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09040086 CITY OIESS: INO BUILDN PERMIT �` � ' PERMIT NO. BUILDING AD 7602NDERRY PL WESTSHORE ROOFING PERMTT ISSUE DATE `WNER'S NAME: SA CONTROL NO. PHONE: BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH RE—ROOT' INSTALL OSB TECH a p C LICENSED CONTRACTOR'S DECLARATION SHIELD 3 0 I LB FELT Job Description mI hereby affirm that I am licensed under provisions of Chapter 9(commencing _Z m with Section 7000)of Division 3 of the Business and Professions Co and my license is a„ in full tome and effect /__ -7 g Z t ? License CI (� Contractor 5 >° O Date + ARCHITECTS DECLARATION f2tz..-1 y� I understand my plans shall be used as public records �u, O in Licensed Pmfcssional OWNER-BUILDER DECLARATION I I hereby affirm that I am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county K m IVE 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 Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area YF=- (commencing with Section 7000)of Division 3 of the Business and Professinns Code)or y 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 not more than five hundred dollars($500). ❑I,as owner of the property.of 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 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 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 reason wrier 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 Worker's Compen- sation,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 Compensation Insu ce carrier and Policy number are: Carrier.S 1-e �,,� Policy No.:i S 7'— 2­2 c>r1 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (T his 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,1 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 provisions of the Labor Code,you must ,Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a, the work for which this permit is issued(Sec.3097,Civ,C.) W Q Lender's Name ]Z Gender's Address V 0 1 certify that I have read this application and state that the above information is LL H correct I agree to comply with all city and county ordinances and state laws relating to 0 building construction.and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. CL (We)agree to save,indemnify and keep harmless the City of Cupertino against tF liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. f�' t�I - ,�1� l Re-roofs Signature ol'Applicant/Contractor Dare T of hoof HAZARDOUS MATERIALS DISCLOSURE Type 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 ode,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes gee go If a roof is installed without first obtaining an inspection,l agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes 'Jallo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- t� i —0 nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the require n which must be met prior to issuance of a Certificate of Occupancy. S Ignaturt:of Applicant Date 4t- )-7—()I All roof coverings to be Class';�"or better Owner or authonzcd agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT# �o CAVIAeV�� P1 .. oe?;oC-r,d d0� OWNER'S NAME: WttA,,Pj N PHONE # i0b GENERAL CONTRACT : I ooK FAX#jot it J b o 2,-3-3 I am not using any subcontractors: n M Signature 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/Contractor Signature Date CITY OF �,UPERTINO RF,_R CUPEkT1NO PERMIT APPLICATION APN # - b� `�Date: /+ I -7 �Q X22 l Building Address: /j O.Z Hol1cmaeu'-Ik I I Owner's Name: ,,�^(, a �� TS \ Phone #: HOA: Yes ❑ No ❑ If yes, provide letter from HOA Contractor: Phone #: ik�)b V�esoN��(e \(\(- inC Fax #: 4(�b +,S6- C)2_33 Cupertino Business License #: Contractor License #: '78'12z1 ' Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 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 # ,z' To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: 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 inclex. Valuation: , d - I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: �L - - - � I x-1 Signature Revised 02/05/09 -� CITY OF C UPERTINO -. REROOF CUPEkT]NO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Corunercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof ReEidential B 1SFDWLR00F r 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES i Commission Fee 1 BSEISMICRE Seismic Re:idential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Stindards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business Li:,ense 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 agi ee 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 b,iilding 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 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 performed. 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 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: E'er —S 0-, V, I�a r job Site Address: G V-V I - Roofing Company Name: 1N e S ►^0�� `�f i 4 e Applicant's Signature: Date: 4 Greg Casteel Building Official Reviled 07/30/08