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07010081 CITE'OF CUPERTINO (*7 T BUILD.,•: n1v11 G DIVISION PET "€, BUILDING ADDRES : PERMIT NO.� OO^ SWIM A-1. 31 . OWNER'S NAME: PERMITL9SDATE G�Yhel�I�YGI i�lrr)t�tr y 3 & 10NE: • ..V— � � SANITARY O. CONTROL NO. • BUILDING PERMIT INFO ARCHITECT/ENGiNEER: �� BLDG ELECT PLUMB MECH U o 0 0 0 400 LICENSED CONTRACTOR'S DECLARATION Job Description 4 U P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing =Z with Section 7000)of Di''on 3 of the Business and Professions ode,and my license is Q 1 O se H in fun force and effect ,Q ]y --+ �lO T`v, j �� , /� �? License C I(e•ti sv \� �(,f/ / , 3 F C Date Conlracfor ARCHITECTS DECLA ON D W 1 understand my plans shall be used az public records So r c(Dr i ' o g aS S , LO H Licensed Professional y OWNER-BUILDER DECLARATION +�<M 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or County t Li which requires a permit to construct,alter,improve•demolish•or repair any structure y Z r prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 L]• �/�O O x (commencing with Section 7000)of Division 3 of the Business and Professions Code)or .0 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number OCcll ancy Type not more than five hundred dollars($500). El I,as owner of the property,or my employees with wages az their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of 9 p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li- ccnse Law docs not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. 0 1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. C7I have and will maintain Worker's Compensation Insurance,as required by Section K�jof the Labor Code•for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Polity number a am« 4i�t �> PMiey No.: 6� CERTIFICATE OF EXEMP77ON FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued.1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date— Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. 0-0 CONSTRUCTION LENDING AGENCY (�rte+ I hereby affirm that there is a construction lending agency for the performance of a the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lenders Address U 0 1 certify that 1 have read this application and state that the above information is Li4 correct.1 agree to comply with all city and county ordinances and state laws relating to Q V building construction,and hereby authorize representatives of this city to enter upon the shove-mentioned property for inspection purposes. E.OW. (We)agree to save,indemnify and keep harmless the City of Cupertino against r..4 to liabilities,judgments,costs and expenses which may in any way accrue against said City O U Z in consequence of the granting of this permit. APPLICANT N ANDS AN WILL COMPLY WITH A L NO -POINT Issued b): Date SOURCE S. a Re-roofs Signature of Applicant/Contractor date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material az defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants az defined by the Bay Area Air Quality Management all new n laterials for inspection. District? 0 Yes �No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have to it is my,(esponsibility to notify the occupant of the requirements which or toiss I a Certificate of Qccupmqf. Signature of Applicant Date tj 6 Owner or authorized agentbate e All roof coverings to be Class"B"or better Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 Fax: (408)777-3333 Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agre 2 to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be appliec.without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the bui lding 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 apprc,val. 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 i irst obtaining an inspection, will require the removal of all new mai erial down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail i:ispection 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 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: ' "l A 0 EIV.04 kly N A 4 Job Site Address: � L Roofing Company Name: Applicant's Signature: ` Date: Greg Casteel Building Official Revived 11/2/04 :F Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C(TY OF 7UPEI�TINO Fax(408)777-3333 Building Department JOB ADDRESS: f PERMIT # 07 o1 Corr 2-- /D L1.2 IV OWNER'S NAME: 4 4f ,eA PHONE # GENERAL CONTRACTOR:914146 FAX # c=v'E�.� Enris I am not using any subcontractors: �� Si gnature Dale Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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 CITY OF CUPERTINO CUPE�TINO PERMIT APPLACATION FORM APN# -3, _ 2()- C J,.2 Date: Building Address:/D, 1l 7 A f �•f6 l) e0A0 , e-rf,,/J Owner's Name: 7 Phone#: Contractor: DeVe �W/1 License#: �� Z Contact: L Cupertino Business License#: Building Permit Info: Job Description: �' •// �� J Residential: X Commercial: ❑ Sq.Ft. Floor Area: Cost of Projec #C;7, o00 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BSEISMICOM Seismic Commercial BUILDING ( BSEISMICRE Bldg Permit Fees BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING 1 E I