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07010107 CITY OF CUPERTINO 61JILDING•DIVISION PERMIT +e� `g:�iTC1R:zRMT�€�N� BUILDING ADDRESS: PERNU NO. SDS M010J07 OWNER'S NAME: �� PERM EDATE )NE: ` ^ „a I ^ �� SANrrARf NO. CONTROL NO. son J \Fy'►� (_�/ ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 O pLICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing � with Section 7000)of Div Bic.#ss and Professions Cade,and my license is /^�L c /'fie}�7 1 <a in full force and a(ett �i©� '70 T rG�j)',/J`J' D Cial S�r�r"'�-�' I J J vJ Z Licenseass 3 Lic.# u E m Date /g 7 Contractor LOS -�{ Lv I �, OCC /�� We& .a ARCHITECTS DECLARATION IY`/^l�ly`JT f r� aa. < I understand my plans shall be used as public records nf VLO J. U.H Licensed Professional (-`E/s ,V,( �-+C H 3 Laq OWNER-BUILDER DECLARATION /')1 /a < I hereby affirm that 1 am exempt from the Contractors License Law for the (� a L 00 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 Z} prior to its issuance,also requires the applicant for such permit to file a signed statement EEC < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation yt- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or �] y _ that he is exempt therefrom and the basis for the alleged exemption.Any violation of (9-1LL6# I Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). .r r ❑1,as owner of the property,or my employees with wages as thea 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 Contractors License Law does not apply to an owner of fl 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- ccnse Law does 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. ❑I am exempt under Sec. B&P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: J I have and will maintain a Certificate of Consent to self-insure for Workces Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 9 1 have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers�c nsatiioon insurance carrier and Policy number are: Cartier. `star ! -�G^�d _Policy No.:0:101Z7 "OLr CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 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 Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z— CONSTRUCTION LENDING AGENCY E-t Cn 1 hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) OW A L.endcr's Name a z I enders Address U 0 I certify that 1 have read this application and state that the above information is L4 "+ correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorise representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Cel liabilities,judgments,costs and expenses which may in any way accrue against said City U z in consequence of the granting of this permit. // ►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �/ �v SOURCE R ULATION_S��.� �i� /,?,01 Re-roof:. ��- Siinatu_m of Applicant/Ctonlractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the 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 roof;shall be inspected prior to any roofing material being installed. ❑Yes `lgNo If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new naterials for inspection. District? C]Yes 6No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 255 34.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the requirements which must be met prior issuan •ofa:Qcni to orOccupaney. Signature of Applicant Date 1 J/� Owncr��..e agent Dare All roof coverings to be Class"B"or better o Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 CUPEKTINO Building Department JOB ADDRESS: C, PERMIT# OWNER'S NAME: ') l PHONE # GENERAL CONTRACTOR aE2 j FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete 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 Building Division i City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 C V n E DT I N® Fax: (408)777-3333 Building, Department Subject: Re-roofing policy for tLe City of Cupertino 1. Prior to permit issuance,you must igree 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 buil,ling4Mpector. 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 rail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new i naterial down to the sheathing, so a proper City inspection can be performed. IMPORTANT: 1. Flat roofs must have a minimum of %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 policyon re-roofing. Homeowner's Name: B yrn e- Roofing Company Name: LS O Applicant's Signature: / 2 Date: Greg teel Building Official Re-ised 1/30/03 Printe 1 on Recycled Paper CITE' OF CUPERTINO REROOF CITY OF CUPEkTINO PERMIT APPLICATION FORM APN# Date: Z- I Building Address: a l 4 l� ►� Owner's Name: Phone#: jA)i rn Contractor: Pho ae#: O License#: - kOo�07 Contact: „�. Phone#: Cupertino Business I, n e#: "S a/me-, �f TypE of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles Other(Specify) �G. ��jg, /'16 Other(Specify) ' Number of existing coverings j ❑ Provide I.C.B.O.Report# ( To be Removed Provide Mfgr.Installation Specs. 11 I Have Read, Understand and Will Comply Witt Cu ertino's`Tear Off Policy: Job Description: " l Z k-/ Jew -2 s Reside tial Commercial ] Fire Zone: Yes ❑ NoZ Confirmed with Planning Te5pt. if there are any restrictions: Cost of Pr 'ect: Type o Constructi Occupancy group: o Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE--r BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUELDING BUSLIC Business License BUILDING