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09050160 CITY OF CUPERTINO �-�. � � ; BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 09050160 10127 COLBY AVE WING' S Rt�OFING NC FERMrrISSUEDATE OWNER'S NAME: S A CONTROL NO. PHONE: (510) 889-9068 BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH 0 a reo C LICENSED CONTRACTOR'S DECLARATION Job Description vO I hereby affirm that I am licensed under provisions of Chapter 9(commencing ZUW with Section70(IO)ofDivision3ofthcBusinessandProfcssityt�C anemyliccnscis T/0 ASPHALT SHINGLES, INSTALL CLASS A ASPHALT H in full force and ec l License ass Co^ter SHINGLE 22 SQ FT. y Dale ARCHITECTS asC iRA ON .� u nd m plans sha11 Mused as public records �yU g u.I- Licensed Profession OWNER-BUILDER DECLARATION ^ 1 hereby affirm that 1 am exempt from the Contractors License Law for the 00 following reason.(Section 7tfi I.S,Business and profcssiuns Code:Any city or county e which requires a permit to construct,alter,improve.demolish,of repair any structure a"N prior to its issuance,also requires the applicant for such permit ro tilt a signed statement Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 5950 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 PN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of trot more than five hundred dollars(5500). 3162804-, . 00 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 for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractors 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 arc 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.). 0 1,as owner of the property,am exclusively contracting with licensed contractors ro 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. B&P C for this reason 0 1 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-insum for Workers Compen- in,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for th ormanc of the work for which this permit is issued. My Worke s mpe 'on I cc cam and Policy number Cartier Policy No.: CER FICA F EXEM ON FRO W RKERS' COMPENSATION INSURANCE (This section need Rothe completed if the permit is for one hundred dollars($I00) 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,., forthwith comply with such provisions or this permit shall be dcemcd 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 Lenders Name 0 Z Lenders Address V C) I 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 V building construction,and hereby authorize representatives of this city to enter upon the Wabove-mentioned property for inspection purposes. >4 a (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 V Z in consequence of the granting of this permit. Date 2 ►- APPLICANT UNDERSTANDS AND WILL COMPLY WITH AV,NON-POINT Issued b): SOURCE REGUI�XTIONS. 'L Re-roofs ! � Signalu o pliiJrH ror 'Date T of Roof DOUS MATERIALS DISCLOSURE Type Will the appr 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(x)? ��tttt All roofs shall be inspected prior to any roofing material being installed. 0 YCs �No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hazardous air contaminants as dcfhncd by the Bay Area Air Quality Management all new uiaterials for inspection. strict? ❑Yes u 2 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- niaHealth&Safely Code Sections 25505.25533 and 25534.I understand that if the building does not currently have a tenant.that it is my responsibility to notify the occupant of the Date require ntsw ich must met pri�..u.cc�aCc icate of u cy' Signatur'Of pplieant u All roofcoverings to be Class'A'or better Owner r orixcd Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 17UPE�TINO Buildirt Department JOB ADDRESS: Ucy PERMIT # 0 1_77 �Lj ��USolvld OWNER'S AME: �n 7''••r z PHONE # GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Sig,iature Date Please check-applicable subcontractors and com :.ete 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 � > 2 v Owner ontr for Signature Date " CITY OF I�UPERTINO .: , REROOF CUPEkTINO PERMIT APPLICATION (�gD,SUI(�U APN # Date: Do Building Address: ! t2_7 �0 Owner's Name: s �,y�q -11-11 �� Phone #: 6 JJ HOA: Yes ❑ No ❑ If yes, provide7etter from HOA Phone#: Contractor: _ �L _5 lo g -- 9'66k Fax #: Cupertino Business License #: Contractor License #: Type of P.00f Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof * Asphalt Shingles X Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings r ❑ Provide I.C.C.E.S. Report# Y To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: - o 0 , l7 _�q_S 1 5;tONJ C (a� 157/A � Residential [ Commercial Lj 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: - 5q I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO REROOF CUPEkTINO 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 2 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof M ilti-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 BUSLIC 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 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 build-ng 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 zny roofing installation. 4. To receive a final sign off from the C ity,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 14 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O.report is required to be c n the job site at the time on inspection. I understand and will comply'with the abcv stated policy on re-roofing. Homeowner's Name: C Job Site Address: Roofing Company Name: Applicant's Signature: VL/ 40 Date: Greg Casteel Building Official Revised 07/30/08