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09030201 77777777777 777777 CITY OF CUPERTINO �����,�TT BULLDIN(a DIVISION PF,111v11T � � . PERMIT NO. BUILDING ADDRESS: 917 COTTONWOOD DR SHADOWFAX ROOFING PERMIT ISSUE DATE OWNER'S NAME: A CONTROL NO. 'LONE: (408) 265-2490 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 o a 0 Q p LICENSED CONTRACTOR'S DECLARATION Job Description W r— I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is RE—RF RMV EXTNG CMP RPLC W/SAME 3 0 YR 3 0 LB FLT o in full 10—Cl. arte and e .t 1/Z V ZLicense Class i L'c• CLS A n- ; Date Contractor ARCHITECTS DEC ATIO a< I understand my plans shall be used as public records �yU L.0y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lmo following reason.(Section 7031.5,Business and Professions Code:Any city or county 4 2 P which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuarrce.also requires the applicant for such permit to rile a signed statement $q.Ft.Floor Area Valuation E_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 X t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or59287 y 5 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not more than five hundred dollars(M). 36917042 . 00 0 I,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.7144.Business Required Inspections and Professions Code:The Contractor's License Law does not apply to 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.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 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- 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. 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: I have and will maintain a Certificate of Consent to self-insure for worker's compen- ...don,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 A SM of the Labor Code,for the performance of the work for which this permit is issued. My Worker' erxperuatia9 saran airier and Policy number ogre: Carries N Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foranc hundred dollars($100) or less) I ceniCy that in the performance of the work for which this permit is issued,I shall not employ any pcis o ' any manner so become subject to the Workers'Compensation Laws aC Ca1Lfo a. Applicant NOTICE T CAVC If,after nV"g this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J Z, forthwith comply with such provisions or this permit shall be deemed revoked. Z� CONSTRUCTION LENDING AGENCY E—i rte. I hereby affirm that there is a construction lending agency for the performance of p! the work for which this permit is issued(Sec.3097,Civ.C.) W ALender's Name 0 Lender's Address I certify that I have ad this application and state that the above information is U mad I agree to comply with all city and county ordinances and state laws relating to O Vbuilding construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes >4 a (We)agree to save,indemnify and keep harmless the City of Cupertino against. Hc.4i liabilities,judgments,costs and expenses which may in any way accrue against said City V Z inconsequence of the gr - 6 anting of is permiL Date ., APP NT UNDERSTAN AND WILL COMPLY WITH ALL NON- INT Issued by: R REGULATIONS. 6 d Re-roof; nature of Ap can ontractor a T of Roof HAZARDO ATERIALS DISCLOSURE Type 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. [3 Yes AN. If a room is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which fit hazardous air contaminants as defined by the Bay Area Air Quality Manascmcnt all new materials for inspection. istrict? [3 Yes JKNo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- 'L 0 nia Health&Safety Cade.Sections 25505.25533 and 25534.I understand that if the building docs t curtently have a t that it is my responsibility m on: the occupant of the Date re mems which m el to issuance of a Certificate of Occupancy. Signat .'40e o Appll All roof coverings to be Class'n"or better caner thorized agent Date "(�3uc) I CITY OF (�UPERTINO C REROOF CUPEi�T1NO PERMIT APPLICATION APN #3 00 Date: Building Address: //I� DX_d?rzXj&) D!� effl_ S�� Phone #: Owner's Name: Gums HOA: Vqe& No ❑ If yes, provide letter from HOA Contractor: Phone #: rX, ` Fax #: X& Cupertino Business License #: Contractor License #: y2 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles P6,Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: , 7j d - �'s� X 816 Residential Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: applicable, include in plan set & the sheet index. Valuation: I Have Read, Understand Will Comply with Cupertino's Tear-Off Policy: Signa e Revised 02/05/09 CITY OF CUPERTINO REF:OOF CM OF CUPEkT]NO FEE SCHEDULE Number of Fee ID Fee Descr".ption Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Re3idential B 1SFDWLROOF 1BCBSC Cal Bldg S uandards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg S :andards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 BUSLIC Business L:.cense B 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 agree to comply with 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the buildin;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 Cite,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 mz.terial down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fe,: 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 ori the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: Job Site Address: 91 4:6 -- I Roofing Company Name: Applicant's Signature: Date: D f Greg Casteel Building Official Revised 07/30/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 �CI11f OF Fax(408)777-3333 '7,UPEkTIN0 Buildin De artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # id • 2 y�-d`'O Z GENERAL CONTRACTOR: FAX # jKdf I am not using any subcontractors: 400-1 Alijnatur Da Please check apphcable subcontractors and complete the following information: SUBCONTRACTOR BUSIN ESS 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 Wte e ontractor Signature