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09040097 CITY OF CUPERTINO � � � ;' BUILDING DIVISION PERMIT PERMIT NO. rBUIL:DING ADDRESS:DDTvRT E7�SmS: 03N mBr L rni TT T TTTI C P r7D T TT T r„r MS52 RS NAME: IssuE DATE 9 9 CONTROL NO. .", S zaa•L'r—T�-'-�z�— )NE: --- (4 0 8) 314 -0870 BUILDING PERMIT INFO Fforce INEER: B� ELECT� PLUM O L10 O MECH pLICENSED CONTRACTOR'S DECLARATION Job Description Ufirm that I am licensed under provisions of Chapter 9(commencing o(Divixion 3 of the Business and Professions Code,and my license is RE-RF M 1V COMP RF I N S TL 3 4 S Q 3 0 YR COMP CLS A a ytec O t ) tR Z License Clash_C — _ Lac'g n Date ��T•---Contractor ARCHITECTS DECLARATIO aI understand my plans shall be used as public records DIV `o,,1 Licensedprofcssional OWNER-BUILDER DECLARATION A< I hereby affirm that 1 am exempt from the Contractors License Law for the q O following reason.(Section 7031.5,Business and profcuion Code:Any city or county which requires a permit to construct.alter,improve,demolish,or repair any structure u—'^ prior m its issuance,also requires the applicant far such permit to file a signed statement 3 ,Ft.Floor Area Valuation a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 9 6 0 0 YF q (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or i R E that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number P y yp not more than five hundred dollars(5500). 31630072 . 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 Contractors License Law dots 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.it, 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 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 Contractors License Law' B&P C for this reason I am exempt under Sec. 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 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. 1 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 WorkSeaforrrnsation Insurance crier and Policy number are: Carrier. Policy No.: CERTI TE OF EMPTION FRO WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars(5100) 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 Compcnation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z 0� CONSTRUCTION LENDING AGENCY E.~•r 4 1 hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(Sec.3097,Civ.C.) (7a Q Lendces Name a Lenders Address [certify that I have read this application and state that the above info muatiun is wcorrect.I agree to comply with all city and county ordinances and state laws relating to V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. Ia. (We)agree to save,indemnify and keep harmless the City of Cupertino against ia liabilities,judgments.costs and expenses which may in any way accrue against said City DaU Z in consequence of the granting of this permit APPLICANT UNDER�T ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:SOURCE R@�ULATIONS.l/.. Re-roof:; ignature of Applicant/ ontractor °areT Of Roof H ARDOUS MATERIALS DISCLOSURE ypeWill true 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 3 shall be inspected prior to any roofing material be0Y� "° If a rool is installed without first obtaining an inspection,I Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. .strict? C]Yes 0 No 4A� 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 docs not currently have a tenant.that it is my responsibility to notify the occupant of the Signatu e of Appl' ant Date requiremems ich must fry.'met prior to issuance of a Certificate of Occupancy (` ✓r — 4 All roof coverings to be Class'J `'or better caner or uthorized ag t no CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION APN # Date: Building Address: IOS-32 �jovr4 `-LVRk)e- 'P Owner's Name��j)j p 4/0,4 M r 0 Phone #: 00 t� HOA: Yes ❑ No ❑ If yes, provide letter from HOA Contractor: 700 Phone Fax #�4 Cupertino Business License #: Contractor License #: .96)lcq, 1C? Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Vk Asphalt Shingles V( Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings dZ ❑ Provide I.C.C.E.S. Report# �A, To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: fewve k l P 3Ll 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. Valuation: C9 I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: C Signature Revised 02/05/09 CITY OF CUPERTINO ' REROOF CUPE OF FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Ccmmercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B r, n 1RER00FRES Re-roof Rcsidential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Rcsidential B 1REROOFMRES Re-roof Malti-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Rosidential B 1BUSLIC 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 th e 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 built ing 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 witho-at first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be p,?rformed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection;'ee 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"/ " 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:�l �iT/r! , 0�-rTl�FEW ►'�l�A�;) Job Site Address: �� /1f �Z`1�� 7 LPA)t q aye Roofing Company Name: SJWG1� Applicant's Signature: 4e C Date: 4,20— 0 Greg Casteel Building Official Reused 07/30/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTIN0 Building Department JOB ADDRESS:/OS-32 /V _ BLS 4Te PERMIT# (l OWNER'S NAME: rt-rf.j4 PHONE #� (901-7 GENERAL CONTRACTOR: /rf 4 S I FAX # I am not using any subcontractors: Signa a Date Please check applicable subcontractors and complete 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 Owner/Co tractor Signature Date