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09030062 CITY OF CUPERTINO � BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 10205 IMPERIAL AVE RICHARD HERNAN EZ PERhIITISSUEDATE OWNER'S NAME: S A ktg 2 9 0 9 CONTROL NO. INE: BUILDING PERMIT INFO FARCHrMCT/ENG:1NEE:R: B� E� PLUMB MECH�apLICENSEDCOOR'S DECLARATION Job Description ereby affirm that I am licensed under provisions of Chapter 9(commcruic gn 7000)of Division 3 of the Business and Professions Code.and my license is RE—RF FLAT ROOF T/0 &NO PLYWOOD,CLS A 4SQ yin uorce and effect. vn Z License Class�---Lle• nF G Date Contractor t�a ARCHITECTS DECLARATION I understand my plans shall be used as public records �yU rg Q y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 2 p O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct, after,�Pro�•demolish,or repair any structure Valuation prior to its issuance•also requires the applicant for such permit to file a signed statement S Ft.Floor Area ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 (1 6000 YtS (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or i 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 3 5 718 0 C 7 . 01 not more than five hundred dollars(5500) ❑1,as owner of the properly,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 dos 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.U• however,the building or improvement is sold within one year of completion,the owrter- builder,will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed contractors w 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' B&P C far this n ❑I am exem tt under Owner Date WORKER N DECLARATIO 1 hereby affirm under penalty of perjury one of the following declarations: have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .-.ton,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 mquircd by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Wor ompensation Insure ce carier and Policy number arc: Carrier Policy No.: CERTIFICATE 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 so as me ect to the Com nsati Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Excmptio.you ould 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 CONSTRUCTION LENDING AGENCY (~.r►. I hereby alum that there is a construction lending agency for the performance of tY+ the work for which this permit is issued(Sec.3097•Civ.C.) L.endees Name C Lender's Address I certify that I have ad this application and state that the sheve information is LUL� correct mad agree to comply with all city and county ordinances and sure laws relating to C> building construction,and hereby authorize representatives of this city to enter upon the s. W above-mentioned property for inspection purpose (Wc)agree to save,indemnify and keep harmless the City of Cupertino against r.-t a CM liabilities,judgments,costs and expenses which may in any way accrue against said City % n 16 V Z in consequence of the granting of this permit. Date / r-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued t y: SOUR REGUL ONS. —�� Re-roof Sig atumofApplicant/Contrac le T of Roof HAZARDOUS MATERIALS DISCLOSURE y� 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 dxr 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 hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. trier? L % C]Yes CTP I have mad 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 tenant,that it is my responsibility to notify the occupant M the Date Arcquigtsw1hicbmybe aprior to issuance of a Certificate of P� Signature of Applicant !7All roof coverings to be Class'R� 'or better t Date ��3C) Z CITY OF,CUPERTINO R� ROOF CUPEkTiNO PERMIT APPLICATION APN # Dat • -3-5 0 C51 4 0k � iao Building Add e O er's Na e: Phone# HOA: Yes ❑ No If yes, provide letter from HOA Contractor: Phone #: Fax #: Cupertino B siness License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles J ❑ Wood Shingles ❑ Other (Specify) 6��• ❑ Other (Specify) Number of existing coverings _ ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: 4� 141 Residential El 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. Valuatio �= — �Do� I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO `✓ RF,ROOF CUPEkT1NO FEE SCHEDULE Number of Fee ID Fee Des cription Fee Permit Type Squares Group ZA I REROOFCOM Re-roof commercial B 1COMMLROOF IBCBSC Cal Bldg Standards B ALL PERMIT TYPES / Commis Sion Fee / IBSEISMICO Seismic Commercial B IREROOFRES Re-roof Residential B ISFDWLROOF IBCBSC Cal Bldl; Standards B ALL PERMIT TYPES Commission Fee IBSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B IMFDWLROOF IBCBSC Cal Bld;; Standards B ALL PERMIT TYPES Commi:sion Fee IBSEISMICRE Seismic Residential B IBUSLIC Business 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:-e-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 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 material 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 fee 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 14 "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 compl with the above stated policy on re-roofing. Homeowner's Name: Job Site Address: 162-0 -7 , t Roofing Company Name: Date: Applicant's Signature: Greg Casteel Building Official Re✓ised 07/30/08 QWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform: A. All the work autho-ized by this permit B. — A portion of the work C. — None of the work If B or C is checked,c nom lete 2 or 3 below. 2. A state licensed contractor will be hires i to do: A. _ All of the work B. - A portion of the w irk (complete section below) -T- Contractor Address/City. Phone # State License # Type of work to -2-S-- fo 3. _ I will utilize unlicensed person(s;i 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. Person/Firm Address/City . Phone Number Type of work to be erformed ...........................................................................,....... I declare under penalty of perjury that the E.bove is true and correct. I have read and understand the owner-Builder Information (rev se side). Property Owner's Signature: Date: b 49� Job Address: r Permit# Any chanes to the information provided cn this form shall be submitted to the City of Cupertino Build Department.