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09050152 CITY OF CUPERTINO BUILDING DIVISION PERMIT N. �? ' If31Y• BUILDING ADDRESS: PERMIT NO. 10341 PHAR LAP DR LOS GA'IOS ROOF09n9ni 52 OWNER'S NAME: PERMIT ISSUE DATE A CONTROL NO. "40NE: (408) 258-9399 BUILDING PERMIT INFO ARCH1TECrfENGINEER: BLDG ELECT PLUMB MECH app LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chaptcr 9(commencing z with Section 7000)of Division 3 of the Business and Professions Code,and my license is <, in full force and effect. q RE-RF FMV EXT SHK RF INSTL 7/16" OSB W/RADIANT D24 License Class 1 Lic,ii y:—a Date Contractor BARRIEF.r RFRS SELCT FELT& PRES SHNGLS BY ARCHITECTS DECLARATION TAII`fTEED CLS A 225 < I understand my plans shall be used as public records CERQ �yU L C in Licensed Professional OWNER-BUILDER DECLARATION <2 1 hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Horsiness and Professions Code:Any city or county 4 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 z< that he is licensed pursuant to tree provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation %I--a (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or $8680 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($500). 3263904:4 . 00 0 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 Required Inspections and Professions Code:The Contractors License Law docs 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.). 0 1,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- ccnse Law does not apply to an owner of property who builds or improves thereon,and, who contracts for such projects with a conuactor(s)licensed pursuant to the Contractors License Law. 0 I am exempt under Sec. B&P C for this reason Owner Dale 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 Workers Compen- eon,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 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 omp/ennuoon Insurance carrier and Policy number arc: Cartier: tG t�µNo Policy No.:E''j9 OoU/q�_ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This 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,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 Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. z" CONSTRUCTION LENDING AGENCY 1 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.) WGi.Q Lenders Name Z Lender's Address V O 1 certify that I have read this application and state that the above information is VL"4 correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hemby authorim representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. LL (We)agree to save,indemnify and keep harmless the City of Cupertino against p..4 liabilities,judgments,costs and expenses which may in any way accrete against said City U Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND W LL COMPLY WITH ALL NON-POINT Issued b is SOURCE REGi1L ONS. 5-/Z-610.7 Re-roofs /-_---- Signature rcant/Contractorbateof goof 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 Codc,Section 25532(a)? All roof:;shall be inspected prior to any roofing material being installed. 0 Yes ]No If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which 'tit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? 0 Yes No J I have read the hazard materials requirements under Chapter 6.95 of the Califor- Z Ile t� nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understated that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements whic m s b me prior to i uancc of a ecru icatc of cipach� Sl attar:of Applicant Date z d 9 All roof coverings to be Class'W'or better Owner or au orized agenta�te - o q C) CITY OF I�UPERTINO REROOF G7Y Of CUPERTINO PERMIT APPLICATION APN# Date: Building Address: U J9 Owner's Name: Phone#: A��a'kz �/o e 110S3 2- Contra r: CI � G' f\ C)C7 1 L Phone #: Z16) � _- Fax#: Cupertino Business License#: Contractor License #: Type of R,)of Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles )4 Asphalt Shingles XWood Shakes o Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) Other(Specify)- Number ther(Specify)Number of existing coverings I ❑ Provide I.C.B.O. Report# Y To be Removed Provide Mfgr. Installation Specs. -`� P - --- Rocs Jot Description:, ,,je IL Residential Commercial ❑ Fire Zone: Yes ❑ N OZI Confirmed with Planning Dept. if there are any restrictions: ❑ Valuation: —� I Have Read, Understand and.Will Comply with Cupertino's Tear-Off Policy: Si re CITY OF ,CUPERTINO RE ROOF CITY OF CUPEkTINO FEE SCREDULE Na Fee ID Fee Description Fee Permit Type Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic C)mmercial B 1REROOFRES Re-roof Residential B ISFDWLROOF 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Se=ismic 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 (pity Of Cupertino 1. Prior to permit issuance,you must agrc e to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 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 ilspection is required. 6. Any roofing which is applied without fust 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 in:;pection 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 E a 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 th�job site at the time on inspection. I understand and will comply with the above slated policy on re-roofing. 1 Homeowner's Name: �G Job Site Address: �=17 414od-A RoofingCompany11 j, 4 Name: L 11S a / M G � Z4d� Applicant's Signature: �i f�) �� y�Z,��,�1 � Date: Greg Casteel Building Official Revised V./2/04 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408).777-3333 CUPERT IN0 Building Department �_ JOS ADDRESS: J / 7�1 - G �� PERMIT # cl v c) t OWNERS NAA/[E- ,� m PHONE ` �/ , 6' GENERAL CONTRACT CC FAX _S_ �� DS - — �'-`� 2,71 - 6 I am not using any subcontractors: Si.cnature D tem Please check applicable subcontractors and com lete the following-information: SUBCONTRACTOR BUSINESS DAME I 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 Ica C O-fvnrnerr/Contractor'Signature Date