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09040103CITY OF CUFEX1I NIJ BUILDING DIVISION PERMIT GiTITA? I?T�1' BUILDING ADDR 11248 OWNER'S NAME: VE: ARCHITECT/ENGINEER: u p O LICENSED CONTRACTOR'S DECLARATION m5 I hereby affirm that I am licensed under provisions of chapter 9 (commencing Z< m with Section 70(10) of Divisio the Business and Professions Co and my license is n H in full force and eft �� v� 2 Lhcensc Class Lic•ft iii--- F Date for ARCHITE S DECLA -� I un rstand my ons shall be d as c records LOU' a H Licensed Professional O < OWNER -BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the p O following reason. (Section 7031.5, Business and Professions Code: Any city or county $ 9 which requires a permit to construct. alter, improve, demolish, or repair any structure y " rn prior to its issuance, also requires the applicant for such permit to file a signed statement Z < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 yF $ (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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 Conuactoes 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 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 Contractor's License Law. ❑ I am exempt under Sec. B & P C for this mason 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-insum for Worker's Compen- uation, 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. mywoftescom nsa on lnsurance carrier and Policy nurpber arc: Cam'er lx � PolicyNo.: (V CERTIFICATE F EXEMP ION FROM WORKERS' COM ENSATION INSURANCE (This section need not be completed if the permit is for anc 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' Compensadon 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 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I 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.) Lenders Name Lenders Address 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 building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the granting of this permit. ANT UNA STANDS AND WILL COMPLY WITH+A' 9NOV-POINT 7�C ESluj AZZ IS Ic t ?-t 161 iiW-0-of Applicam/contfactor _ Dare t HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future . 'ng occupant store or handle hazardous material as defined by the Cupertino M ' rpal Code, Chapter 9.12, and the Health and Safety Coda, Section 25532(a)? ❑ Yes ❑ No i Will the app cant or future building occupant use equipment or devtbuil .it hazardous air contaminants as cjCfio6d by the Bay Area Air Quality M District? ❑ Yes � No I have read the hazardous materials requirements under Chapter 6.95 of tnia Health & Safety Code, Sections 25505,25533 and 25534.1 understand that if t 'ifors-1i tat currently, have a tenant, that itis -My responsibility to notify the occupant of the Owner or INC 408)626-932 Job Description RE -RF RMV EXT 1LYR OF CEMWD INSTL NEW 30# ASTM FLT&EAGELITE LIGHTWEIGHT TILE CLSA 7SQ Sq. Ft. Floor Area 35621041.00 Required Inspections Issued by: Re -roofs Type of Roof Valuation Occupancy Type Date Z/-2 1-d/ All roofs shall be inspected prior to any roofing mat al beihg_iLnstW1ed. If a r is installed without first obtaining an inspection, gree to remove all never -mil na-1-s r insperdorf- - 2 lol- Sig nature !f A plicant. Date All roof coverings to be Class'jW' or better PERMIT NO. PERMIT ISSUE DATE S A CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB 0 Job Description RE -RF RMV EXT 1LYR OF CEMWD INSTL NEW 30# ASTM FLT&EAGELITE LIGHTWEIGHT TILE CLSA 7SQ Sq. Ft. Floor Area 35621041.00 Required Inspections Issued by: Re -roofs Type of Roof Valuation Occupancy Type Date Z/-2 1-d/ All roofs shall be inspected prior to any roofing mat al beihg_iLnstW1ed. If a r is installed without first obtaining an inspection, gree to remove all never -mil na-1-s r insperdorf- - 2 lol- Sig nature !f A plicant. Date All roof coverings to be Class'jW' or better ev CITY OF CUPEkTINO CITY OF (�UPERTINO REROOF PERMIT A=PPLICATION 03 APN # ;2� /„v v v Date: Building Address: XA-L-� �1� LT Owner's Name: 0 KI C ( Phone #: HOA: Yes ❑ No If yes, provide letrer from HOA q A - Contractor: Phone #: 4d- 9132l Fax #: "lam' _ Cupertino Business License #: Contractor License #: 5 721-7,511 Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ��00 ,, ,, ❑ Wood Shingles Other (Specify) W� X Other (Specify) ' Number of existing coverings I ❑ Provide I.C.C.E.S. Report # To be Removed ❑ Provide Mfgr. Installation Specs. h,p-o �� 0 - Job Description: /�tK AA_� ;r ��l �� _ i UM0. 6 SAW 0 U 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: 1 - I Howe Read, "rstan d Will Compl with Cupertino's Tear -Off Policy: Signature Revised 02/05/09 a_ CM OF CUPS T1NO CITY OF C UPERTINO REROOF FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Cornmercial B 1COMMLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1RER00FRES Re -roof Residential B 1SFDWLR00F JCommission 1BCBSC Cal Bldg Standards Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Re3idential B 1 REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BCBSC Cal Bldg S,:andards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B Community Development Department Building Division City of Cupertino 10300 Tone 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 a;lee 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 app:.ied without first obtaining all inspection and written approval from the build ing inspector. A final inspection and approval shall be obtained from the wilding inspector when the re -roofing is completed. 3. All roofs shall be inspected prior to z ny roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre -inspection and/or tear off ap;:)roval. 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 niaterial down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood na:l 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 ? " 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: o1 'J �4 l� Job Site Address: 12'+-0 C �Tk, t ji A (� vu r Roofing Compaxry..Name. Applicant's Signa Date: Greg Casteel Building Official Revised 07/30/08 CITY OF ..,UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS:1124 1 2�� (,40 -AL -WA � j PERMIT # oy k93 OWNER'S NAME: -7,011 BUSINESS LICENSE # PHONE # L40V- (o2-� - 752 c� GENERAL CONTRACTOR: , ,: - YOof f i N" i FAX # !4ug— 2-(o 6 I am not using any subconttors: ___.___. --cighature Date Please check a licable subcontractors and complete the following information: Owner/ Contractor Signature Date 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/ Contractor Signature Date