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07010106 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � ���� � f PERMIT NO. ^ BUILDING ADDRESS: U �1 PERMIT ISSUE DATE OWNER'S NAME� (�/�� • 'TVh�/V��/���/(1�_Wsh J�`jr^, //''�� Q SA ARY NO. CONTROL NO. INE: ..y/ `./�/M •�/I"—v • / BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p C LICENSED CONTRACTOR'S DECLARATION �O ^�. Des rips t I 4 V 1 hereby affirm that f am licensed under provisions of Chapter 9(commencing w•A (vJ, 11 I(1I(( =z with Section 7000)of Division 3 of the Business and professions Code,and my license is , r!V1 I/I���. y nsta I in full farce and effect Q pf s.�--1^I TqF0 � �I ��}Va "w z License Class a� Lic.8 ' 1 v �/g w Date Contractor ^ Lei ARCHITECTS DECLARATION `C-'` ' I y-t 1 understand my plans shall be used as public records 4 wo y Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct alter,improve,demolish,or repair any structure ValUatiO prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area -z< that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 q /O x F in (commencing with Section 7000)of Division 3 of the Business and Professions Code)or It that he is exempt therefrom and the basis for the alleged exemption.Any violation of OCC an Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Y yp not more than five hundred dollars(5500). Q Las owner of the property,or my employees with wages as their sole compensation, wilIdothcwork and the structure is not intended oroferedforsale(Sec.70",Business Required Inspections and Professions Code:The Contractor's License Law docs not apply w an owner of 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.it, however,the buildingor 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.). Q I,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- cense 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. am exempt under Sec. B&P C for this reason Q[ Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: J]have and will maintain a Certificate of Consent to set(Ansure 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. I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation insurance carrier and Policy number are: Carrier /d�' =Policy 06 '� C CERTIFICATE OF EXEMPTION 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.I 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 Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY (�.gym 1 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.) LLl Q Lender's Name aZ Lcndees Address U C) I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against l) liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date / APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. �- /�� Re-roof's Signature of Applicant/ ontractor Dale T ofRoof HAZARDOUS MATERIALS DISCLOSURE Type Will dee applicant or future building occupant store or handle hazardous material as 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. 0Yes 9rNe If a roc is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which all new materials for inspection. emit hazardous air contaminants as defined by the Bay Area Air QualityManagement District? ❑Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safct Codc,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant that it is my responsibility to notify the occupant of the Date requirements whi4 must be met nor to issuance of a Certificate of Occupancy. Signature of Applicant .n — All roof coverings to be Class"B" or better Owner or authorized agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 CITY Of Telephone(408) 777-3228 C U PERTINO Fax(408)777-3333 Buil-ding De artment FGENERALCONTRACTOR- B ADDRESS: PERMIT# WNER'S NAME: PHONE# G © FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and com Mete the followin 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 Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date Community Development Department 1 Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 C U PE DTI NO Fax: (408) 777-3333 Building; Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must a,3,,ree to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be app:ied without first obtaining all inspection and written approval from the build ng-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 m iterial 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 or.the job site at the time on inspection I understand and will comply with the above stated policyon re-roofing. Homeowner's Name: u.,:_-J.ob.Si.te-.A A-ress:_. Roofing Company Name: �' Q O A plicant's Signature: L Date: Greg teel Building Official Revised 1/30/03 Printed of Recycled Paper 4-701 COW CITY OF CUPERTINO REROOF CITY OF CUPEkTINO PERMIT APPLICATION FORM APN# Date: // -C1L?� Building Address: " Owner's Name: Phone#: Contractor: Phor e #: 40,Y License#: �- -93 9 9 k60 Yo Contact: Phon:#: / Cupertino Business icen e#: S�� 3 � Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles C3Wood Shingles C3Other(Specify) ❑ Other(Specify) Number of existing coverings f ❑ Provide I.C.B.O.Report#NYN To be Removed ❑ Provide Mfgr.Installation Specs. I N " I Have Read, Understand and Will Com l With Cu ertino's Tear Off Polic Job Description: r Residential Commercial ] Fire Zone: Yes ❑ No Confirmed with Planning Deft. if. there are any restrictions. i5 Cost of Project: Type o Consructi Occupancy group: 79 7; O Qty. if A licable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING