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09110110CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20348 CLAY ST CONTRACTOR: TBD - TO BE PERMIT NO: 09110110 DETERMINED 'NNER'S NAME: MILLER MARTIN H AND CLAUDETTE OWNER'S PHONE: 4083423031 ❑ LICENSED CONTRACTOR'S DECLARATION C License Cla s `� Lic. # Contractor Date I hereby, affirm that I a license under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. 1 hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, 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 provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses whi h may accrete against said City in consequence of the granting of this pe Additionally, the applicant understands and will comply with all non-po' s rce regulations r the Cupertino Municipal Code, Section 9.18. natu Dat_/// Fol I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, 1 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating wilding construction, and hereby authorize representatives of this city to enter n the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18, Signature Date DATE ISSUED: 11/19/2009 PHONE NO: r r r BUILDING PERMIT INFO: BLDG ELECT PLUMB r r r MECH RESIDENTIAL COMMERCIAL JOB DESCRIPTION: RE -ROOF OSB 30 ILB PAPER PRESIDENTIAL COMPOSITION CLASS A 28 SQUARES Sq. Ft Floor Area: I Valuation: $7600 APN Number: 36938030.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b Date: RE -ROOFS: All roofs shall be inspected prior to any rooting material being installed. If a root' is installed without first obtaini inspection, I agree to remove all new materials for inspection. Signature of Applic Date: ALL R COVERINGS TO LASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the B Area Air Quality Management District 1 will maintain compliance with C ertin'o,,,� nicipal Code, Chapter 9,12 and the Health & Safety Code, S do 25505, f��-", and 25534. Owner or authorized :�, Date! r CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO k „r REROOF CUPEkTINO PERMIT APPLICATION Coq 110110 APN # Date: ing Addr r L) Ois ame / /� fT 1 Ph e #: HOA: Yes ❑ No [g If yes, provide letter from HOA Contractor: Phone #:. � &�:Fax C v #: Cupertin Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof .X. Asphalt Shingles X Asphalt Shingles iK 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: � c��- C ,,-- 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. Valuation: . I Have Rpad;,Vnderstand and Will Comply with Cupertino's Tear -Off Policy: Revised 02/05/09 CITY OF CUPERTINO CITY OF REROOF CUPEkTINO FEE SCHEDULE Number of Squares Fee Ila Fee Description Fee Group Permit Type IREROOFC MM Re -roof Commercial B 1COMMLROOF Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1 BSEISMICO Seismic Commercial B 201- 1REROOFRES Re -roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1 BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE Seismic Residential B I1 BUSLIC I Business License B Community Development Department Building Division City of Cupertino 10300 Tone 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 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 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 stated policy on re -roofing. Homeowner's Name: Job Site Address: Roofing Company Applicant's Signature; Greg Casteel Building Official Revised 07/30/08 CITY OF ,.MkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department j�(n3 j e� � r � (, l PERMIT #�I I O 11 OWNER'S NAME: BUSINESS NAME PHONE # � GENERAL CONTRACTOR: Cabinets & Millwork FAX # F� I am not using any subcontractors: Signature Please check applicable subcontractors and complete the following information: Date Owner/Contrac ignature Date :'i 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 Owner/Contrac ignature Date :'i