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09030053 CITY OF CUPERTINO 7 BUILDING PIVISION PERMIT � 1 ��..... . r .............. BUILDING ADDRESS: PERMIT NO. 11686 PALM SPRING CT LOS G,kTOS R OWNER'S NAME: PERMIT L95UE DATE ")NE: SA CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH RE—RF RMV EXT SHKRF INSTL Q Lad Z Q D 000 LICENSED CONTRACTOR'S DECLARATION TYP 3 )ASTM FLT&GRND Qb"escription mI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z W5 with Section 7000)of Division 3 of the Business and Professions Code.and my license is cn in full fora an llec !00 7V Z Licenac 1 Lic•g 0 F in Date Contractor f ARCHITECT'S DECLARATION < I understand my plans shall be used as public records Dyu L p y Licensed Professional n y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the r a O following reason.(Section 7031.5,Business and Professions Code:Any city or county 4$ria which requires a permit to construct,alter,improve,demolish,or repair any structure Zy prior to its issuance.also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the provisions of the Contractors Lir:cnsc Law(Chapter 9 Sq.Ft.Floor Area Valuation Y FIn (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 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). ❑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 Contractors License Law docs not apply to an owner of Q 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 sale.). ❑1.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors u- 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 Owe 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 Workers Compcn- -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 Workers Compensation Insurance,as required by Section 37 of the Labor Code,for the performance of the work for which this permit is issued. My Workers a pens ' n Instars cc carrier and Polity number arc: J(�.�� Cartier. Polity No.: O 0 0;r v CERT CA OP EXEMPTION FROM ORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc 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 Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z► CONSTRUCTION LENDING AGENCY (~-r 1 hereby affirm that there is a construction lending agency for the performance of fx.7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name a z (.enders Address U 0 I certify that 1 have read this application and state that the above information is Ll;.►' correct 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 above-mentioned property for inspection purposes. W W (We)agree to save,indemnify and keep harmless the City of Cupertino against ,E-4 0. ,r rA liabilities,judgments,costs and expenses which may in any way steric against said City V Z in consequence of the g ung of this permit y. Date �G 5 r. APPLICANT U STANDS AND WILL COMPLY WITH ALL NON-POINT Issued b SOURCE RE S. Re-roofs Signature of Applicam/Contractor D' 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;shall be inspected prior to any roofing material being installed. ❑Ycs �No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove i hazardous air contaminants as defined by the Bay Area Air Quality Management all new naterials for inspection. .trict? ❑Yes �'No I have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand dial if the building does not currently ha a tenant.that it is my responsibility to notify the occupant of the requirements h t be met prior to issuance of a Cenificatc of Om y/v y Signature of Applicant Date All roof coverings to be Class'n"or better Owner or authorized agent Date CITY OF CUPERTINO 0 03 RI ,ROOF CUPERTINO PERMIT APPLICATION APN # 2 Date: Building Address: / 8� fala Owner's Name: Phone #: Contractor` �� '`�� Phone #: ( G ✓G'l� i W41 Fax#: tl r ZZ Cupertino Business License M Contractor License M Type of roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles Wood Shakes ❑ Wood Shakes to Wood Shingles ❑ Wood Shingles ❑ Other(Specify) X Other(Specify) �1� Number of existing coverings ❑ Provide I.C.B.O. Report# To be Removed36 Provide Mf Installation Specs. Job Des ription: Residential Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the a)plication or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: (J (� I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 6/16/08 ` - CITY OF CUPERTINO .� .r REROOF CUPEk INO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Conanercial B 1REROOFRES ' Re-roof Residential B 1SFDWLROOF 1BSEISMICRE Seismic Res'dential B ccP 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Re&.dential B 1BUSLIC Business Lic ense 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 tYe 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 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 rail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new r aaterial down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If,you call for a plywood na 1 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 Raid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of;i "per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be cn 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: 0 Roofing Company Name: Applicant's Signature: Greg Casteel Building Official Revised 07/30/08 Community Development nN-:-\ r., 10300 Torre Avenue _ Cupertino CA 95014 _-`� r Telephone(408) 777-3228 CITY or Fax(408) 777-3333 kXPEICiINO Building D epa- meet JOB ADDRESS: PERMIT (�3 1;� 03 ,0105-3 OWNER'S NAME: ' PHONES< .� y GENERAL CONTRACTOR: j� �:�� CJS.. r FPs-x0!/ 0 I am not using any subcontractors: Sig�lature a` Please check applicable subcontractors and complete the following-information: 8s SUBCONTRACTOR BUSIN, )-SS NAME I BUSINESS LICENSE -L Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Pl-astering Plumbing Roofing Septic Tank Sheet Metal (--Sheet Rock Tile Owner/Con ct Signature ate