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04110166 (2) CITY OF CUPERTINO "' +�` ' '�Te�ru- — BuamN'G DlVlsloN PERMIT GONTRA.Ub INF,O'RMATI(3N M , . k. . BuaDINC ADDRESS: ELLIOTT ROOFING PERMIT NO 76 RPQR� DR OWNER'S NAME: PERMR ISSUE DATE BILL BOOTH ONE: SANITARY N0. CONTROL N0. (831) 423-0675 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 u0o LICENSED CONTRACTORS ECLARATION Ib Description y� F 1 hcuby.o lrm Nat 1 am tic onsad ur n eovaimus nr Chapur 9(CommencinOe5Cf1p g ^ with Se 07 )of Dlvl.hm3oftWBwin d Protesslons Code,and my It,..is mrmumrq n,tierteaL/�,✓�„�9�j. REROOF W/COMP . SHINGLES 5 Licensg.[laaa k.p Date Con ARCHITECTS DECI.A N /1�aL,�� � oP� I rtunJ m lam shall M used ss public cOR & iu Licensed Peofc o a p VZ— OWNER-BUILDER DECLARATION 30 Y 1 hcmby.(Sere on 1 1. exempt fare Ne Contractors License Law for the po follwhich guiresa Permit 7rire+e and Proimprove. donum Coo.:Any ciry or County 3 0 which requires a permit re Co.,.omwcs, ]amapplicant improv,h Permit t or e a sig ed tatement priorm.lissuata4men req.the theevaimmt for suchpermit mLicense Law statement ��< that heeNkensedpueetar7000)of Division 3 Ne Co usinesanPonasionC odc)or Sq.Ft. Floor Area s, Valuation $ (Commencing with ge eiatin rom n d mon for of the alleged c Business Pro(cu vi.1.6 o of (hal he u exempt therefrom end Ne buffs far be e1leg.d eamptian.Any violation of Section 7031.5 by any applicant for a pentyl subjects Ne applicant an a civil pemlty of 3 6dffW?ZA'&er0 0 Occupancy Type non ream Nan 0m hundred dollars(5500). ❑I,as ownerof Ne property,ormyemployco,with wages uNeirmlecompensa0on, will do the watrkand Neshucmre is not intended or offered fonale(Sec.7044,Business Required Inspections and Professions,Code:The Contaminates License Law donot apply m an o anc r of q p Property what builds or improv themon,and who does such work himsel f or through his own employees,provided that such improvements ere not intended mnRead formic.If. however.Ne building or improvement is sold within one yev of compledon.Ne Owner. builder will have the burden of proving that he did not build or improve for purpose of - ask.). (]1,as Owner of the properly am escluively convecting with licensed Con racoma b Construct the project(Sec.7044.Business and Profession Cade:)The Conmctaes Li. ave law does not apply to an owner of property who builds or improv Neeson,and who contracts for such projects will a contractor(s)licensed position on the Contractors License Law. - - C'IamesemplundeeSem ,B&P C for Nis..on ._ war Data WORKERS COMPENSATION DECLARATION I hereby affirm under pentlty of perjury ane.17th.following decla bons: 1 have and will maintain aCeetificate of Consent in self-Insure for Worker's Compen. , cation,as,provided for by Section 3700 of the Labor Code.for Ne perfor rence of the work for which his permir is issued. ❑I have and will maintain Worker's Compensation Insurance,Is acquired by Section 37W of the Labor Code,for N.performance of the work for which this permit is Issued. a Wojrkcra Ca Inmrance aricrA Po`t'ty no;bc) roc: a er C!! . Poll FROM /erJ ql.� CERTIFlCATEOFEATIO INSURANCE or WORKERS' �•�p6 COMPENSATIOn INSURANCE r�Y ` (ThI¢section necJ ran he catmpkuJlf the permitbfnronc hundred dollars(51001 nr less.) , 1 catiry that in this performance of the,work for which this Permit is issued,I shall not employ any person in any manner m u a become subject to lM Worked ComNoundon Lawsof Callfomla.Dal. Applicant NOTICE TO APPLICANT:If,after making this Contracts or Exemption,you should beam,..bjcel an the W.rkces Compensation provisions of tM Labor Code,you mal .,O foMwith comply with such provirmas or this permit shall he deemed revoked. „E,i M CONSTRUCTION LENDING AGENCY 'Tei► IhembyaRnm that there is a construction andingapency ran the Kniturnmen.f W' the work for which this permit is issued(Sat.3097,Civ.C.) 0 Lend.es None z Lattices Address J Q 1 cenlfy Nat I hem read this application and sou WI th.showw,information It _^ 0 (✓ building I agree to Comply with all city and county ordinances and sok lana slating line �(J building co recto Co,andmply hereby mty ad representatives thio city lnawsrupnn to r Lij above-mentioned property,fm Inspection pugwses. g1. (We)agree to sort,indemnify and keep harmless du City of Cupenot against F to liabilities,judgments;costs and espemes which may in my way accrue a gain.aid City , (,)7 in consequence of the granting oh mil. r7 AP LICANT UNDERS4AN WILL COM WITH ALL NON-POINT Issued by: Date S RCE REGULATION Re-roofs Signature at Appli tlti larData HAZARDOUS MATERIALS DISCLOSU E Type of Roof WIII Ne applicant or ruuro building uccupmt stare orhan0le hazsrtlous matarial as defined by the Cupertino pal Code,Chapter 9.12,mil the Health and Safety Me.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. M ❑Yes A-10 WIII the applicant or future building occupant use equipment or devices which If a roof is installed•witht first obtaining an inspection,I agree to remove mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials foninspection. District? i ❑Yrs C/ a (have nod the byyarddnnas up l iremc5534.1 rC�fi.95 or Ne Glifog �/� ria Hcalth&Safcl C IScNons]S 25533 mJ 25534.1 un dNan if the Wildin l/!' / ('/ Docs nor currently a tanm v i my msponsi 'lit nsl'y Nc acupam of Nc - a requimer�a. moot I uU3. a 6 of cuPan Si atureo Applicant Date ZIE n ser mmonv g t Dau All roof coverings to be Class "B"or better Community Development F 10300 Torre Avenue 9 Cupertino CA 95014 ` Telephone(408) 777-3228 CI OF Fax(408)777-3333 �UPEI�TINO Buildin De artment JOB KESS: PERMIT # 7,0 OWNER'S NAME: % PHONE # GENERAL CONTRACTOR: c , FAX # I am not using any subcontractors/ Signature Date Please check applicable subcontractors and complete the following ' ormation: 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 Ank Sheet Metal Sheet Roc // Tile liei caner/Contract r Signaturr e Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 Fax: (408) 777-3333 SUPEkTINO 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: Job.Site Address: Tov7 ;.. Roofing.Company Name: A plicant's Signature: ` r Date:\—✓ 4 �J Greg eel Building Official Revised 1/30/03 Printed.on Recycled Paper ` - `' ` CITY OF CUPERTINO MA REROOF CUPERTINOPERMIT APPLICATION FORM APN# _ 6 6 17 a� Date: � � O Building Address: l 760-7 l,3,�--er-P�c-kCoAnro C4 94521 Owner's Contractor: r✓ I,o Phone#: License #: g3�) 123-0678 y q Contact: 113� . 79 Phone#: Cupertino Business License #: lZ Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles- Asphalt Shingles X 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: hero — Tem sl.c, {ro Sk;P slew 7 nail. +/z C�SQi Residential Commercial ❑ Fire Zone: .Yes ❑ No ❑ Confirmed wi e t. if there are restrictions: Cost of Project: -- --J Or Type of C io Occup cy gro 1©,132 - Qty. .f AV i bl Fee ID Fee Description Fee Group BPERMFEE BldgPermit Fees BUILDING BENERGY Energy BUILDING' BSEISMICRE Seismic Fee Res BUILDING ', . . BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Feer BUILDING BUSLIC Business License BUILDING •