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04070129 (2) CITY OF CUPERTINO & BUILDING DIVISION PERMIT 'CONTRACTOR INI<'URMATION' BUILDING ADDRESS: PERMIT NO. KEVIN SULLIVAN ROOFING 04070129 OWNER'S NAME: PERMIT ISSUE DATE NE:HENRY qrT40CK 1TALLRY 0A.149 DR SANITARY qRkOL N0, ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �pp LICENSED CONTRACTOR'S DECLARATION �I_ T., m,,,..,v;� a 1 Wmby 0).f that I am licensed under provisions of CWpter 9(romm.ring Iw`'Y■p' `�L�•rpt" a< with ScctlOn]0110)af Division 3of the Buainesand Pr caalens Codc.and mylicens la imm�m .naercea / EROOF D0? Licen¢CI Lk.g Ell Date ConumtOr r AUGplans shall W used as pub 's Isend est a records G _ 2004 3 G Licensed Professional OWNER BUILD A OWNER-BUILDER DECLARATION BUILDING +� 1 Wrthy am.dust I em.scurpfrom dm RATIO a/a License law for to C.0 o following moon.(Section 7031.5,Business and precarious Code:Any city or county n a which requires a permit m construct.altar,improve,demolish,or repair any structure Fly prior m is,isotone,also rectums the applicant for such permit Ale a signed statement Valu FFss< thanhe is licensed pursuanto the provisions of the ConnecConnector'sLicens,Law(Chapter 9 Sq. Ft.Floor Area ator Cs'm mommncingwiNSecuon]B00)o(Division3ofdte Bunnessand Prafesians Coda)or $ that me u exempt therefrom and the basis for On alleged exemption.My violation of Section]031.5 by airy applicant for a permit subjects the applicant 10 a civil purely Of 3 6TF20VAI 0 0 Occupancy Type not more Nn Eve hundred duties(S30D). ❑1,u owoer of the property,or my employces with wain an their sok compensation, will do the work end Ne eruc um u not intended m.ffcmd fo...is(Sec.7041,Bounce .it Professm.Code:The Canbacmfs License law does rt apply to an owner of _Required Inspections property who builds or improves thereon,and who does such wark himself or through his own employer,provided Nu such Improvements arc not Intended or offered for ale.IL however.the building or improvement is wed within one year Of nmpletion,Ne owner' builder will have On burden of praying that he did not Wild or Improve for purpose of ❑L as Owner of the property,am exclusively contracting with licensed conmdon to consumer the project(Sec.7W,Business and Professions Code:)The Contractor's Li. cons,law docs not apply to an owner Of property who Wilde or improv daemon,and, who concocts for such pmjcm with a conuactnr(O licensed punrm to ON Coronation License law. ❑Ism exempt under See. ,BAPCfermismnon Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby aRrm under perky of perjury oro of One follmving declanor: 1 have and will main Wn a CcrtiAcate of Consent to selFinsum for WorYeri Compm. sari..,r provided for by Section 37W of the labor Code,for the performance of the work for which this Permit is issued. ❑1 haw and will maintain Workers CompcoWion Innrance,as required by Section 37W of me Labor Code,fr me performance of Ute work for which this Permit is fund. My Workmen Compensation Insurance carrier and Policy number are: Cam E IFICATE OOP E7(EMPI'IOPoliN FROfd.3)WRRERS?Z , COMPENSATION INSURANCE ('ruin malar need norbccmnplcwd if Re permit is forms,hundred dollen($100) or less.) 1 certify that in the performance of the work for which this permit is issued.I shale not employ any person in ray mnnerso as in become subject to the Workri Comperflon Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become tuhj=t in me Worker's Compensation provisions of the labor Com.you must O foMwith comply with such provisions or this permitshall o deemed revoked. Zy CONSTRUCTION LENDING AGENCY ,4 1 hereby efirm mat inert is a construction lending agency rat the Performance of G'> the work for which this permit is issued(Sec.3097,Civ.C.) IA Lender's Nun. Des I<nder's Address VQ I certify that I have tend this application and state mat the move information Is (y building I agree m comply Mm all city and county odtrncex and cote lows relating e / I,,E Correct. I agree to co and with al aumorid representatives origin man l ws septi the / W movamenlioned property for inspection purposes. tF^y d (We)agree to raw,indemnify and keep harmless On City of Cupertino again, p) liabilities,Judgments.costs and expenses which may in ray way serve against said City U F'•r 7 in consequence of the lamming of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 4Da SOURCE REG}}��TI�O�N_�5�..,,,,, / 7 Z/ Re-roofs Srgr H RDOUS MATERIALS DISCLOSURE Date Type of Roof Will the applicant or future building oceupnlsmre or handle himadous material as deRrd by the Cupertino Municipal Code.Chapter 9.12.and ma Health and Safety AMILCosla,Sguon 25532(a)] All roofs shall be inspected prior to any roofing material being installed. Y. Will the applicnt or future building Occupant use equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as dc0ned by the Bay Area Air Quality Management all new materials for inspection. Dishes] 0 Yes KN.q�� I have read IW haraduus materials reyuimmenu under Chapter 6.95 of me Califor. ria Health&SafetyCode,Sections 25505.]5533 and!25534.l understood ren if me Wi w lding — i!1(,� does not currently have a Irr cnt,that in is my responsibility w dry ted«'cupnt of me G�"7� t/ �' reyutremenls which most JmCL prior m houtace ora Certificate of OecopaOGy� re0 Date owner o Dam All roof coverings to be Class "B"or better 1 Community Development .' . - 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 #UPEkT[NO Building Department JOB ADDRESS: PERZA # OWNER'S NAME: PHONE # 08 05">,- 2 GENERAL CONTRACTOR: _ FAX# I am not using any subcontractors: Signature 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 umbing Roofing _ Aj 0 Septic Tank Sheet Metal Sheet Rock • Tile ac or lgnature Date Community Development Department Building Division : City of Cupertino 10300 Torre Avenue CITY Of Telephone: (408)777-3228 U P E 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. 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: A `J" s A Job Site Address: S S� (r✓lr �17. /�//tcP• Roofing Company Name: �ii.✓ 64s /lrJG1.f/iC.��o#�i�✓� A plicant s Signature: iEk% ate:11yir- Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper - CITY OF CUPERTINO REROOF D <' 7 o Z �y CUPERTINO PERMIT APPLICATION FORM I APN# Date: 7 < b Buildin Address: T s. .S7F5Z ,fG- Owner's Name: Ph ne.#: sc 2� --o—" Contractor: Phon Lic se#: �i/1"' r_—, S'u-6x4 vn� 617 C- 03wj— onta r honelk: upertino Business License#: �u- P _fLII �9 V (�"� — ' Type o Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles q/Asphalt Shingles C7�/ Wood Shakes ❑ Wood Shakes 1-1 Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings— ❑ Provide I.C.B.O.Report# a./1`o be Removed ❑ Provide Mfgr.Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic Job Description: IA,Lve L-VoDS aF fth.�Gr�3 /.�tiAzt. "� 3 G , ql 7 Su,,, Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are an restrictions: LJ Co of Project: Type of Construction: Occupancy group: Qty. 'f A tc bl Fee ID Fee Description Fee Group PERMFEE Bldg Permit Fees BUILDING NERGY Energy BUILDING SEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING • Z�-3