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05090206 (2)
CITY OF CUPERTINO BUILDING DIVISIONPERMITCONTRAGTOR INFORMATION BUILDING ADDRESS: ECONOMY ROOFING PERMIT NO.05090206 10618 NATHANSON AV OWNER'S NAME: PERMITISSUEDATE MARIO D' ORTENZIO 2988 NEAL AVE. 09/29/2005 NE: SANITARY NO. CONTROL NO. (408) 615-7200 ARCHITEC rENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH x00 LICENSED CONTRACTOR'S DECLARATION O O O O U 1 hereby affirm Nat 1 am licensed under previsions of Chapter 9(commencing Job Description U with Section 7")of Division 3 of the Busixu and Professions Code.and my her.is +moo in full fa eandeff q ucg 23 REROOF—T/O SHAKE, INSTALL COMP. = Liceme Clazs g_ Date O Contractor F r oN C 9 e° ARCHITECTS DECLARATION y I understand my plea shall k used u public me.,& a 1yU gof Licensed professional (� OWNER-BUILDER DECLARATION X 1 herebyo slum thin 11. exempt s an the CommCo License Law for the ,]O following muoa Permit t 703 1.5.Business and Professions Code:Any city or county <m which mquirosae.alsowports,thealcor,impmw,h Permits ar repair my edavumam L z i that hor e its i licensed p rsuam to the thovisio s of for sucChangan's Lio m Law statement E�`a that me cing wit pursuant to the of Division of the Contracmr'alxcnUlaw(C Coon)or Sq.F[. Floor Area alttH(100 yQ (CnmmeMlagWIJ1Section'/O'JO)ofDIv111onJnfNCBYLOeband Professions CMl[)aI 1`$15000 a that he H exempt ncmfMM and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant m a civil penalty of APN Number e u ane not mom IMn flim hundred dollars($300). /P Y Type i,umnmofthepmp ay,mmyemployenwithwageautkirmlemmpevadon, willdotheworkand Ne,t umurmtintendedmoffemdforsale(Sa.7W,Buaness and Profrzaov Cade:The Contractor's Limnaa Law dors not apply in an owner of Required Inspections property who builds orimpravv thereon,and whodoessuch wart himself or through his awn employees,provided that such improvements are not intended proffered fmsle.If. however,the building or improvement is veld within one your of mmpleuon,the owner- builder will have the burden of proving that k did not build or improve for purpose of axle.). ❑1,u owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec 704,1.Business and Profusions Code:)The Commem's Li. rue taw don not apply to an owner of property who builds or improves uuwon,and who contracts for such projects with a camracsur(s)licensed pursuant in the,ConuacmYs License La . ❑1 am exempt under Sec. ,B&P C for this mann 1031(W', ner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty,of perjury cone of the following declarations: 1 have and will maintain aCertiOcve of Covens to Ulf-inure fm Wo lac r'sCompen- h,as provided for by Section 3700 of Ne Labor Code,for the performance of the rk for which Nis permit is issued. I have and will maintain Werkels Compcvauon Insurance,az required by Secuen of the labor Code,for Ne performance ofIk work for which this permit is issued. WmkcfsCom vauon lnwnna a¢sm and Policy muumbc,go: �ier, v Al -�t1✓vIU Policy N.,NOI CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu shim raced rut kcomplead trio,permit is faro.hundmAdollvs(SIM) or less.) I certify that in the performance of the work fm which this permit is issued.I dull not employ any pawn in any manner w as in become subjeeuo the Worker'Compensation LSWs of cahfornia.Data Applicant NOTICE TO APPLICANT:If,after making this Cmdricam of Exemption,you should become subject to the Workers Compensation provisions of the Labor Codc,you must .J O fo d with comply with wen provisions or this permit Shall be dermad revoked. Z''7 CONSTRUCTION LENDING AGENCY (—t Itemby affirm that Here is a construction lending agency for the perfurmance,of rl the work fur which Nis permit is issmd(Sec.3097,Civ,C.) 0. Q lender's Name Z) z Lender's Address U Q 1 certify that 1 have=it this application erW sate thin the shove informatim It ta. correct.I agree to comply win all city and county Ordinances and gain laws relating to 0 U building construction,and hereby authorise mpmsenatives of this city to enter upon the U shove-mcnuaned pmpc costs for i e pe aces which may (Wo)agree to ave,indemnify and keep harmless tk City of Cupertino against rvFiZ incommonerace orh,staring ft his psrlit. meyinany way accrue against said City U z A eonsegmrme of the RSrAN of nu permit. Z Q 6 ^ APPLICANT UNDERSTAND$,AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 4" SOURCE RE A77pNS. 1 C gD/T Stgnewrc of pplicanUCon nor /� Re-roofs Data HAZARDOUS/ A RIALS DISCLOSURE Type of Roof Will the applicant or future 6 tf Iding Occupant store or handle ha,,ardous mucrial az defined by rte Cupertino Municipal Code.Chapter,9.12.and du Health and Safety ak.scetim'5 3, All roofs shall be inspected prior to any roofing material being installed. -1 Yes o If a roof is installed without first obtainingan inspection,I agree to remove Will the applicant or forum building occupant ruin cyvipmcnl or dcvicn whim p g 1�06_ it hmardov air contaminants at definN by the Bay Area Air Quality Management all new materials for inspection. P❑Yes `0L 1 have read the Wardens mamrjalsmquimments underChapmr6.95 ofthe Calier- Health&SafetyCodc,Secumu 25505.25533 and 25534.1 undersand thvifthe building rn not currently haw a Imam,that it 1a my mmom5i HlymaUdIY dtom.'amrlfNCairemems Rm(In - MO. ccrti0amofOccapan . Signature of Applicant Date wmrorauthamcJagcm Dam All roof coverings to be Class "B"or better !01 Community Development 130 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 #UPEkTINO Building Department JOB ADDRESS: PERMIT # 10 6I � Nr,+ka0sC, --o ?,o'2-06 OWNER'S NAME: Qtevz PHONE # qc F 1}q6 - O f( U GENERAL CONTRACTOR EC—O,J o� o ;� FAX # �� ' 4 I am not using any subcontractors: f _ �- 3y- 0:3- Siq6Ze Date Please check applicable subcontractors and comfTete the followinginformation: 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 I Septic Tank Sheet Metal Sheet Rock Tile �— -65 Owner/Contra Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408) 777-3333 11UPEkTINO 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: �C d 2f�� O.�'�n 1 1 0 ")Z 17 Job Site Address: M( �l�ti rnn7S7�n� /� Roofing Company Name: E L o^j ort 1 / K o©_1 iJ q Applicant's Signature: i Date: Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO c� / REROOF OF CUPERTINO PERMIT APPLICATION FORM NW' APN# 3 2 � 3 1)13 Date: c/' 3(� — O Building Address: Iob�� Owner's Name- Phone q: / J'0 opt .Jz, o 'K�;,S) �fG -UI (O Contractor: / P ne #: License#: C 5-.C,o/JOM\ �o�-F�' uo - C — f,?KQ39 Contact: � Phone #: Cupertino Business License #: 1 le P_ 1( zfq — ((l l Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles -6 j Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles l ❑ Other(Specify) 27 Other(Specify) �'°�'� ,rL, (COMA Number of existing coverings ❑ Provide I.C.B.O.Report# PO To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and riply With Cu ertino's Tear Off Policy: Job Desen'pttion: 41'0,,vResidential ommercial Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. there are any restrictions: LJ Cost of Projec �S O ()0 Type of Const ct�pn: Occupancy group: Qty. if A licable Fee ID Fee Description Fee Group BPERMFEE Bld Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING / BUSLIC Business License BUILDING ry 7 o6