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03100108' CITY OF CUPERTINU T(I INFi7iiMA' . BUILDING DIVISION PERMIT::_'CONTRA, >; BUILDING ADDRESS: F'RAGUGL IA ROOFING PERMIT NO03100108 OWNER'S NAME: P O BOX 1435 PERMIT LS5UEDATE NE` (408)257-7663 SANITARY N0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH - LICENSED CONTRACTOR'S DECLARATION ' Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70W) of Division 3 of the Business and Professions Code. and my license is in full force and effect. L 01 S Z Z 7— License Class Lic. R REROOF ' Date1f9 ( ; Curstractor RCHITECTS DECLA ATION 1 understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION f hereby al'Erm that I am exempt from.lhc Contractor's License Lew for the following reason. (Section 71)3 1.5, Business and Proressinos Code: Any city nr county which requires a permit to construct, alter, improve. demolish, or repair'any structure prior to its issuance, also requires the applicant for such permit w rile a signed statement that he is licensed pursuant t0 the provisions of the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Iraluition (cOmmencing with Section 7(X)0) of Division 3 or the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of 34248002.00 APN Number Occupancy e P Y TyP Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of not more than five hundred dollars (5500). ❑ 1, as Owner of the pmperty, or my employees with wages as their sole compensation, will do the work, and [hestfucmtnis not intended or offered forsele (Sec. 7044, Business 3 05 _ FRME Required Inspections and Professions Code: The Contraelet9 License Law does not apply to an owner of property who builds orimproves thereon, and who does such work himself orthrough his 307 — INSULATION Own employees, provided that such improvements are not intended oroReredfor sale. If, 601 — ROOF TEAR OFF' 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 602 ROOF+' PLYWOOD NAIL sale.). 603 - ROOF BATTENS ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See. 7044, Business and Professions Code:) The Contractor's Li- 604 — ROOF IN -PROGRESS cense Law docs not apply to an owner of property who builds or improves [hereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law. ❑ I am exem pt under Sec. . B At PC for this reason Owner Date ' WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: I have and will maintain a Certificate of Consem to self-insuro for Worker's Compen• ' sation, as provided for by Section 3700 of the Labor Code, for the performance of the work If r which this permit is issued. , have and will maintain Worker's Compensation Insurance, as required by Section 3 of the Labor Code. for the performance of the work for which this permit is issued. My Work e ' m nsation Insurance a Tier and Policy number are: ` ' Caner: r—H "1 Policy No.:11 3 -OL CERTIFICATE OF EXEMPTION FROM WORKERS-M&I&I W COMPENSATION INSURANCE (This section need not be completed irthe permit is for one hundmd dollars (SlBtl) lir less.) ' I cenify that in the performance Of the work for which this permit is issued, I shall not employ any person in any mannerso as to become subject 10 the WOrkers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making shin Cenificale of Exemption, you should become suhjec[ [o the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such prnvisions or this permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY I hereby afTum that there is a construction lending agency for the performance of the work for which this permit is issued (See. 3097, Civ. C.), Lenders Name Lender's Address I certify that I have read this applicatinn and state that the above information is ' correct. I agree 10 comply with all city and county ordinances and state laws relating 10 building construction, and hereby au[horim representatives of this city to enter upon the above-mentioned properly for inspection purposes. (We) agree In save, indemnify and keep harmless the City of Cupertino against 1 liabilities, judgments, costs and expenses which may in any way accrue against said City in consequence of the grand of this permit. /^ APPLICANT UNDERS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date / SO R EREGULAT Re -roofs Type of Roof APIA Sigdalur m/Contractor Date HAZARDOUS MATERIALS DISCLOSURE 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, sec 2ss32(a)7 Yes Yes �No All roofs shall be inspected prior to any roofing material being installed. a roof is installed without first obtaining an inspection, I agree to remove' Will [he applicant or Future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. latrict7 ❑ Yes Ihave read thehra urdous atcrialsrequirements underChaptter6.95Ofthe Califor- nia Health&Safely Code, Sections 25505,25533and 25534,1understand lhatiRhebuilding- 4 docs not eurenlly ha tenant, that !I is my responsibility to nn I, the occupant of Glc rcquiremcnts wli h l - met prior ttt issuance of a CCnifiealC Oce p�rtry. atlkbe of Applicant Date CJ All roof coverings to be Class "B" or better G nri.mdagent Data r � �Y CITY OF UPEkTINO 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 1997 UBC Standards IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " 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: u�� ' V! Job Site Address: _2-2- G 7- a ce9clY 57�� Roofing Company Name: 5�5a- alk- 460 &3 Applicant's Signature: Ooil Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper Date: and manufacturers specifications on re -roofing. 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. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " 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: u�� ' V! Job Site Address: _2-2- G 7- a ce9clY 57�� Roofing Company Name: 5�5a- alk- 460 &3 Applicant's Signature: Ooil Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper Date: i v i CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM 0 3 1 b 0 105 r� APN # � � � � Date: 6 /I Building Address: z, -6 zZ rte', -5 _ Owner's Name: G I� �- � �/_ � � Phone 11:6 Contractor:u J� o�dPhone #:�D� ?r�� OZ�I License #�ZZ Seismic Commercial BUILDING BPLANCHK Contact: �� ��� Phone #: ��.�.�^0ZF Cupertino Business License #: Business License Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof 13Asphalt Shingles *"13 Built -Up roof k Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) umber of existing coverings b Provide I.C.B.O. Report # To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: y� P � � r Tee'e9L,4AC's_�I �.do Ca ��J� ' Residential Commercial ❑ Fire Zone: YeA No ❑ Confirmed with PlanningDe t. if there are an restri uamlr Cost of Project: ©(� Typt, of Cons o Occupancy p: 0 � y DMcabG 1 Fee TTS FPP T7Pcrrintinn 11_1,�_ �_� Fria irrmn BPERMFEE Bld Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING W -2, -� Y- 7