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09050118u°pO ;i 7 N ; v22 3tt�CC 7�U °3 ray p0 tm� rt^rn —2< EFC i CITY OF CUPEKITNU BUILDING DIVISIC?N PERMIT BUILDING ADDRESS: OWNER'S NAME: yITECTIENGINEER: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is n full force and effect. .icensc Class _Lic' Sam Contractor ARCHITECTS DECLARATION I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any stmcture prior to its issuance, also requires the applicant for such permit to Glc a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 (5500). 0 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 rot 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 sale.). al. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's 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 Contrectofs License Law' B& P C f this n 0 I am exempt un er See. Date Owner WO LARATION 1 hereby affirm under penalty of perjury one of the following declarations'. 0 I have and will maintain a Certificate of Consent to self-insue for Worker's Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the t for which this permit is issued. have and will maintain Worker's Compensation Insurance, as required by Section 3100 of the Labor Code. for the performance of the work for which this permit is issued. My Workees Compensation insurance carrier and Policy number am: Cartier:Policy No.: CERTIFICATE OF SKEMPnON FROM WORKERS' COMPENSATION INSURANCE Cnhis section recd ret be completed if the permit is for one hundred dollars ($100) or Icss.) 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 b%jgCt o the Workers' Compensation Laws of California. Date J Applicant Exemption, you should NOTICE TO APPLICANT: If, after maki P become subject to the Worker's C pensation provisions of the Labor Com you must ,J z forthwith comply with such provisions or thu permit shall be deemed tcvo Z � CONSTRUCTION LENDING AGENCY [� 4 1 hereby affirm that there is a construction lending agency for the performance of Q! i the work for which this permit is issued (Sec. 3097, Civ. C.) W Q Lender's Name ]Z Lender's Address V I certify that I have read this application and state that the above information is LL "corcct. I agree to comply with all city and county ordinances and state laws misting to 0 U building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. W (We) agree to save, indemnify and keep harmless the City of Cupertino against CIA to liabilities, judgments, costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. ►+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE REG ATI S. Signature of Applian Date HAZARDOUS MATERIALS DISCLOSURE 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)? 0 Yes WO 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 District? 0 Yes N Nu 1 have toad the hazardous materials requirements under Chapter 6.95 of the Califor- nQ 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 requirem nits yihich must be met prior to issuance of a Certificate of occupancy. Owner or autho Date Job Description TEAR OFF, OLD SHAKES,.DRY ROT REPAIR, I X 8V BOARD REPLACE 2X6 ROOF BOARDS, INSTALL FELTEX UNDERLAYMENT, NEW FLASHING, NEW METAL, INSTALL Sq. Ft. Floor 366450C4.00 Issued by Re -roofs Type of Roof Rl Required Inspections Valuation / v All roofs shall be inspected prior to any roofing material being installed. If a roof s installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature: of Applicant All roof coverings to be Class". ' or better Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 CITY OF CUPEkTINO Buildirl De artment JOB ADDRESS: PERMIT #,, 1114E CrA Q4 DN U rc v� C.t {LLL OWNER'S NAME: '1 ASN V M r R PHONE # 43S44U 204 GENERAL CONTRACTOR: -0 j-5 r i NA L i Z FAX # i3% I am not using any subcontractors: Signature Date , , _.a ,.t„a 4-Uo 47.,71ncwrinQ infn... n inn- Ylease cnecx-- 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 iib (3f- F i NA uz,�--D FHoa `1 ��- Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date CITY OF CUPERTINO R11'jR0OF CITY CUPEkTINO PERMIT APPLICATION APN # Date: ,6( 5 lei Building Address: 0I+ bz.C�4 r T c `1 Zvi Owner's Name: A,� Phone #: HOA: Yes ❑ No ❑ If Yes, provide letter from HOA `�`�� �, C! Contractor: ►svkzi,_F_ Rz�) F i N(- VY_ Phone #: • � `�� r �� � 1 w aj r.,A Z � t� Fax #: Cupertino Business License #:., . j �� I Contractor License Type of hoof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles id Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) oa Other (Specify)1IL�_ +A CTM_ Number of existing coverings _ w Provide I.C.C.E.S. Report #,« ❑ To be Removed a Provide Mfgr. Installation Specs. F_s Q -iILlq T 'V_� F i N R - 2Z S�) 12-2-1 S Job Description: i``sk%�_ i.� r L i_> `y:r►�.� �, s`�i "'� .VSs; ! k` ���� �L4P' �� �� wf'� AU_ Fi_ l i k_X V� ,�z; L.1�. 11��t� -} 1 .1�� ��(�� iVi�; %.i fes'+ LM Ni - rStL:H ;i.�+_ 1"1. 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: 11 _ I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO 'a'," REF;OOF CITY OF CUPEkTINO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Siandards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B ,oTAL s 9*7 � REROOFRES Re -roof Re 3idential B 1SFDWLROOF Z7 / 1BCBSC Cal Bldg S-:andards Commission Fee B ALL PERMIT TYPES. ` 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BCBSC Cal Bldg S Andards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1 BUSLIC Business License B Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 r Fax: (408) 777-3333 Building ]department Subject: Re -roofing policy for the City of Cupertino 1. Prior to permit issuance, you must agrE e 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 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 ma':erial 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 car be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " 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: W-)4 "N) ► A Job Site Address: I I )A •_ C AWDN3 V S_� C ► (LC.L4 C. J K A i t N 10, CA q S 01 + -- Roofing Company Name: 1-"rj I NA L1 V,-� Applicant's Signature: Date: 2L W1.39 i Greg Casteel Building Official Revised 07/30/08