The URL can be used to link to this page

07030066 CITY OF CUPERTINO BUi�I)ING DIY IS10N PERMIT C�1 'I'R1�GTQR INF' RMATI©1Y. PERMIT NO. BUILDING ADDRESS: 1103 ELMSFORD DR LOS GA.10S ROOFING 07030066 OWNER'S NAME: _ S',///iJ n PERMIT ISSUE DATE v (��G� 888 FAULSTICH CT 03/09/2007 SANITARY NO. CONTROL NO. ONE: (408) 298-9399 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH !9Z LICENSED CONTRACTOR'S DECLARATION Job Description u t- I hereby affirm that I am licensed under provisions of Chapter 9(commencing :Z� withScction70()U)ofDivisian3ofthcBusincssandProfcssiunsCodc,andmyliccnscis REROOF--REMOVE 2 LAYERS (E) ROOFING-INSTALL 7/16" t a a in full force and effec OO7U ; z 9 License CLle•� OSB & ROOFERS SELECT FELT & PRESIDENTIAL COMP-30 E p Date-111ContDEractor i ARCHITECT S CLARA ION �cclt I N61 k.2 7 J SQUARESi a a 1 understand my plans shall he used as public records J >yU U.ti Licensed Professional a OWNER-BUILDER DECLARATION ja 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 a prior to its issuance,also requires the applicant for such permit to file a signed statement othat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $10368 i 3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of A��l Number Occupancy Type not more than five hundred dollars($500). 362060 )6 . V V ❑1,as owner of the property,or my employees with wages as 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 q 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.). ❑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 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 Sea B&P C-for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: - 1.7 I 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. ❑1 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 Workers nsation Insurance carrier and Policy number arc: Carrier. ComrN N 10 Policy No.:660 Z Z 9� 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,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 Workec s Compensation provisions of the Labor Coda you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z " CONSTRUCTION LENDING AGENCY E r Cn 1 hereby affirm that there is a construction lending agency for the performance of Q!,n> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lender's Address U O 1 certify that I have read this application and state that the above information is Lt r corset_I agree to comply with all city and county ordinances and state laws relating to rJ- U building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. Q. (We)agree to save,indemnify and keep harmless the City of Cupertino against ,Fy liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the ting of this permit. Date ►'� APPLICANT UN S NDS AND WI CO Y WITH ALL N-P INT Issued ty: SOURCE REG TTO _ �113 U Re-roof; Signatu pplicant/Conttactor I UateType of Roof HAZARDOUS MATERIALS DISCLOSURE 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 roofs shall be inspected prior to any roofing material being installed. ❑Yes ❑No Will the applicant or future building occupant use equipment or devices which If a tool'is installed without first obtaining an inspection,I agree to remove .:mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials Qinspection. District? ❑Yesu 1 have read the hazardousmaterialsrequirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,Sections 25505,25533 and 25534.I understand that if thc building does not cu y have a tenant,that it' y responsibility to notify the occupant of the rcgt rcmcntg wh' h must be met ' issuance of a Ccruficatc of Occu cy. Sl tu:'e of Applicant Da e 3 U All roof coverings to be ass ' or better authorized agent Datc • CITY OF CUPERTINO REROOF d OF CUPERTINO PERMIT APPLICATION FORM APN# 3 Building Address: Own e ' Name: Phone#: zPW— e912 Contractor: Phone#: 40 License#: SS (�—� Is 2!qs-9-322 �'OOY07 Contact: — - Phc ne#: �� Cupertino Business�Yf license# : Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles W� Asphalt Shingles >6, Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles >. Other(Specify) '19. Other(Specify) 6 S !3 Number of existing coverings — ❑ Provide I.C.B.O.Re ort# To be Removed W Provide Mfgr.Installation Specs. I Have Read, Understand and Will C211iRly Wish Cu ertino's Tear Off Policy: Job Description: Z Residential Commercialx z ❑ 30 S cf cti mwt-g Fire Zone: Yes ❑ NoZ Confirmed with Planning Deft. if. there are anrestrictions: LI Cost of Project: Type o Ccnstructi : Occupancy group: , Qty. if Applicable Fee ID Fee Description Fee Group [ BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BLUDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 CUPEkTINO Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you mus-: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 buildinginspector. 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 t:) any roofing installation. 4. To receive a final sign off from the City,the followingsteps 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 with out first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. IWORTANT: 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 a:),ove stated policyon re-roofing. 7 � Homeowner's Name: ___-��ohSite.Addr_ess � --- —-------- -- Roofing Company Name: O Applicant's Signature: Date: Greg Cdteel Building Official Fevised 1/30/03 Prir ted on Recycled Paper Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 ,M Of Fax(408)777-3333 TPEkTINO Building Department JOB ADDRESS: � 3 ��S , f�; PERMIT'-,")' -70-3 �a� / o ,� OWNER'S NAME: PHONE# YoY Z`19` 3? GENERAL CONTRACTOR: os (-7,1kw A o y F FAX# U�j Z a/� - S 7 Z I am not using any subcontractors: f v, 3 `� O� Signature Date Please check applicable subcontractors and complete the following 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 L-blGer/ Signature Date