Loading...
04010033 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONT-"GTOnR INFO M"Y ON:,,' BUILDING , BUILDING ADDRESS: 1E1MITN004010033 OWNER'S NAME: PERMIT ISSUE DATE E: TTW SANITARY N0. CONTROL NO. 1ARCHTFECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uLICENSED CONTRACTOR'S DECLARATION I hereby affum that 1 am licnsed under provisions of Chapter 9(commencing IOb DCSCrIptlOn ec'on7IXN1)mfD.vinimnJof the Bca and ProfcsainnsC d,end myliccnseis ec dere REROOF se s N �e Dam contract CONTRACTOR: CARDINAL" ROOFING £ ndARCHITECTS DE ATION WKW uerstand my pan ls eball he used public rccnrQs �yU C Licensed Professional OWNER-BUILDER DECLARATION F.R n ay 7AA4 Hq 1 north,Unit. at 1 am exempt from the Contracmrs License Law for the O O following reason.(Section 7031.5,Business and Profcssions Code:Any city or county 5$( which requires a permit to construct,alter,improve,demolish,or repair any structure FAL ,izv` prior it)its issuance.also requires the applicant for such permit ro Me aligned statement £ < that he is licensed pursuant to the provisions of the Contractor's License law(Chapter9 Sq. F[.Floor Area Valuatd09000 yF0 (commencing with Section?(1(ID)of Division 3 of the Business and Professions Code)Or 4-4 y that he Is exempt therefrom and Use basis for the alleged exemption.Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty,of APN Number Occupancy Type not more than five hundred dollen(5508). - - ❑1,as owner of the property,many employees with wages u their sole compensation, 35613020 . 00 will do the work,and the structure is not intended or offered for sale(Sec.7(N41,Business and Professions Code:The Commerce's License Law does not apply in an owner of Required Ins A L s;ris) property who builds or improves thereon,and who doessuch worklidraWfor through his Me employ=s,provided that such Improvements src not intended mortared for sale.if, ��� 0 however,the building or improvement Is mid within one year of compledon,the owned 2004 sf builder will have the burden of proving that he did not Wild of improve for purpose of Y .]A). I,as owner of the property,am exclusively contracting with licensed contractors to BUILDING Construct the project .7014,Business and Professions Code:)The Contractor's Li- cense Law tl=s not apply to an owner of property who builds or improves thereon.and who contracts for such projects with a contracmr(s)licensed pursuant o the Contractor's License law. O 1 son exempt under Sec. B S,P C for Hussman. Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury o=of the following declarations: eve and will maintain a Certificate of Consent to selfdnmm for Wmrkeb Comism- - n.es provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is iuucd. - 1 have and will maintain Worker's Compensation Insurance,u required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. y Work c6C In�e qe raRcc carticP li oli I C er. /l�Nl�'!OJ✓ /!"1L'dl as'lV// - CERTIFICATEOFEXEMPTI FROM WORKERS' COMPENSATION INSURANCE (This section need nothecomplemd if the Permit is formic hundred dollars(SIM) or less.) I certify that in the performance of the work for which this permit is issued,I shall not - employ any person in any manner an as to become subject o the Workers Compensaiion - Laws of California.Dam - Applicant NOTICE TO APPLICANT:IL after making his Certificate of Exemption,YOU should - WContC aahjecl m the Worker's Compensation provisions of the Labor Code,YOU must - O forthwith comply with such provisions or this from,shall be d=med revoked. �•t r~�. CONSTRUCTION LENDING AGENCY 'rt I hereby affirm that there is a construction[ending agency for the Performance of a the work for which this permit is iuucd(Sec.3( 1,Civ.C.) /^ W�Q LA d aAdd.er'a _ z Lender's Add.. U 0 1 certify that 1 have read this application and state that the above information is CO F correct.1 agree to comply with all city and county ordinances and state laws relating to 0 building ConsWction,And hereby authorise mprcsentativars of this city te enter upon the W ahovo-mentioned property for inspection purposes. / Ey�a, (We)agree to save,indemnify and keep harmless the City of Calcuttan against G y liabilities, costs and expenses which may in any way accrue against said City - Uz APPCI�AiceoftOhcgrTtAm6Dn5thispermLLCOMPLY WITH AL NO -POINT Issued by: Date SOURC ONS L Re-roofs natufcof A,plica Contractor -SO AZA0.DOUS MATERIALS DISCLOS E Type of Roof Will thea licant Offuture building Occupant sure or handle haysrdous material U defined by K Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.Sednnss532AY1 All roofs shall be inspected prior to any roofing material being installed. I0y. Will the applicant or mlum building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove hagardnus air contaminants u dcrined by the Bay Arca Air Quality Management all new materials for inspection. - - rict? ❑Yes I have read the haamdnismamrials requirements under Chapter 6.95 ofthe Califon /J ni. ealth ik SafeyCode,Sections 35505.25533 and 25534.1 understand that ifthe'halding `r not curtend m e unh th it' myrtspouihilitymnmdlythe=cu of Ne rtmcm I(m pct tp uancearaCcnincamof Signature Applicant Date rte orawhori'rcd cot /p Dam All roof coverings to be Class "B" or better w Community Development Department { Building Division City of Cupertino 10 {a 300 Torre Avenue * CITY OF Telephone: (408)777-3228 UPEkTINO 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: Job Site Address: Roofing Company Name: G� N�L ;�F�?yj,L�G C.G, r Applicant's Signature: Date: ��Dy ` Gregot 0 Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO p o 0�3 REROOF CUPEI�TINO PERMIT APPLICATION FORM APN# 1 5561box I Date: / �a Building Address: /1833IZ4 ,E Owner's Name: Phone Contractor: Phone#: License#: Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: Built-Up Roof )Lf Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# ,&L To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: T�•a2 ill/" Residential Commercial ❑ Fire Zone: Yes ' Z No ❑ Confirmed w' anntng Dept. if there aze restriction S. LJ Cost of Project: 0 Type of Cons tru i Occup cy up� Qty. . AljcaOie 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 X77 .