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09060169 CITY OF CUPERTINO BUILDING'DIVISION. PERMIT BUILDING ADDRESS: PERMIT NO. 1 127 DENISON AVE WORK ERCE ROOFING WEE 09060169 PERMIT ISSUE DATE OWNER'S NAME: BgtS A CONTROL NO. '-10 408) €92-5096 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 � 0 900 LICENSED CONTRACTOR'S DECLARATION Job Description v I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing 1 T with section 7000)of Division 3 of the Business and Professions Code,and my license is n<a in full force and effect. RE—RF FMV EXT WDSHK INSTL OSB FELT 14" SUNTUNNEL ; z License Class V-'4 Lic.x ei!66 3 INSTL F.SPHLT SHGL 245Q CLS A Dale 06- ;0— 04 Contractor w w4c G�rt t2B� '`c ARCHITECTS DECLARATION lit d rstanJ pl7 shall tp u public ords Dku )CUR't 'a °- h u.F' Licensed Profc anal—�' U0, 0, OWNER-BUILDER DECLARATION I hereby alTirm that 1 am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county 429 which requires a permit to construct,alter,improve.demolish,or repair any structure y rn prior to its issuance,also requites the applicant for such permit to file a signed statement E_ that he is licensed pursuant to the previsions 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 Codc)or 1111 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). 31628027 . 00 I,as owner of the property,or my employees with wages as their sale compensation, will do the work.and the structure is not intended oroffered 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.). ❑L as owner of the property,am exclusively contracting with licensed contractors to 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 conu-=or(s)licensed pursuant to the Contractor's License Law. ❑1 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: 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen- _vtion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. [g 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 Compensation Insurance carrier and Policy number ate: Carrier. S4 a6 FOt,­J Policy No.: 2114-0006-44L Zl1 ) 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 Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY [~.cam-• I hereby affirm that there is a construction lending agency for the performance of tYr 5 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 0Z Lender's Address U C) I certify that I have read this application and stare that the above information is fL corm 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 a above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Nliabilities,judgments.costs and expenses which may in any way scenic against said City V Z in consequence of the granting of this permit. Date -- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b'i: SOURCE REGULATIONS. M\i,._1 A-id U—I'Le_ 06­10—017 Re-roofs Signatute ofAppli t/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of'Zoof 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 Cotte,Section 25532(a)? Ne All roof: shall be inspected prior to any roofing material being installed. Yes Will a roof is installed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. .trict? Yes t No 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 docs not currently have a tenant,that it is my responsibility to notify the occupant of dee rccros which must be met prior to issuance of a Certificate of Occupancy. S ignatuP'of Applicant Date 17; J n^qef Asn=-::VL z ab"3oTO'► All roof coverings to be Class A!'or better Owner or authorized agent Date 0�0(0 0i �09 CITY OF CUPERTINO RE ROOF CUPEkT1NO PERMIT APPLICATION APN # Date: o r Zo o Building Address: / 0( 1-,7 Je_vx,Sam �v e C� c � �, y Owner's Name: �(ka, Phone #: boy HOA: Yes ❑ No ❑ If yes, provide letter from HOA Phone #: oF Contractor: WD"j, P CC-9- 12 0,0�t hs 4 Fax #: L(°� Cupertino Business License #: Contractor License #: 11633 �- 3 9 Type of hoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles x Asphalt Shingles 0, 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: pe r,,A,V-e e s t-+�5 k�a L�� S��L� . �! h s� �z o S�� CC Residential Commercial Green Building: Please complete relevant po rtion 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: � I ( l I ?, &'I I Have Read, Understand and Will Comply witli Cupertino's Tear-Off Policy: Signature Revised 02/05/09 a CITY OF C UPERTINO REROOF CUPEkTINO 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 Z� 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissio:z Fee 1BSEISMICRE Seismic Re;;idential B 1 REROOFMRES Re-roof ML lti-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Re3idential B 1 BUSLIC Business L:cense B 1 5-KYL1 0 Sr 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 ie-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 buildvlg 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 Ci.y,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 fE e 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: Vk Job Site Address: /b 1`11: 1e.-ai s cn-. Ave - '�` t� �1 �_o>c- Roofing Company Name: UkDUviz- Applicant's Signature: I v`` J' Arq e I �eDate: D6 3 0 Greg Casteel Building Official Reviled 07/30/08