un property forinspection purpowhich ms (We)egms to save,indemnify and keep harmless the City of Cupcnino against F Z fine oea.judc or,beeosuand capemeswhich may in any way eccmc against said City .f, z in comegnence of Ne granting fNis Ptrmik SOURCE REGULATION A S AND WILL COMPLY WITH ALL NON-POINT Issued by: di Date Re-roofs $T(Ifrars of r Htr AROOUS MATERIALS DISCLOSURE Dale Type of Roof Will dhe applicant or future Wilding occupant mom or handle Irrcassous material u defined by the Cupenino Municipal Code,Chapter 9.13.and the Health and Safety Sec15532(x)? ,/a All roofs shall be inspected prior to any roofing material being installed. Will thea applicant or future building ocon quip. If a roof is installed without first obtaining an inspection,I agree to remove PP g pant use equipment or Marta which g P immt ardnus air conumioants u defined by NC Bay Area Air Quality Management all new materials fOr inspection. ❑Yes I have read the hazardous materials requimmcnu under Chanel 6.95 of the Califor. nix HcalN&SafctyCadc,Section MM5,15533andM534.1undc wdthmifdc Wilding dors not currently have a mrrank Nat it u my ropur ahility to notify tic occupant of tW myvimmcnu which muuW met priorto issavxe are Ccnifmam of Occupanry. Signature of Applicant Date Owner orauthorimdagent Dam All roof coverings to be Class "B"or better F Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 UPEkTINO Building Department JOB ADDRESS: PERMIT # to5 l t 1'in 16 r-K L OWNER'S NAME: k1 14 X- PHONE # , Lj W P _ GENERAL CONTRACTOR FAX # I am not using any subcontractors: O y_ t_o.S Signa , e' Date Please check applicable subcontractors and complete the following information: ha 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 L/[/Roofing Septic Tank Sheet Metal Sheet Rock Tile r Owil er/ ontractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue 0CITY OF Telephone: (408)777-3228 UPE IST I N O 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. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled 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: 141 d�,� Job Site Address: _]0':� l�� MAK) • 16c tc ` ti Roofing Company Name: C D011,) t 0 V& 1 D Nc� Applicant's Signature: Date:2—Y-- f_(7os Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper lu CITY OF CUPERTINO, REROOF �S� CUPEkTINO PERMIT APPLICATION FORM APN # Date: Building Address: 031 K La/ Owner's Name: Phone#: r A d r 7 3v Contrator: Phone #: icense #: O no Contact: Phone #: Cupertino Business License#: 1e Type ofRod Covering: Existing: Proposed: ❑ Built-Up Roof ❑ �BB ili-Up roof ❑ Asphalt Shingles C�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: �- OkC A Vvy rz Tvl5Anc I O , oC LA, Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning D_ept. if there are any restrictions: u Cost of Project: o v Type of Construction: Occupancy group: `l6Sv: Qty. if A licable Fee ID Fee Description Fee Grou 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 7 °. S"�