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09030069 CITY OF CUPERTINO BUILDING DI';ISION PERMIT tt PERMIT NO. BUILDING ADDRESS:10047 CRESCENT RD GUTHRIE PERMIT ISSUE DATE OWNER'S NAME: P A CONTROL NO. O : BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH p C LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z w with Section 70(1))of Division 3 of the Business and Professions Code,and my license is RE-RF 2 5 S Q CLS A COMP RF MADE OF SKIP e'y in full force and effect. License Class Lic.0der SHEETNG PLYWD, 30LBS FLT PAPER 40 YR GAFF ELK =t p Date pRCH1TEC1'S DECLARATION I understand my plans shall be used as public records m �yV 4 c y Licensed Professional OWNER-BUILDER DECLARATION nr I hereby affirm that I am exempt from the Contractors License Law for the '�p O following mason.(Section 7031.5,Business and Professions Code:Any city or county C Pi which requires a permit to construct,alter,improve,demolish,or repair any structure o'ti prior to its issuance.also requires the applicant for such permit to rile a signed statement $ Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q' 1 0 0 0 0 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 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not mote than five hundred dollars($500). 32616027 . 00 ❑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(See.7044,Business Required Inspections and Professions Code:The Contractors 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 wiallA ha 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- cense Law docs not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractof(s)licensed pursuant to the Contractors Lic00se Law' ❑1 am exempt ue Sec ,H&P C for this reason Owner Data WORKER'S COMP SATION DECLA ON 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 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. ❑I 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 Compensation Insurance carrier and Policy number arc: Cartier. / Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Chis 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 WOrkcri Compensation Laws of Cal(fomi Date Applicant NOTICE TO APP CANT:If,after making this Certificate of Exemption,you should become subject to the Workers 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 (.t►. 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 Q Lenders Name Lenders Address z U 0 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 V. building construction,and hereby authorizt representatives of this city to enter upon the above-mentioned property for inspection purposes. W W (We)agree to save,indemnify and keep harmless the City of Cupertino against rF-t rA liabilities,judgments,costs and expenses which may in any way accrue against said City _ U Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE EGULA31 NS. J q--iQ—D`1 Re-roof: Signature of ppli o for Dare T Of Roof HAZARDOUS MATERIALS 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 roof i shall be inspected prior to any roofing material being installed. ❑Yes NO If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or Tutu riding occupant use equipment or devices which nit hazardous air contaminant fined by the Bay Area Air Quality Management all new Materials for inspection. Jistrict? ❑Yes ❑No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a t nant.Drat it is my responsibility to notify the occupant of the Date requirements w'ch must be met prior to uance of a ficate of Occupancy. Signatu)a of Appl ieant 4=d fj All roof coverings to be Class' `'or better Owner or authorized agent Date a CITY OF CUPERTINO g�o3obuq R�;ROOF CUPEkT1NO PERMIT APPLICATION APN # Date: D C) -5 Zc o Building Address: l 7 Owner's Name: LT r- 9 4 LD Phone #: 7— ?CQ HOA: Yes ❑ No ❑ If yes, provide lE tter from HOA Contractor: 0 Phone #: //,7 Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles -;C---,Asphalt Shingles 0� 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: 1�, o c� F ,�V oZ`, (,4 FF EL K 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: - / C I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: i Signature Revised 02/05/09 - , CITY OF CUPERTINO ~�'��' RIROOF CUPEkT1NO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bld€; Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1REROOFRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldl; Standards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldl; Standards B ALL PERMIT TYPES CommiE sion Fee 1BSEISMICRE Seismic Residential B 1 BUSLIC Busines; License 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 building inspector. A final inspection and approval shall be obtained from the I uilding 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 aterial down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood naL inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection c;m be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of lei " 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 policy on re-roofing. Homeowner's Name: 1 Job Site Address: j n o Lj:1 Roofing Company Name: Applicant's Signature: Date: Greg Casteel Building Official ReNised 07/30/08 OWNER-BUILDER VERIFICATION 0 700300� 1 1. (Check one) I or my immediate family ;parent,spouse or child) will perform A. All the work authorized by this permit B. A portion of the wc,rk C. _ None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. A portion of the work (complete section below) Contractor Address/City. Phone # State License # Type of work to 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. PersorVFirm Address/City . Phone Number Type of work to be -performed ................................................................................... I declare-aider penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(rev se side). Property s � e Owner' Signature: S Date: Permit# Qq COd Job Address: 1 rl��f �L _ Am changes to the information provided on this form shall be submitted to the City of Cupertino Build Department.