06100118 CITY OF CUPERTINO
BUILDING DIVISION PERMIT 6 Ni� } ,..
PERMIT NO.
BUILDINGADDR7532 FATTIERWOOD DR YORKSHIRE ROOFING OF NORTHERN 06100118
OWNER'S NAME: PERMIT ISSUE DATE
tt YANG
4;E__ SANITARY N . C OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION Job Description ol C I hereby affirm that I am licensed under provisions of Chapter 9(commencing
;Z m with Section 70110)of Division 3 of the Business and Professions Code,and my license is
!=y in full force and effect REROOF-GERARD STEEL OVERLAY SHAKE-2ND OVERLAY
u ? License 1 Lic.#
F p Date F _ Contractor o (R3)
ARCHITECTS DECLA ATION
ecu;< I understand my plans shall be used as public records
r�U
.a
Oin Licensed Professional
0 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
:00 following reason.(Section 703 1.5,Business and Professions Code:Any city or county
%m which requires a permit to construct,alter,improve,demolish,or repair any structure
?Zy prior to its issuance,also requires the applicant for such permit to file a signed statement
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valua�'n 0 0 0
t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
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 APN Number Occupancy Type
not more than five hundred dollars(5500).
0 I,as owner of the property,or my employees with wages as their sole compensation, 35928045 . 00
will do the work and the structure is not intended or offered forsale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs 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.IL
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 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.
0 I 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:
n I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 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 Wor/kkcrs�L.Compensat/ /
iio''n Insurancecarrierand Policy number are:
Carrier�TR� l 14/ Policy No.: Is 3.!5,
CERTIFICATE OFtEXEMPTION 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 O CONSTRUCTION LENDING AGENCY
[� 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.)
WQ Lenders Name
az L.cndees Address
U Q I certify that I have read this application and state that the above information is
LL►� correct.1 agree to comply with all city and county ordinances and state laws relating to
Q V building construction,and hereby authorne representatives of this city to enter upon the
above-mentioned property for inspection purposes.
nWi (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
tJ Z in consequence of the granting of this permit. -�
0•11 APPLICANT UNDERSTANDS AND WILL COMP L WITH ALL NON-POINT Issued by:s4ta4&V
Date
SOURCE REGU ATIONS,
Re-roofs
Signaturof ApplicanUCyfitractor 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 roofs shall be inspected prior to any roofing material being installed.
❑Yes Vo
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 materials for inspection.
District?
0 Yes o
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 undcrstind that if the building r�, Q l�
docs not currently have a tenant,that it is my responsi '' notify the occupant of the -
requirements which must be met prior to issuance arc of Occupancy. S 1 ature of A 1lcant Date
- ��A(.-o r� All roof coverings to be Class"B"or better
OwnqAr authorized#Iferir Date
CITY OF CITPERTINO
REROOF
CUPEI,TINO PERMIT APPLICATION FORM
APN# Date:
Building Address:+5_-)2� p �-
Owner's Name: V/L 6 � 54 Phon #
Con act r: 1 Pio Licen #:n, )U0FT; ' r
PZ�_ U&-&-70 1
Con act: Ph e Cupertino Business License#:
4 v tV� 0z
Typ of Roof Covering:
Existing: Proposed:
Built-Up Roof ❑ Built-Up roof
Ib Asphalt Shingles ❑ Asphalt Shingles
XWood Shakes ❑ Wood Shakes
EJ- Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ . Other(Specify)
Number of existing coverings Provide I.C.B.O.Report# t/
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No 0-' Confirmed with Planning Det. if
there are anrestrictions: LJ
Cost of Project: Typf of onstruction: OccupancToup:
Qty. if
Applicable 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