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05060066 (2) CITY OF CUPERTINO r '°^ 'A «° m-� " "'•"°'""' ' ` '1"' ° ` 0 BUILDING DIVISION PERMITCONTRACT0114NFURMATION:g 9u1LDING ADDRESS: RESPONSIBLE ROOFING INC PERMIT NO 05060066 P OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY O. CONTROL NO. ARCHITEMENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH p o t� 0 0 yoOZ LICENSED CONTRACTOR'S DECLARATION Job DriSCrl eon 1 hereby affirm Wt I am Ikenscd under provisions of Chapter 9(mmmeecing r pt n IN Secdon 7M)of Division 3 of the ButinceeW ProfnsHv Code.and my licensee - 1` a LweE"rte uM ort 9 REROOF W/FOAM ROOF �Uf l�t(w. t� E© z Lkcvc lou uc.1 Dam Con-- V1� RCHTIE(IDS DECLARAT N 1 undersand my plans shall he used as public"cordo 00 Licensed Professional OWNER-BUILDER DECLARATION CmiurON 0 F 1 hereby.(Sero onn 1 em exempt from the Conine Co e:Anse Law for the � 1'ylf JIfI I❑ f O O following mason.(Salon 7xxxson Business and improve. dcoons Cade:Any city s munty 1 'f(f/\ $ which m9vima a permit re cores t e,p ser,improve,h permit e ml t t or mPaf any ttrucum �' J i I 11/(_ Prier n its issuance,also ntpoise lW applicant forsuch Commerce's U.M.Laved eukmcm —w \ < (that he comms cingwidpursuanunthapmvivions 3ofdief thic usinesinicerolcul CWpmr9 Sq.Ft. Floor Area Valuation zt$ (commencing exewilh Section nd of Division of Heeged sempt Professions Cndc)ur 3� that he ie exempt Ihem(rom and the bub far Na alleged exemption.Any=.; of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 70413Q&bQO Occupancy Type not mom than five hundmd dollars(2500). I,u owner of tiro profeny."my employers with wages u Nebsale compewtlon, willdo the work,and Netwctuse is rmtinlanded"offered forsahe(Sm.7044,Budrcu Required Inspections and ProfessiCoronariesCode:The Coronaries rem e r's License law t apply an owner of q p property who bulldt er im proves Hereon.and who does such work himself or through his own employces,pmvided diminish ireprevemenu we but Intended"offered for sale.if. however.He beili log or Improvement is sold within one year of completion,the owner. builder will have the burden of proving Hat he did not build"improve for purpose of .1.1. ❑1,as owner of the property.am exdnh my mouacting with licensed anuurs to construct the project(Sec.7044.Business and Professions Cade:)The Conuanoes U. \ cease law dors not apply in an owner of property who Wilds or improve Heron,and who concis for such projects with a cantrssur(s)licensed pursuant m the,Commerce, Lke.Law. ❑I am exempt under Sec. .B k P C for this moon _ Owner Dau WORKERS COMPENSATION DECLARATION 1 hemby aRtm under penally of isdury aro of the following declaration: 1 haw and will maintain aCeeificem of Covent in sel6insum f"Worker'sCompem- urian,as pm i&d f"by Sanson 3700 of the labor Code.for He performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,u required by Section 7700 of the tabor Code,for He performance of the work far which this permit is issued. My Workers C.ompenado Insunn Carrier and Policy number am: Cable fess � /�� Policy No.: r CERTIFICATE OF EXEMPTION FROM WO COMPENSATION INSURANCE (This section need net becomplcmd flux permit Isforanc hundmd dollus(SI0(0 nr her.) 1 unify that in the performance of the work for which this permit is issued,I shall not employ any person In any mannertn as in become subject o the Workers'Compeuation Laws of California.Dam Applicant NOTICE TO APPLICANT:If.after making this Cenile m of Exemption,you should become subject in He Worker's Compensation prewlsio"of HC ISWn Coda.you most ,J7O foMwith comply with such Provisions"is Permit nail W deemed revoked. .. q Vy CONSTRUCTION LENDING AGENCY (—t Ihereby affirm that them its construction lending agency for He performance of fYr the work for which this Permit is issued(Sec.3M.Cm C.) GQ Lender's Name , D z Leiners Address U O I cenify that I Mw mad His application and mm that dm above Informause is U. cortex I agree to comply with all city and county ordinances and nam laws misting in O Wilding construction.and hereby authrrim representatives of this city to enter upon pace W shove-mentioned property for inspection purposes gy (We)agree to saw.Indemnify and keep harmless He City of Cupertino against 0 liabilities,judgments.costs and expenses which may In any way acme against aid City U`l in consequence of the granting of this Permit. FI APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE�REGUyTIONS./ Re-roofs Signature of Applicalut/Oommiketer Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant"future building occupant stem arbandle huardous materia ss defined by be Cup. no Municipal Code,Chapter 9.11,and the Hcatth and Safety Croda,Od '25531(a)? All roofs shall be inspected prior to any roofing material being installed. Will thcapplicant of roto"Wilding occupant use equipment or devices whichIf a roof is installed without first obtaining an inspection,I agree to remove it harardna air contaminants u defined by the Bay Arta Air Quality Management all new materials for inspection. 70_-: ❑Ihave&Safe Cele.&.it ma305, re33and2534,1 u Chapmrd.95 if He Caifm HCaIIh&Smm the Im ardous ateria,15577 and rats un 1 rChapt r Nairthe buiCalifn.es not currently hats a moan,that It u my responsibility m nail'y dm occupant of theuimments which must bemet ptjgr miuvanae a,atdnam of Occupancy. Signature of Applicant Date ire All roof coverings to be Class"B"or better "autha' a cot Dam Community Development 10300 Torre Avenue Cupertino CA 95014 I Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: PERMIT# 102 j 09-0 600 CC OWNER'S NAME: WQ PHONE # 4pf, 2S -9b4G 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 Plumbing Roofing Q25 az1 �j Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Qnature Date Community Development Department Building Division i City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 00F Fax: (408)777-3333 4UPEkTINO 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, r 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: Job Site Address: 102 5-k{ Y I jY rA w0i Roofing Company Name: 5nnne,- -As \Jk-na_ A plicanYs Signature: Date: 6,`/(1j \�11r61J�1DCX1 Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper �1oati✓ CITY OF CUPERTINO L50, REROOF CUPERTINO PERMIT APPLICATION FORM APN# Date: bib- 24-OZ5 Building Address: kc),2-60 Owner's Name: Phone#: C4ov) 2-51--1 4 Contractor: Phone#: License#: P-eSoonsibl e Tt-C. [ �r Tj fL 51X Contact: Phone#: Cupertino Business License#: �cl Pe -na (tpsc)s�-SI51 Type of Roof Covering: Existing: Proposed: - M,'Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles �l ❑ Other(Specify) M" Other(Specify) -i1D0 (� Number of existing coverings 1 ❑ 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 Polic : Job Description: 5w2.2(2 okf 9YCn\.cQ. . Trs}Gtl1 A 5pravV m race Residential G?<, Commercial: ❑ " n? Fire Zone: Yes ❑ No ❑ Confirmed with Planning D there are any restrictions: Eept. if Cost of project: Type of Cy truction: Occu anc group: ,A$ (0,-1450.°° �2.-r0(S� g � 2 . 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 X37.