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09060069 CITY OF CUPERTINO BUILDING DIVISION PERMIT + fiI TIZ I TCis � BUILDING ADDRESS: PERMIT NO. OWNER'S NAME: PERMIT ISSUE DATE A 9 CONTROL NO. (408) 298-93)9 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION Job Description U P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code.and my license is o`y in full force andcfVLgoo -7 RE-RF RMV EKT WDSHK RF., INSTL 7/16"OSB & ? License Clas C.i Lic.8_ Date fes ! O Contractor F I BRG LA S S ARCHITECTS DECLARATION I understand my plans shall be used as public records '^9 REINFORCD F�,T, INSTL WDCREST SHNGLS BY OWENS °" CORNING CLS A 24SQ G y Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's Liccnse Law for the in 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 Z prior to its issuance,also requires the applicant for such permit to rile a signed statement _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation F$ (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 arty applicant for a permit subjects the applicant to a civil penalty of Apr'Number Occupancy Type not more than five hundred dollars($500). [11.as owner of the property,or my employees with wages as their sole compensation, 36911040 . 0 0 will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections 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 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. ❑1 am exempt under Sec. B&P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: '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 ore tion 1 urance carrier and Policy number army: Q Carrier eL a 0+ o Policy No.:y1 / el 01 () CERTIFICATE OPTION 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 Worker's Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. r••„ y CONSTRUCTION LENDING AGENCY r r�r I hereby affirm that there is a construction lending agency for the performance of �i> the work for which this permit is issued(Sec.3097,Civ.C.) a Q Lender's Name z Lender's Address 0 I certify that I have read this application and state that the above information is cored 1 agree to comply with all city and county ordinances and state laws relating to Vbuilding construction•and hereby authorize representatives of this city to enter upon the r W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments•costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. u" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE R ULATION . , .� G`�' 0 9 Re-roofs SignVA of Applicant/Comractor 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 N inspected prior to any roofing material being installed. ❑Yes '�No If a roof is insta Will the applicant or future building occupant use equipment or devices which l ed without first obtaining an inspection,I agree to remove hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. :ict? ❑Yes KNO I 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 J does not currently have a tenant,that it is my responsibility to notify the occupant of the 611 Aq requirehich must be prior to issuance of a Certificate of Occupancy. Sig ture of Applicant Date 11 o All roof coverings to be Class''"or better Own or authorized agent Date -� CITY OF CL PERTINO REROOF CITY OF CUPEVI ENIO PERMIT APPLICATION APN # y6 . U0 Date: Building Address: o � - - Owner's Name: jo Phonee #: 7Gj X23 - /�.3 y Contractor: �� >y z� Phone #: PSI "� `` � ,�(-�_' �.I'' 'j'�',,''l �a ��✓i�� Fax#: Cupertino Business License #: . Contra(efor License #: Type of Roof 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 ❑ Provide I.C.B.O.Report# P To be Removed Provide Mf . Installation Specs. AL Job Des ription: jj000-s8f Residential Commercial Green Building: Please complete relevant portion A 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 Comply with Cupertino's Tear-Off Policy: Si re Revised 6/16/08 CITY OF CUPERTINO J C REROOF CITY OF FEE SCHEDULE CUPEkT] O Number of Fee ID Fee Description FeePermit Type Squares Group l! Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commerci�'i B 14 1RER00FRES ' Re-roof Residential B 1SFDVVLROOF G=- f 1BSEISMICRE Seismic Residentia. B 1 1REROOFRES Re-roof Multi-Family B 1MFDWLROOF M 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B Revised 6/16/08 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 tD 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 v6thout 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 approva" 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 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 stat ad policy on re-roofing. Homeowner's Name: " , fob Site Address: t175-S t/ r o Roofing Company Name: Applicant's Signature: Greg Casteel Building Official Revised 07/3)/08 x - . 1c Community Develop== 10300 Tor,e Aver_ut .,: Cup=rim o CA 9014 Telephone(408) 777-3228 CIiYOF Fax(408) 777-3333 JOB A1]D1 ESS• PET?XTIT QST ( go (, UyC9 OW iNER S NAME: PHONE =