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05060037 (2) • CITY OF CUPERTINO77777777747'- BUILDING 't 774 BUILDING DIVISION PERMIT �CONTRA ',Q[i.TN'1'U'ItMATI(QN, ; B ILDINCIADDRESS: WESTERN ROOFING COMPANY PERMrrNO0S060037 OWNER'S NAME: PERMIT ISSUE DATE lTT<TTNO NE: SANITARY O. CONIAOL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH I� 0 0 0 s�+od' LICENSED CONTRACTOR'S DECLARATION Job Description KJIJ� u 1 hereby sfirm Nn I am licensed under Provision of Chapter 9(mmmcmin{ p i with Section 701k))of Division 3 of the Business and Profusion Code,and my license is < in full farts entl eReu 5°"z Data .« 61 REROOF W/METAL ROOF F Data Conkaamr �- ARC CDEC 1 understand my plena shall be used u public blit me rtcorN 3w Licensed Poefuuiwal OWNER-BUILDER DECLARATION <I I hereby affirm that I em exempt from the Corawtoes License Law for the i A o following MAmn.(Section 7031.7,Business and Prefessinn Code:Any city or..my $ which requires a permit to construct,altar,improve.demolish,or repair my structure FZfym prior to its issuance,also requires the applicant for such permit to file reigned statement gg < that to I.licensed pungent to tho previll.na.1'the Cortmoor's Leon.LA.(Chapter 9 Sq.Ft. Floor Area Valu don (commencing with Section 7000)of Division 3 of Ne Businessand Profession Code)or .. that he is exempt therefrom and the bub for Ne alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3�4r0 0 Occupancy Type not mom than five hundred dollars(9500). ❑1,as owner of the property,ar my employees with wage.as their sole eompensadon, will do the work end The structure Is not Intended on offered ford.(Sec.70th,Business and Profe tam Code:The Coamuc oes License Law does ant apply u an owner of Required Inspections property who builds or Improves thereon.and who does such work himself or through his own employee,provided that such Imprommmus art not Intended wafered fords.If. however.the building or improvement Is said within one year of compladon,the ower. builder will have am burden of proving that he did not build or Improve for purpose of Ask.) . }I r^ T Co 1.as owner of the property,.m uness and contseuing with licensed ewtrgmr i. Contract the project(Sec.too0a,Business sed Professions ds or I The Comucros.and ; cease Law data not apply a an away of property who d p or bnprowa carton,and who enuacu foraueh projects MN a contrsemr(Oliumed purwnt m Ne Cana.cmh License exempt 5flry§ ❑lam exempt under See ,BkPCfor this reason Owner Data > Aft WORKERS COMPENSATION DECLARATION �j- I I beach,elfinn antler perry of perjury one of the following dalentiom: t._,_� I ham an,will Maintain •Cselfreaseaf Conont to self-imurt for Worker's Corepen. don,As provided for by Section 3700 of the Labor Cade,for the performance of the work for which this Permit is issued. ❑I haw and will maintain Workers Compensation Insurance,M required by Section 3700 of the Labor Code.for the performance of the work for which Ni.permit is issued. My Worker's Com^nation Inwnna artier and Polity number "or. Policy No.: CERTIF ATE OF EXEMPTION FROM WORKER COMPENSATION INSURANCE CrAssecOnn need not he completed If the permit B foranc hundred dollmz(g10() or leu.) 1 certify Not in the performance of the work for which this Permit is issued.I shell not employ any Forma in any reactor an As m become subject a dte Workers'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Conneaut of Exemption.you could became subject m the Worker'.Comix r sation provisions of the Uhor Cade,you mug ,JO foMwith comply with such novialam at Nb re permit gall be deced makcd. z� CONSTRUCTION LENDING AGENCY E+ Ihereby affirm that there is a construction lendingagency for rite Performance of the work fur which this permit h issued(Sec.3097,Civ,C.) QUndoes Nurse z Lender's Md. U O 1 comfy that 1 have read this application and seta Nat Ne above Mfomudun I. ' . cortin I grte m mm ply with all city and county onlinartcee artd stage law rtlating to Ct, building construction,and hereby Authorize teprretnudw.s of Nb city to enter upon rias aWw-mentiowtl property for Impaction purposes gy (We)egret he eve.indemnify and kap hsnnkg the City or Cupertino agsimt y IiablliYu.judgmenu,costs and expenses which may In my way am tamstdd City Use in consequence of the granting of this Permit. r. APPLICA NDERSf��y1NNlpppS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �'-C-J' /j SOURC MLA ' / �^ ^ O� J(( Re-roofs Signuurc of Appllcan"Conuactor Data HAZARDOUS M .RIALS DISCLOSURE Type of Roof Will the applicantser future Wilding Occupant mom or handle hmrdow no eral As defined by the Cupertino Municipal Code,Chapter 9.12.and lite Health and Safety aillWoda.SectiYes on 25532(.)7 ❑No All roofs shall be inspected prior to any roofing material being installed. ❑ Will the applicant or future Wilding occupant use equipment ar devices which If a roof is installed without first obtaining an inspection,I agree to remove It harardnw air contaminants u de0ned by the Bay Area Air Quality Mmegement all new materials for inspection. 7d. strict? ❑Yca ON. I hfor- a Safct NehnaNnm 25505,55]3mma5534.lydcmwd.95ofthe Wilding / j/ n^�` Q bJ Hcalthd:SafctyCak.Section 25N13,25373and25534.1 unotify t thmiftht Wilding /y(� C.:J b J " not cu�stly hew a tenant that h b my reeponNhility u nndfy the aaupmt of Ne ut to Lw hmas e s primutimumccofaCeriff s, inccPancSignatureofApplicant Date ° All roof coverings to be Class"B"or better ner or amWriecd agent data II Community Development 10300 Torre Avenue aCOF Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPERTINO Building De artment JOB ADDRESS: PERMIT# R (Z— O G o 6-T 7 OWNERIS NAME: PHONE # GENERAL CONTRACTOR / FAX# I am not using any subcontractors:P 49�4YnPiu4-eA Signattl0e J Date Please check applicable subcontractors and complete 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 UPEI�TINO 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 Y4 " 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` 7'f A U kA n b� `ta�'/ 0K A-ff-I Job Site Address: / n l 13 b C_6 1) 12— Roofing 12—Roofing Company Name:�� tri—Cb-� 1�Lt �a.ti 4V Applicant's Signature: Date: r��—� Q S Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO a REROOF CUPEkTINO PERMIT APPLICATION FORM APN# 3� 2— Date: Building Address: Lei �2 Owner's Phone#: Contractor: �vE�S �fzof Phone Og�SSS 77y9 License A:�2 S S3 cY Contact: I Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles V Wood Shakes ❑ Wood Shakes Ml�'Wood Shingles ❑ Wood Shingles _ ❑ Other(Specify) ❑ Other(Specify) AX T� Number of existing coverings O 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 Qk=f, JIJ00041AL— ( 306 `-n1 -' zwaon Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: E Cost of Project: Type ofConstruction: Occupancy group: O Qty. if Applicable 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 2� JQ-7 /