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09030054 CITY OF CUPERTINO n BUILDING DIVISION PERMIT C�£ TI A TC1 Imo` }RM I N BUILDING ADDRESS: PERMIT NO. 1155 HUNTERSTON PL LOS GATOS R OWNER'S NAME: PERMIT ISSUE DATE ONVIVIAN B9X !q26 SA CONTROL NO. ARCHITECTIENGTNEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH RE—RF RMV EXT CMPRF INSTL D O D D goo LICENSED CONTRACTOR'S DECLARATION ROOFRS SELCT FLT& DUMQDescription WI hereby affirm that I am licensed under provisions of Chapter 9(commencing Y� with Section 7000)of Division 3 of the Business and Professions Code and my license is 14N in �Z full foe and Lk.N �(2Z l LivenCl �ARCHr=S Contractor 5 Q� � nFC Datc o , r DECLARATION i i� I understand my plans shall be used as public records �yU 4 O y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractors License Law for the p O following mason.(Section 7031.5,Business and Professions Code:Any city or county y^Pi which requires a permit to construct.alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement z< that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valuation YF (commencing with Section 7000)of Division 3 of the Business and Professions Code)or e g$ 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($500). ❑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 Contractors License Law does not apply to an owner of �l 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 ❑1,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 Contractors License Law. ❑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: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- ,ation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. '4I have and will maintain Workers Compensation Insurance,as required by Section 376b of the Labor Code,for the performance of the work for which this permit is issued. My Workersore rias' a carrier and Policy number am: 1 Carrier Insursn Policy No.: `0 3yQ7� D O 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.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,atter making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z 0 4CONSTRUCTION LENDING AGENCY [�CM I hereby affirm that there is a construction lending agency for the performance of (x> the work for which this permit is issued(Sec.3097.Civ.C.) W A Lendces Name L.cndees Address U C) I certify that I have read this application and state that the above information is LL► correcL I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes O h (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 U Z in consequence of the g ng of this permit. / -- APPLICANT UND A DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date _ / SOURCEREGUL j v Re-root's Signuure of ApplicaHAZA DO D1. 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 roo.'s shall be inspected prior to any roofing material being Installed. ❑yes No Will the applicant o future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. ,hstrict? 11 ❑Yes p]No I have read the hazardous materials rcquiremcnts under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 75534.1 understand that if the building docs not currently have F�� s my responsibility to natty the occupant of the mquiremcnm w'h m issuance of a certificate of Ocu Signature of Applicant Date All roof coverings to be Class'n"or better Owner of authoriz agent f Dail 003 o� Sy CITY OF CUPERTINO RF ROOF CITYCUPEI�TINO PERMIT APPLICATION APN # /`n /�//� Date: / Building Address: LL &;�S & Owner's Name: Phone #: ` �.d 4 e l za Contractor: s Phone #: O,,r IF-� Fax#: 9 Z/ Cupertino Business License #: Contractor License #: ` Raa7c,,-) Type of lzoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof * Asphalt Shingles A Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other(Specify)F -a4l6,,, PjzIu pv, Number of existing coverings j ❑ Provide I.C.B.O. Report# To be Removed t�_ Provide Mfgr. Installation Specs. !r/ a `/ Job Des A l 0?3 � 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: S2-_3 Or f- I Have Read, Understand and Will Comply wit:i Cupertino's Tear-Off Policy: Signa r Revised 6/16/08 CITY OF CIUPERTINO REROOF CITY OF CUPEkINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 1RER00FRES ' Re-roof Residential B 1SFDWLROOF 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Re;,idential B 1BUSLIC Business License B Revised 6/16/08 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 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 C.ty,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 niaterial down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood na:.l inspection and the job is not ready, you will be charged a re-inspection i ee 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: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 ol. oicyn re-roofing. Homeowner's Name: ^ Job Site Address: �� � � 0 Roofing Company Name: Applicant's Signature: ,? D te: r J Greg Casteel Building Official Revised 07/30/08 ` Community Development �" 10300 Torre Avenue Cupertino CA 95014 -K Telephone(408)777-3228 CITY OF Fax(408)777-3333 XPE TINO Building Department JOB ADDRESS: PERMIT o OWNER'S NAME: PHONE L GENERAL CONTRACTOR: FAX I am not using any subcontractors: Signature D to Please check applicable subcontractors and comp ete the following information: SUBCONTIRACTOR BUSINESS NAME I 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/Con act r Signature a