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04030010 (2) CITY OF CUPERTINO BUILDING DIVISION PEIMIT 1,T1 1CT�URIN 'U�'IA .IU � '': BUILDING ADDRESS: SUNSET ROOFING PERMIT"'04030010 9381 MYRTI.E.W00D DR OWNER'S NAME: PERMIT ISSUE DATE PAWLOVICH LINDA 817 ONE: SANITARY NO. CONTROL NO. (800) 513-2575 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p C86 LICENSED CONTRACTOR'S DECLARATION I Money affirm Nat 1 am licensed under previsions of Chapter 9(commencing Job Description svithSecde ] )ofDivision 3ofNeReal PotessionsCode.and n Ii�s tel. 5 n� in full fo eerte _1,5r Tr 5 REROOF FINALED i License 1 Lic.ar' n' Dak Conlan i Asshall ATI MAR 0 8 2004 rade. rad my plans shall M cud as public rceortla Oa iCn Lkcnutl professional SOWNER"BUILDER DECLARATION BUILDING aI I herchy a1Rrm that 1 am exempt from the Contractor's License Law for the a O following reason.(Sued an 7031.5,Business and professions Code:Any city or county $F which require a permd us connect,alter.improve.demolixh,or repair any armcture prior to its issuance,also requires the applicant for such permit to Ole a sigwd statement that he is licensed purrmtto the promotion of the Cmumm's Licence Law(Chaplet 9 Sq.Ft.Floor Area Valuation H (commencing is exempt therefore and t f Divisionfr of the egad exempt on A.,vi Code)or y�� that he is exempt therefrom and the buss far to alleged exemption Any violation of Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of 3%PN7ihf Acr00 Occupancy e not mem than Ove hundred delta.(SSW). P y'f'y�]P ❑I,a5 owner of the pmpe.y,or my employcm with wage,M Iheirwle mmpenwtian, will do the work and thestruclum is not intended"offered forests(Sec.7044.Business and Pmfesames Code:The Convector's License Law does set apply m an owner of Required Inspections grape ray wha Wilds or improves thereon,and who does such work himself or through his awn employees,provided that such impmvements sure not intended mortared for sale.If, however,the building or improvement is and within one year of oempletion,the maner- builder will have the burden of proving that he did not build or Improve("purpose of sale.). ❑1,as ower of the property,am exclusively contracting with linseed contracmrs in construct the project(Sec.7044,Business and Professions Cede:)The Contractor's U. «rase law does not apply to an owner of property who builds or impmvm thereon,and who contracts for such projects with a conuacmKs)licensed pu.uant On the Carmekla Lken sw. am exempt end.Sec. .B A:P C for this recon Owner Data WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of dine following declarations: 'I have and will malnuln a CeniOwle ofCommet m self4mum for WorkcYs Compote sation,as provided for by Section 37W of the labor Code,for the Performance of the work for which this permit is banned. ❑1 bare and will maintain Worker's Compensation Insurance,at required by Section 37W of the labor Code,for the performonm of the work for which this permiiIs issued. , ' My Worker's Compmenti n insurance conics ane Policy number am: Cartier. Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSA7ION INSURANCE I Missectiw wed not be completed lithe permit is intone hundred dollars(SIM) or lona) I cenify that in the perfoonan a ar the wte(or which this pq it is issued,l shell Out employ any person'n anym rtes bjecL to Laws of C00f9Q'I L LRJI ApPlicmt xi - !A TO APP�CANT:IL afk �ting thisia�ak ea empt uhjca m the Worker's Compcmation previsions of the labor Code.you must .JOcomply with such provisions or this permit shall Is,deemed revoked. M CONSTRUCTION LENDING AGENCY [—iI hereby affirm that them is construction lending agency for the performance of Oe> the work fur which this permit is issued(Sec.3W7,Civ.C.) W A Lenect. Name a z Lender's Md. V Q I certify that 1 have mad this application and state that the above information is 0 U commit.l agree l9 comply with all city m0 county ordinances and site laws relating e Q V building cottoned ion,me hereby echimp kpresenulivca of this City mcnkr upon the W ahovc(We) g e property for Inspection purposes (We)agree to save,indemnity and kith harm City of Cupertino egdnrt t„v �j liablliuea.judgmenu,corals and expenses which may l y way some against mid City V F7F77 in consequewe of Ne a t ng of this permit. APPLICANT U DS" DWI OMPLY WITH ALL N-P NT Issued by: Date SOURCER D Re-roofs gnature o ma amrm[of Delpf HAZAR13 U MA IALS DISCLOSURE Type of Roof Will the applicant ar future ng weltmnlatom erhandlc Wandous material as derined by the Cupeniw unicipal Code,Chapter 9.12,and the Health and Safety oda,section 25532(a%s All roofs shall be inspected prior to any roof]n material being installed. ❑Yns u If a roof is installed without first obtainin in action,I agree to remove Will the applicant Oj future buil n "eupam sex equipment or devices which i� it havareaus air cone.netts as d recd by the Bay Area Air Quality Management all new materials for'inspection. Districl7 ❑Yc5 U Iharc real theh a nalsrequimmcnts under Chapterb.95ofthe Calif.,. nia Fkvlth&Safety Codc,S I 2I ,255 -125534.1 unMrsmndthatil ilding does not curmndy harc a Moon,that it ism reapamihility m notify the "cup t of c kyvimmc c ' un rw' once ora ccniEcato Occupan ` S' r Of Ap cant Date X�r Owner authnae agent / , wk All roof coverings to be Class "B" or better r ` - Community Development 10300 Tone Avenue +! Cupertino CA 95014 Telephone(408)777-3228 Cl OF Fax(408)777-3333 �UPEI�TINO Building Department � JOB ADDRESS �i PERMIT vv �Q U OWNER'SN Z—IA-.)6tdz PHONE # GENERAL CONTRACT v u 5 ET &00P:1 — FAX# o� s I am not using any subcontractor _ Signa a Date Please check applicable subcontractors and complete the following information: 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 Tile 3 —� d er/Contract r i at„�rQ _--- Date Community Development Department Building Division City of Cupertino Wel 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 OUPEkTINO 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 co/mply/wpit�h the above stated policy on re-roofing. Homeowner's Name: /pV Job Site Address: ( ter 3 0 Roofing Company Name: A plicanYs Signature: Date: • Greg teal Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN# �/ . I 6 a Date: Building Address: 38I r� �! LClva�� per, Owner's Name- j� P one# q //V J ?,Ltd" �/� © .� 2.6 Z, `� / r� Contracto�vu C_� � _ u�phone Lice"VZ / 3 C '/ Contact r Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof > Asphalt Shingles 'W- Asphalt Shingles 3 ❑ 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: � �VloUt Z LRS CpMF� T'�Y N�lv/S Residential Commercial ❑ EW JVl j I a 1 je S fN N6-t� - Fire Zone: Yes ❑ N Confirmed with Plannin D there are anrestri s: Cost of Pr Type Constructi Occupancy 7,p- rp: y. if lic ble 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 � 7S 2�