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09060036 CITY OF CUPERTINO BUILDING DIVISION PERMIT Co r ItRlkIN: BUILDING ADDRESS: PERMIT NO. LLE RI GHT INC- 090600_36 OWNER'S NAME: PERMIT ISSUE DATE PHON S A CONTROL NO. (408) 377-8777 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH � 0 0 Z LICENSED CONTRACTOR'S DECLARATION Job Description U C I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is �y in full force and � �� RE-RF RMV E)CTNG RF & INSTL 30#FLT, NEW.FLSHNG, ? License CI Lic.X F-� Date ITContractorn^�r 40YR SHNGL 3AF ELK CLS A 27SQ h ARCHECCS DEC RATION 04 d 1 understand my plans shall be used as public records yU H Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the ❑O following mason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish.or repair any structure Za prior to its issuance,also requires the applicant for such permit to file a signed statement x that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation I­$ (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or 2 7 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(5500). 32601012 . 0 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 Contractor's License Law does not apply to an owner of q p 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 Cade:)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 Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason 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-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 Cpe a � u carrier and Policy number arc: Carrier. 5 -' Policy NO.:-IW 153 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not 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 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 O forthwith comply with such provisions or this permit shall be deemed revoked. N CONSTRUCTION LENDING AGENCY .4 ria 1 hereby affirm that tore is a construction lending agency for the performance of w> the work for which this permit is issued(Sec.3097.Civ,C.) a Q Lender's Name Z Lender's Address 0 1 certify that 1 have read this application and state that the above information is "4 correct I agree to comply with all city and county ordinances and state laws relating to ~E-^ building construction.and hereby authorize representatives of this city to enter upon the Wabove-mentioned property for inspection purposes ~ (We)agree to save,indemnify and keep harmless the City of Cupertino against y cn liabilities,judgments,costs and expenses which may in any way steric against said City Z in consequence of the granting of this permit. Date APPLICANT UN RST S AND WILL COMPLY WITH ALL-1 NO -POINT Issued by: C/ SOURCE T7 l� 01 ,9� Re-roofs Signa u o ApplicanVContractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 ❑No Will a roof is instal ed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. trict? ❑Yes ❑No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have rant,that it is my responsibility to notify the occupant of the rcyuirc is ltc mel prior to issuance of a Certificate of Oc P;- Signature of Applicant Date Dato All roof coverings to be Class''r? `'or better CWvfile'r orauthorized agent CITY OF CUPERTINO a_eK REROOF CUPEkT1NO PERMIT APPLICATION APN # GO Date: /.6 /� Building Address: �08 / 4W&V� & Owner's Name: Hop,� 4,?VC U- Phone #: HOA: Yes ❑ No LTJ If yes, provide letter i:rom HOA Contractor: Phone #: 3,7? 777 Fax #: X756-0 2- Cupertino Cupertino Business License #: Contractor License #: �-- Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ZAsphalt Shingles a,"'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# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: Ae reel C / d 14 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. ValuatiO yHaveRea U erstand and Will Comply with Cupertino's Tear-Off Policy: Revised 02/05/09 CITY OF CUP:ERTINO ` REROOF CUPEkT1NO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1REROOFRES Re-roof Residential B 1SFDWLR00F 2 � 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 Residential 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 re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings sh no be applied without first obtaining all inspection and written approval fron e building in:;pector. A final inspection and approval shall be obtained from the buildilg 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 material down to the sheathing, so a proper City inspection can be perform gid. 7. NOTE: If you call for a plywood nail inspE ction 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: �kjlxc, r 177"e__ Job Site Address: Roofing Company Name: Applicant's Signature: Date: Greg Casteel Building Official Revised 07/2"0/08 y, Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '-UPEI�TINO Building Department JOB ADDRESS: ,/jPERMIT# OWNER'S NAME: fr - XZe ,65 PHONE # .. GENERAL CONTRACTOR: � FAX # I am not using any subcontractors: Signatt re Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESt') 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 E�il�Sl j Septic Tank Sheet Metal Sheet Rock Til Owner/Contractor Signature Date