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09040049 CITY OF CUPERTINO t�1tT�I3N PERMIT BUILDING DIVISION PERMIT NO. BUILDING ADDRESS: 19146 ANNE LN TIP-TOP ROOFING pMiTLSSUEDATE OWNER'S NAME: S A CONTROL NO. 'ONE: (408) 370-6425 BUILDING PERMIT INFO MECH ARCHiTECT/ENGiNEER: gLCDO, ELECT PLUMB a C C LICENSED CON TRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing _yro with Section 70(10)of Division3oftheBusinessandProfessionsCode,and mylicense is RE-RF TSO 3LYR INSTL 30LB FLT& 30YR DIM SHNGL CLS 2'4 y in full force and effect" 6& 6 �' A 2 4 SQ j v�Z License CI Lic•# F p Dam U`1 C Contractor ! �— ARCHITECTS DECLA ATI N i understand my plans shall be used as public rds D,u `O y Licensed Ptufessional OWNER-BUILDER DECLARATION y i hereby adTirm that 1 am exempt Gum the Contractor's License Law for the p O following mason.(Section 7031.5,Business and Professions Code:Any city or county e$9 which requires a permit to construct,alter•improve•demolish,or repair any structure $ Ft.Floor Area Valuation y"rn prior toils 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 q e 7 7 4 0 x $ (commencing with Section 7000)of Division 3 of the Business and Profession Code)or Occupancy Type y that he is exempt therefrom and the basis for the alleged exemption.Any violation o[ Section 7031.5 by any applicant for a permit subjects the applicant to a civic penalty of APN Number net more than five hundred dollars(s5W)" 37507013 . 01 ❑1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does 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 sok.). ❑I as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business ess and professions ho builds de:)11M COntraCtOor"reproves thereon .U- cense Law does not apply eproperty who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. B&P C for this reason (3 I am exempt under Sec. Date Owner 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-insurc 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 Com nation Insurance carrier and Polity number are: Cartier. Policy No:/M/ J l CERTIFICATE OF EXEMPTION FRO WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(S 100) or less) 1 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 Workcrs'Compensation Laws of California Date Applicant N0110E 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 ,J`Z, forthwith comply with such provision or this permit shall be deemed revoked. Z oZ CONSTRUCTION LENDING AGENCY HI hereby affirm that there is a contnuction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Namc f1. Lender's Address U C) i certify that i have read this application and sure that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to C V construction,consction,and hereby authorize representatives of this city to enter upon the ahovc-mentioned property for inspection purposes h>4 a (We)agree to save,indemnify and keep harmless the City of Cupertino against tHy rA liabilities,judgments,costs and expenses which may in any way accrue against said City Date U Z in consequence of the granting of this permit APPLICANT UNDERSTAND AND WILL COMPLY WiTH ALL NON-POINT Issued by: SOURC RYGULAT1ONS. ;, � ��tit, Re-roofs Signature o6 pp I;canuconuactor °ate 'j' of Roof HAZARDOUS MATERIALS DISCLOSURE y 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 All roofs shall be inspected prior to any roofing material being installed. Code,Section 25532(a)? Cl Yes FNo If a roof is installed without first obtaining an inspection, agree to remove Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Arca Air Quality Management all nevi materials for inspection. strict? ❑Yes No ry C� 1 have read the hazardous materials requirements under Chapter 6.95 of the Califon- ��� ria Health& reV Codc,Section 25505,25533 and 25534.1 understind that if the building j docs not currently have a tenant that it is in responihility to notify the occupant of the Dates requirements which must et prior to issuance of a Certificate of Occupancy. $ignat ur of Appl ieant rl ♦. All roof coverings to be Class'n"or better Owner or thorized agent Date CITY OF CUPERTINO0�� UJB` REROOF CUPEITY CkTINO PERMIT APPLICATION APN Date:,, 7�f Building Address: Owner's Name: Phone,#:I/ ,Cl; HOA: Yes El No Q if yes, provide letter from HOA Contractor: Phone #: C _,7 Fax #: Contractor License #:CupertinoYusiness License #: ly�Z I/ � Com, ?uc Type of Roof Covering: Existing: Proposed: a Built-Up Roof o Built-Up roof �x Asphalt Shingles /)91 Asphalt Shingles • Wood Shakes Li Wood Shakes • Wood Shingles Wood Shingles • Other (Specify) u Other (Specify) Number of existing coverings _5 u Provide I.C.C.E.S. Report # To be Removed u Provide Mfgr. Installation Specs. Job Description: 4, cz, Residential Commercial Lj Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the <Lpplication or if there are any restrictions: applicable,.include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signa�tur� Revised 02/05/09 CITY OF CUPERTINO , J REF:OOF 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 Commercial B 1REROOFRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg '"tandards B ALL PERMIT TYPES Commission Fee / 1BSEISMICRE Seismic Rf;sidential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal B1dg'5tandards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic KI-sidential B 1BUSLIC Business 1,icense 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 appLed 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 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 pE rformed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fie of$176.18. The re-inspection fee must be paid before another inspection c an be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 14 " 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. Homeowner's Name: Job Site Address: Roofing Company Name: c7Z � Applicant's Signature: i Date: Greg Casteel Building Official Reprised 07/30/08