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09030011 CITY OF CUPERTINO BUILDING DIVISION PERNIIT � � � BUILDING ADDRESS: PERMIT NO. 22409 N WALNUT CIR TBD - TO BE DETERMINED nqnnni 1 PERMIT ISSUE DATE 'NER'S NAME: l4ltAWNb� CONTROL NO. PHONE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 u p p LICENSED CONTRACTOR'S DECLARATION Job Description oo C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z(�� with Section 70(10)of Division 3 of Um Business and�P]rofessions Code,and my license is TEAR OFF ROOF TILES & REPLACE W/ 40 YR n y in full force and efface �' r "1 j Z License Class �,- Z � •+� '�' 3 F p Date T Conuaetor ARCHITECTS DECLARATION I understand my plans shall be used as public records L. O y Licensed Professional 0:5 OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contrattoes License Law for the p o following reason.(Section 703 1.5,Business and Professions Code:Any city or county y$ 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 Ft.Floor Area Valuation that he is licensed r!FE apursuant to the provisions of the Contractor's Liccase Law(Chapter 9 q Y.I- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 110 00 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(S5W). 35703062 . 00 0 1,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 dues 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.). 0 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 Taw 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 Ute contractors License Law. r1 I am exempt under Sec .B At P C for this reason ,ner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 0 I have and will maintain a Certificate of Consent to self-insure for workers compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: CarrierkT_JC U i I!,Policy No.: C' ERT(FlCATE OF EYeEMP170N FROM RKE ' COMPENSATION INSURANCE (This section need riot be completed if the permit is for one hundred dollars(S 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.Dare Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subjett to the Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY Er rA I hereby affirm that there is a construction lending agency for Uro performance of a 5 the work for which this permit is issued(Sec.3097,Civ.C.) W Q lenders Name 0.Z Lenders Address U O 1 certify that I have read this application and state that Use above information is V." correct.l agree to comply with all city and county ordinances and state laws relating to 0 V construction,consction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes (We)agree to save,indemnify and keep harmless the City of Cupertino against rHy CA liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. CaleAPPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: / S R R�EGULATION� l Ppr'`oroun �� -1- Ci Re-roofs Signature of A rear or Date Roof HAZARDOUS MATERIALS DISCLOSURE Type / Will the applicant or future building occupant store or handle hazardous material tefincd by the Cupertino Municipal Code,Chapter 9.12•and the Health and Safety ;c,Section 25532(x)? All roofs:hall be inspected prior to any roofing material being installed. 0 Yes 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes c No 1 have read 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 �� _0 U does not currently have a tenant,that it is my responsibility to notify the occupant of the iA requirements which must be met prior to issu of a Cenificate of Occupancy. Signature ) ppll nt Date & b _9 All roof coverings to be Class" "or better Owner or authcnze agent Date CITY OF CUPERTINO RE ROOF CUPEkTINO PERMIT APPLICATION bgo5cb � i APN # Date: S7 63 NO2 . 60 0' _0 e-(_ o � Building Address: Owner's Name: Phone #: IJA �> HOA: Yes ❑ No ❑ If yes, provide lel ter from HOA Contractor: Phone#: L � Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 'p Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) -�j i�=�� ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: o t, / 04 uV(,� L r_ Residential NCommercial ❑ 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. Valuation: — / , o© I Have Read, Understand and Will Comply witi Cupertino's Tear-Off Policy: Si ature Revised 02/05/09 ^� CITY OF CUPERTINO RE ROOF 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 Commission Fee 1BSEISMICO Seismic ('ommercial B 1REROOFRES Re-roof Residential B 1SFDWLR00F C 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof T4ulti-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B / 1 BUSLIC Business License B 1 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 buildir g 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 ar y 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 nai 1 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 pet formed. 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 1/ "per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O.report is required to be oil the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: T t� I C / A -7 < b V r &.1 L-./ Job Site Address: 7 7 �) Roofiing Company Name: � Applicant's Signature: Date: d -0 4/- Greg Casteel Building Official Rev sed 07/30/08