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09030095 CITY OF CUPERTINO BUILDING DIVISION PERMIT �k' TRt �? �t'1TI� . BUILDING ADDRESS: PERMIT NO. 19472 ROSEMARIE PL TNT ROOFING OWNER'S NAME: PERMIT ISSUE DATE CAT WT.ST>~prlD—=n—nQ_=__GD4I' 'LONE: S A CONTROL NO. (408) ;:77-0800 ARCHITECI7ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 90 p LICENSED CONTRACTOR'S DECLARATION Job Descriptionm C I hereby affirm that I am licensed under provisions of Chapter 9(commencing t� with Section 7000)of Division 3 of the Business and Professions Code,and my license is 'Z< infullforce and eff, (i34 f 2� RMV SHK RF INSTL OSB TECH SHIELD 30LB FLT 40YR j n Z License Cl as Lic.# y�,o Date Contractor. COMP SHNGLS 41SQ CLS A AR HITECTS DECLAR ON < I understand my plans shall be used as public records X96 OLicensed Professional y OWNER-BUILDER DECLARATION 1 hereby alTirm that I .exempt from the Contractor's License Law for the C a O following reason.(Section 7031.5,Business and Professions Code:Any city or county y:9 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 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation e F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $15425 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(5500). 37501004 . 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(Sec.7044,Business Required Inspections and Professions Code:The Contractor's 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.). ❑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 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 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- sation,as provided for by Section 3700 of the Labor Cote.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 Worke p salon Insurance carrier and Policy num r are: Cartier Polity No.: CJS CERTIFICATE OF EXEMPTION FRO ERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foram 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY [r.fir I hereby affirm that there is a construction lending agency for the performance of . (Yr the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name ]z Lenders Address V 0 1 certify that I have read this application and state that the above information is LL r-" cored.l 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 Uabove-mentioned property for inspection purposes. LL (We)agree to save,indemnify and keep harmless the City of Cupertino against rF-c liabilities,judgments,toss and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. ►" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N f�N7 Issued b,,;: Date �' 7`� SOURCE R 1/ ((( Re-roofs G7 -Sigxkum of pplirant/Comractor Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle harardoas material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? tutre All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove ❑Yeso Will the applicant or building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new r Taterials for inspection. ,strict? ❑Yes o /% 1 have read the de,Sections materials requirements under Chaptertang that if the Calling for- ria Health&SafctyCodc,Sections 25505,25533 and 25534.!understand that ifthe building docs not currently have a tenant,that it is my responsibility to notify the occupant of the req ' m w '1 USE be met prior to issuance of a rtifrcate of Oce ancy. �G Sigc of Applicant Date Owner rautharizcdagent pa�tev/ All roof coverings to be Class'A.'or better CITY OF CUPERTINO 0703 (M RE,ROOF CUPEkTINO PERMIT APPLICATION APN # Date: � c l Building Address: 1qV7Z_ I�0se ►v"_1 ••e. ?t . Owner's Name: ck l w e a(c ,�j� W, l' Phone#: �Jlc?) __1 HOA: Yes ❑ No ❑ If yes, provide letter from HOA Contractor: T—P--t T ��'s O Phone#: (4U$ Z-7-7-0 -80L) Fax #: q(j8 &bCt ' Ld U 3 Cupertino Business License #: Contractor License M S 52 Type of hoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles qk_ Asphalt Shingles )�_ 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: ` elk Q� S�✓�.�� QUO N-r'--�( () ' � Sl1 eIC( 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. Valuat}'042-4 ,OT .1 I Have Read, Understa d Will Comply witli Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO REROOF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commis,,ion Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic lZesidential B 1 REROOFMRES Re-roof lvlulti-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic :Zesidential B 1 BUSLIC 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 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 nz it inspection is required. 6. Any roofing which is applied withou t first obtaining an inspection, will require the removal of all new n•aterial down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nai.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 liE "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/( 40,abovstated pollicy on rre-roofing. R rHomeowner's Name: � � W P) kv l Job Site Address: (� Z- p NL(W,%._'e P C . _ Roofing Company Name: - 1\1/ a. 3 i3/U Applicant's Signature: ► �---� Date: Greg Casteel Building Official Revised 07/30/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �'UPERTIN0 Building Department JOB ADDRESS: PERMIT # Z 2q e wPct t PL qv3 OWNER'S NAME: PHONE # 1.4" 7 WU GENERAL CONTRACTOR: FAX # 2W - I am not using any subcontractors: 3 Signature Date Please check applicable subcontractors and comn:)lete the following information: SUBCONTRACTOR BUSINESS NAME 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 O er Contractor Signature Date