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09080178 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING A156RLSS! i 1 161 SANTA TERESA DR CONTRACTOR:ROYAL KNIGHT ROOFING PERMIT NO:09080178 I CO INC 'i(? ' "'R'S NAME: MOORE JEAN S 4171 WILL ROGERS DR DATE ISSUED:08/19/2009 O%o4t.R'S PHONE: 4082520771 SAN JOSE,CA 95117 PHONE NO:(408)241-7160 ❑ LICENSED CONTRACTOR'S DECLARATION C� BUILDING PERMIT INFO: BLDG ELECT PLUMB r License Class_ —9 Lic.#_��S 7� - Contractor&_)My(� to ?-1,?—07 MECH� RESIDENTIAL� COMMERCIAL' I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING SHAKES& (commencing with Section 7000)of Division 3 of the Business&Professions REPLACE WITH Code and that my license is in full force and effect. CLASS A SHAKES 27SQ I 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 Sq.Ft Floor Area: Valuation:$15000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION APN Number:35616010.00 Occupancy Type: 1 certifv 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 S upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED nndemnifv and kaep harm'e�s the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which,may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municinal Code,Section 9.18. Issued by Date: ri � ❑ OWNER-BUILDER DECLARATION RE-ROOFS: kII roofs shall be inspected prior to any roofing material being installed. If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of nstalled without first obtaining an inspection,I agree to remove all new;materials for the following two reasons: nspection. h 1,as oweer of the property,or my employees with wages as their sole compensation, 1 will do the work,and the structure is not intended or offered for sale(Sec.7044, :signature of Applicant: _ Date: Bus(nes &Protessions Code) _ 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE w1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain performance of the work for which this permit is issued, n ompliance with the Cupertino Mupicipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by :safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this additionally,should I use equipment or devices which emit hazardous air ontaminants as defined by the Bay Area Air Quality Management District I will c !permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall I lealth&Safety Code,Sections 25505,25533,and 25534, 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 t) r a -ed become subject`.o the Worker's Compensation provisions of the Labor Code,1 must - � G+�./C'-f � ! forthwith comply with such provisions or this permit shall be deemed revoked. !!I /0-1.4STRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's 1 certify that I have read this application and state that the above information is f)r which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to~eliding construction,and hereby authorize representatives of this city to enter he above mentioned property for inspection purposes.(We)agree to save Lender's Address f� .-inky and keep harmless the City of Cupertino against liabilities,judgments, t costs,and expenses which may accrue against said City in consequence of the f granting.of this permit Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION i with all non-point source regulations per the Cupertino Municinal Code,Section I understand my plans shall be used as public records. i 9.18. --------- ------------- -- I{ Licensed Professianal Signature __ ___Date____ 0 [ v? 0 (7e CITY OFCUPERTINO PWROOF CUPEkTINO PERMIT APPLICATION APN # Date: o I -© Building Address: lllel A)T l,`RESA Owner's Name: �Jv�, C Phone #: HOA: Yes ❑ No If yes, provide letter from HOA Contractor: Phone #:i(C�.,ZV1_ -716 p 1�p KAj/6 or RavF ISG Fax #: Cupertino Business License #: Contractor License #: ��gs7 Type of]goof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles jk Wood Shakes q 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. of Job Description: 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 Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO aR REROOF CITY OF CUPEkT]NO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1 REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissicn Fee 1BSEISMICO Seismic Ccmmercial B Z� 1 REROOFRES Re-roof Re 3idential B 1 SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee I 1BSEISMICRE Seismic Re3idential B 1 REROOFMRES Re-roof ML lti-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissio:l Fee 1BSEISMICRE Seismic Re:,,idential B 1BUSLIC Business Lizense 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 b6lding inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to an., roofing installation. 4. To receive a final sign off from the Cit;,,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 nai.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 per=ormed. 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 or.the job site at the time on inspection. I understand and will comply with the abov a stated policy on re-roofing. Homeowner's Name: Job Site Address: Z/16/ � 1 � r Roofing Company Name: Applicant's Signature: te: Greg Casteel Building Official Revi;;ed 07/30/08 Community Development SO 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,...UPEkTIN0 Building Department JOB ADDRESS: PERMIT # 0g080 ► � OWNER'S NAME: PHONE # 7 GENERAL CONTRACTOR: T a FAX # I am not using any subcontractors: Si e Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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 po pt_ A l6,gT e®F A Septic Tank Sheet Metal Sheet Rock Tile Owner/C tractor Signature Date