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0903109 CITE OF CUPERTINO � .. BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 10349 LEOLA CT DAN ELLIOTT'- PERMIT ISSUE DATE OWNER'S NAME: S A CONTROL NO. 2089 'HONE: (408) 5!,9-7327 BUILDING PERMIT INFO ARCH I rECrIENGINEER: BLDG ELECT PLUMB MECH p LICENSED CONTRACTOR'S DECLARATION Job Description m C I hereby afGcm that I am licensed under provisions of Chapter 9(commencing _z m with Section 7ti(IO)of Division 3 of the Business and Professions Code,and my license is RE—RF 1 LMV S H K S &BUR I N S T L OSB #3 0 F LT 3 0 YR D I MN S L A- in full force and effect e r/ Z License Class Lic•8 Contractor FBRGLS SHNGLS CERTAINTEED LNDMRK CLS A SQ ARCHITECT'S DECLARATION tt -� I understand my plans shall be used as public records DW L.O y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractofs License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county 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 Sq,Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Y F$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $10127 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(5500). 37504022 . 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.7044,Business Required Inspections and Professions Code:The Conuactoes License Law dors 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 Contractor's 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 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- aon,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 3700 of the Labor Code,for the performance of the work for which this permit is issued. ,) ^ My Worker's Compensatign Insurance carrier and Policy number :s S,j 1) O ?0-74— Carrier. (�`'�— v C1 Carrier Policy No.: 1�\ 3 CER7TFICA OF IiXEMP1TON FROM WORKERS' C0 PENSATION INSURANCE (rhis section need not bo 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 0 CONSTRUCTION LENDING AGENCY E.r r-• I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name ] Z Lenders Address U 0 I certify that I have read this application and state that the above information is LL I-,, correct I agree to comply with all city and county ordinances and state laws relating to 0 U building construction.and hereby authorize representatives of this city to enter upon the Wabove-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against V) liabilities,judgments,costs and expenses which may in any way accrue against said City V'Z in consequence of the granting of this per ' Date ►" APPLICANT TANDS AND COMP WITH ALL NON-POINT Issued t y: SOURCE REG LA O 3-_23`O Re-roof; - Signature o plicae ontractor Dare T Of Roof HAZARDOUS MA 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 rooj's shall be inspected prior to any roofing material being installed. C3Yes 14 No If a roo r is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which 't hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. uict? _,_1\ 0 Yes �Nu 1 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 J docs not,u vo a tenant that it is my res rtsibility to notify the occupant of the Date requirem nus hich m st m t 'or to issu a Certificate of Occupancy. Signature Of Applicant �3—� All roof coverings to be Class'A.'or better Owner orized agent Datc CITY OF CUPERTINO C' REROOF CUPEkTINO PERMIT APPLICATION dCta -73 APN # Date: Building Address: I c,-�4 Owner's Name: Phone #: � � c (� c \NNN WA_ 40(�< Gey )li�\�s xZ7 � Contractor* �� Phone #: 3 Z 7 Ab C G"_ c Fax#: C__�`7 l -15% % Cupertino Business License #: Contractor License #: (o 11 3 I> `76 C - 3°� Type of P.00f Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles r* Asphalt Shingles a Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. 1 R 5 r Job Description: V-e X oq-4�_ k n S 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 ine.ex. Valuation: I t 0 I Have R Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 6/16/08 CITY OF CIUPERTINO REROOF 'V Of SCHEDULE CUPEI�TINO Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 1REROOFRES Re-roof ReEidential B 1SFDWLROOF / 1BSEISMICRE Seismic Residential B 1 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Re3idential B 1BUSLIC Business Ucense B Revised 6/16/08 Community Development Department Building Division City of Cupertino 10300 Tone 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 build ng 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 zny roofing installation. 4. To receive a final sign off from the City,the following steps are required: 1) Pre-inspection and/or tear off ap,:)roval. 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 naJ inspection and the job is not ready, you will be charged a re-inspection iee 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'/ "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 w'th the above (stated policy on re-roofing. Homeowner's Name: ULiC0 CA QNp x- Job Site Address: k 0 ��C� ©'a C4- �-�- 1 a Roofing Company N A A b Co Applicant's Signa Date.- Greg ate:Greg Casteel Building Official Revised 07/30/08