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B-2017-1245r CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: CONTRACTOR: PERMIT NO: B-2017-1245 10165 SCENIC BLVD CUPERTINO, CA 95014-2724 (357 09 084) ARMSTRONG INSTALLATION SERVICE EMERYVILLE, CA 94608 OWNER'S NAME: HO HAROLD C AND MARIA M DATE ISSUED: 07/28/2017 OWNER'S PHONE: 408-705-7515 PHONE NO: (510) 777-1234 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: License Class B. C33, C39 Lic. #245291 Contractor ARMSTRONG INSTALLATION SERVICE Date 11/30/2018 X BLDG —ELECT _PLUMB MECH X RESIDENTIAL COMMERCIAL I hereby affirm that I am licensed 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. JOB DESCRIPTION: OVERLAY; FOAM OVERLAY - (13 S.Q.); ONLY TEAR OFF (1 S.Q.)- I hereby,affrrm under penalty of perjury one of the following two declarations: UPPER ROOF AND APPLY FOAM OVERLAY; r. I have and will maintain a certificate of consent to self -insure for Worker's ompensation, as provided for by Section 3700 of the Labor Code, for the . rformance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by 0 Section 3700 of the Labor Code, for the performance of the work for which this Sq. Ft Floor Area: Valuation:. $13800.00 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 APN Number: Occupancy Type: and state laws relating to building construction, and hereby authorize 357 09 084 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 which PERMIT EXPIRES IF WORK IS NOT STARTED may accrue against said City in consequence of the granting of this permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR Additionally, the applicant nderstands and will comply with all non -point source regulations per a Cupertino M nicipal Code, Section 9.18. 180 DAYS FROM LAST CALLED INSPECTION. S' re Date 7/28/2017 Issued by: Jasmine Archbold Date: 07/28/2017 I hereby affirm that I a 'exempt from the Contractor's License Law for one of the RE ROOFS: following two reasons: All roofs shall be inspected prior to any roofing material being installed. If a roof is i. I, as owner of the property, or my employees with wages as their sole installed without first obtaining an inspection, I agree to remove all new materials for compensation, will do the work, and the structure is not intended or offered for inspection. sale (Sec.7044, Business & Professions Code) 2. I, as owner of the property, am exclusively contracting with licensed Signature ofApplicant: contractors to construct the project (Sec.7044, Business & Professions Code). Date: 7/28/2017 I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER i. 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. HAZARDOUS MATERIALS DISCLOSURE 2. I have and will maintain Worker's Compensation Insurance, as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the Section 3700 of the Labor Code, for the performance of the work for which this California Health & Safety Code, Sections 25505, 25533, and 25534. I will permit is issued. maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the 3. I certify that in the performance of the work for which this permit is issued, I Health & Safety Code, Section 25532(a) should I store or handle hazardous shall not employ any person in any manner so as to become subject to the material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I Worker's Compensation laws of California. If, after making this certificate of will maintain compliance with the Cupertino M 'cipal Code, Chapter 9.12 and exemption, I become subject to the Worker's Compensation provisions of the the Health & Safety Code, Sections 0 25533, and 34. Labor Code; I must forthwith comply with such provisions or this permit shall be deemed revoked. Own r authorized agent: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information isCY TIO correct. I agree to comply With all city and county ordinances and state laws I hereby affirm that there is a construction ding agency for the performance relating to building construction; and hereby authorize representatives of this city of work's for which this permit is issued (Se .3097, to enter upon the above mentioned property for inspection purposes. (We) agree Lender's Name to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in Lender's Address consequence of the granting ofthis permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal ARCHITECT'S DECLARATION Code, Section 9.18. 1 understand my plans shall be used as public records. Signature Date 7/28/2017 Licensed CUPEIt7INO REROOF PERMIT APPLICATION NEW COMMUNITY DEVELOPMENT DEPARTMENT o BUILDING DIVISION 10300 TORRE AVENUE o CUPERTINO, CA 95014-3255 (408) 777-3228 • FAX (408) 777-3333 • building ancupertino ora -F> 2.01--I? 4,5 PROJECT ADDRESS APN H OWNER NAME PHONE EMAIL STREET ADDRES C11 Y, STATE, ZIP FAX CONTACT NAME PHONE & 1AIL STREET ADDRESS C CITY, STATE, ZIP Fax ,�, [3 OWNER OWNER -BUILDER 13J3/ OWNERAGENT CONTRACrOR ALJC RACTOR AGE ❑ ARCHITECT ® ENGINEER ❑ DEVELOPER E3 TENANT C NTRAC ORN ME LICENSE IBER .Q . LICENSETYPfi BPS. LIC./! CO ANY N 14E FAX STREET ADDRESS CIT]', STAT ZIP PHONE ARCHITECT/ENGINEER NAhfE LICENSE NbNMER ` BUS. LIC. N COMPANY NANI E E-MAIL FAX STREET ADDRESS CITY, STATE ZIP • PHONE USE OF SFD or Duplex ❑ Multi -Family ROOF AREA: VALUATION: STRUCTURE: ❑ Conuilercial EXISTING ROOF TYPE:BUILT-UP ROOF ❑ASPHALT SHINGLES ❑ WOOD SHAKES E3 WOOD SHIidGLES ©OTFifiR (SPECIFY) REMOVE/REPLACE ❑]ES IF NO. PLYWOOD =-,, ]13D ❑ OSB PITCH:,� ROOF y S.® x:12 A 4. PROPOSED ROOF TYPE: ❑ BUILT-UP ROOF ❑ ASPHALT SHINGLES ❑ WOOD SHAKES ❑ WOOD SHINGLES /OT�I�R ICC -ES REPORT N DESCRIPTION OF WORK: By my signature below, I certify to each of the folio ty ng: I am the property owner or authorized agent to act on the property owner's behalf,I have read tlfis application and the inforniation I have is provided trect. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws resatding stn I authori f, representatives of Cupertino to enter the abov-identifi property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFO T O 'QUIRED O FICEUSEONLY — If building is associated With a Home wnees Association, provide letter PLANCHECKTYPE ROUTINGSLA' Of approval from HOA. ❑ OVER-THE-COIA�i'ER ❑ BUII,1)INGPLANREVIEW — Provide Planking approval to verify if there any restrictions. PRESS El EXPRESS ❑ PLAN IINGPLANREVIEW Provide copy of Manufacturer's Installation Specifications. ❑ST❑ i FIRE FIREDDEPT Provide signed copy of Cupertino's Tear -Off Policy. O : ReroofApp_2011.doc revised 03/16111 k