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09040004 CITY OF CUPERTINO BU[LnING DIVISION PERMITI�iQMA �N PERMIT NO. BUILDING ADDRESS: 10141 ORANGE AVE MDC ROOFING n9oannn4 OWNER'S NAME: PERMIT ISSUE DATE A CONTROL NO. 'riONE: (408) 27'--9548 BUILDING PERMIT INFO ARCHITEC IENGINEER: BLDG ELECT PLUMB MECH u p p LICENSED CONTRACTOR'S DECLARATION fob Description jv C1 hereby affirm that I am licensed under provisions of Chapter 9(commencing z with section 70()0)of Division 3 of the Business and Professions Code,and my license is boy in full force and eff RE—RF RMV 2 LYRS WDSHK&SHNGLS INSTL 7/160SB z Licenso Lie'p 3 0#FLT 'F p Date ARCHITECTS DECLAIIATION - I understand my plans shall be used as public records &3 0 YR A; PH LT S HNG L S CLS A 2 0 S Q 'aV 4/1/9 Cl)NTRCTR RENWD BSL #24875 C y Licensed Professional ona 0 OWNER-BUILDER DECLARATION ' I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county y$Pi 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 c that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $q.Ft.Floor Area x F- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $7300 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(M). 35716057 . 00 ❑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 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. ❑1 am exempt under See. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .on,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 am enation Insurance yhrier and Polley number are: Carrier. ( Policy No.:6Dll'�3 ER iFICATE O EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed i(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,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 Worker's Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provision or this permit shall be deemed revoked. Z"'' CONSTRUCTION LENDING AGENCY (~- I hereby affirm that there is a contraction lending agency for the performance of fY, the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name ]z Lender's Address U O 1 certify that I have read this application and state that the above information is LL►-' correct.1 agree to comply with all city and county ordinances and state laws iclating to Vbuilding construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City o(Cupertino against nF"y C*4) Liabilities,judgmcnLs,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this perm' Date ` 5 0APPLICAVUERSTAN S D ILL OMPLY WITH ALL NON-POINT Issued by: S. Re-roofsnt/Comractor Date HAZARDOUS A SCLOSURE Type of F-oof 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 Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ° If a roof:s installed without first obtaining an inspection,I agree to remove Will the applicant or future ilding occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new n 4App for inspecti n. aria? ❑Yes �Nu %� , i I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,Section 25505,25533 and 75534.1 understand that if the building Wwnerorautlhori7.c fly have a tenant,that it is my responsibility to notify the occupant of the requireInjch must be met prior to issof a Certificate of 0 c panLa QzWeZ__ t. Sig aturf cant Da e All roof coverings to be Class'"or better agent Date OC30� voo � CITY OF CUPERTINO aul- RE ROOF CUPEkTiNO PERMIT APPLICATION APN # _ _ Date: Building Address: 10jZ41 e(JI-nn ca . 1501 Owner's Name: '- " � Phone #: I P cr 14,,;; r��2 d HOA: Yes ❑ No ❑ If yes, provide lel ter from HOA p (off Contractor: Phone &0t)17/- � Fax #: lJ (p Cupertino Business License #: Contractor License #: � q� -7!5K0 790 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# L ❑ To be Removed ❑ Provide Mfgr. Installation Specs. S Job Description: l v�P l y e 6 ©� (17 )06 C S U Ic P a o C> rt u QS ►^ f Residential/K 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:- - I Have Read, Understand and Will ply wits Cupertino's Tear-Off Policy: Sig ature Revised 02/05/09 - , CITY OF CUPERTINO ! RERDOF CUPEkT1NO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Corrmercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1 REROOFRES Re-roof Residential B 1 SFDWLROOF ( ' 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Res]dential 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 the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards and manufacturers specifications on r�!-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 fe E! 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 ori the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: ��C'If C7 Job Site Address: �� COY CL►'\Q P l� - Roofing Company Name: /kAD.C_ -1245 o.f I\ Applicant's Signature: Date: /07 PP �' Greg Casteel Building Official Revi:;ed 07/30/08 v ;. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY Of Fax(408)777-3333 ''UPEkTINO Buildi:n De aAment JOB ADDRESS: PERMIT # 0 v OWNER'S NAME: `i-e� PHONE # (,,S- / GENERAL CONTRACTOR: /n,6 o t FAX # \/I am not using any subcontractors. Si;;nature 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 T' Owner/Contra Si Date