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09030043 CITY OF UPERTINO BUILDING DIVISION PERMIT � I`.k31I � Rt �� . BUILDING ADDRESS: PERMIT NO. 11721 SOUTHSHORE CT YOUNG' S CONSTRUCTION OWNER'S NAME: PERMIT ISSUE DATE SHU S A PHONE: CONTROL NO. (408) 377-6839 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG� ELECT� PLUMB� op LICENSED CONTRACTOR'S DECLARATION tat I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description Z with Section 7000) Division 3 of the ess and Prof 'ons Code.an license is 'may in full force and , RE-R00: 7/16" OSB 3 0 IB FELT PAPER AND SHINGLES License Class Lie.8 E O Date Contractor ARCHITECCS DECLARATION a U I understand my plans shall be used as public records C y Licensed Professional y 3 OWNER-BUILDER DECLARATION +< I hereby affirm that I am exempt from the Contractor's License Law for the O O following reason.(Section 7031.5,Business and Professions Code:Any city or county e,.,V which requires a permit to construct,alter,improve,demolish,or repair any structure Z*n prior to its issuance,also requires the applicant for such permit to file a signed statement < that he is licensed pursuant to the revisions of the Contractor's License Law(Chapter 9 S Ft.Floor Area m o P P P q• Valuation x F- (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 $8500 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than rive hundred dollars(5500). 36653007 . 00 C1 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 and Professions Code:The Conuactor's License Law does not apply to an owner of Required Inspections 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 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 Contractoes License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I have and will maintain a Certificate of Consent to self-insure for Workees Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the for which this permit is issued. have and will maintain Worker's Compensation Insurance,as required by Section 9 of the Labor Code,for the performance f the work for which this permit is issued. My Worker's Co pe ce cam and Policy number are: Cartier Polity No.: CA OF EXEM ON FROM WORKERS' COMPENSATIO 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,after making this Certificate of Exemption,you should become subject to the Worker's Compensation previsions of the Labor Code,you must .J O forthwith comply with such provisions or this permit shall be deemed revoked. Z CA CONSTRUCTION LENDING AGENCY [�►-t I hereby affirm that there is a construction lending agency for the performance of a 5 the work for which this permit is issued(Sec.3097,Civ.C.) WCI.A Lender's Name Z Lender's Address U C) I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to Vbuilding construction•and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes H a (We)agree to save,indemnify and keep harmless the City of Cupertino against h-r to liabilities,judgments,costs and expenses which may in any way acme against said City U Z in consequence of the granting of this permit. APPLICA NDERSTANDS AND WILL A�MPLY THALL NON-POINT Issued by: Date SOURCE U ONS. l� © Re-roofs Signatt66 of Applicant/Contractor bate — HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Mu No icipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? ❑Yes All roofs s hall be inspected prior to any roofing material being installed. 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 emit hazardous air contamin as defined by the Bay Area Air Quality Management all new mi.terials for inspection. District? Cl Yes ❑ u 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505.25533 and 25534.1 understand that if the building docs not ndy have a tenant.that it is my tbilit to notify the occupant of the require which must be met prior to issuan of a Ccrdf tc of Occup an Signature(If Applicant Date Owner or authorized agent Date' All roof coverings to be Class'JT'or better CITY OI' CUPERTINO REROOF CUPEkTINO PERMIT .APPLICATION 09 b APN # Dater a Building Addressf Owner's Name: �zi _ \� l � Phone #: Cr 1 2__ HOA: Yes ❑ No If yes, provide 1 atter from HOA Contractor, Phone '�,-, Cupertino Etusiness License #: Contra c or License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X 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: Residential Commercial El Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the itpplication or if there are any restrictions: ❑ applicable, include in plan set & the sheet in lex. Valuation: I Have Rad, Understand an�_ imply with Cupertino's Tear-Off Policy: �v Signature Revised 02/05/09 CITY OF CUPERTINO REROOF CITY OF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee De wription Fee Permit Type Squares Group 1RER00FC0M Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bld; Standards B ALL PERMIT TYPES Commi;;sion Fee 1BSEISMICO Seismic Commercial B ` 1REROOFRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bld€; Standards B ALL PERMIT TYPES Commis Sion Fee 1BSEISMICRE Seismic Residential 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 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 niiil inspection is required. 6. Any roofing which is applied withot t 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-iinspection fee of$176.18. The re-inspection fee must be paid before another inspection gm be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of lei "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 policy on re-roofing. r- Homeowner's Name: V1 V1 " Job Site Address: ` F7 1 y` b V��- C /� Roofing Company Name: Applicant's Signature: ,, CA D Greg Casteel Building Official Rev sed 07/30/08