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04030257 CITY OF CUPERTINO BUILDING DIVISION PERMIT 'C,ONTRACT�ORINF,URMATpION ';; BUILDING ADDRESS: PERMII NO.Q 4 0 3 0 2 5 7 OWNER'S NAME: PERMIT ISSUE DATE ONE:AMY SANn7ARYN 0 OLNO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ,10p LICENSED CObnRACIOR'SDECLANATION JobDescri tion Yto 1 barony affirm Nn I am licensed under pmvisiana of Chapter 9(commencing P a_rB <Z wish Secure 7")of Division 3 of the Bupnygand Professional Code.and my license is F �a LE® ^mai in full da n �G/ REROOF QW'® j Ja License A Le.N ^fo D con r CONTRACTOR: BAKER ROOFING APR i2, 2004 O A CHrMCI•S A ON +as 1 undcmund my Plana shell c merlds 6 . 3 C Licensed Pndcuianel BUILDING O IID R LARATION U +� I Wrthy atom 1 Am uempt from the Cretsa"Cm License lsw for the i p o which reason.(Section 7113 L5.Business and Profassiau Cook:Any city ns mum, $� which roquim,A pumit ro enwruct,alter.impmm,demolish.or mpalr any structure FIy priorin its issuancc.Alan rquirroslWapplicant for such Permit tomeasigned sutemcot S Ft. Floor Area Valu p Fthsthc is licensed pursuant use provisions of Ne Contractors License Law(Chapter 9 tl• �y QQQ mks (ecomcocing with Section 70001 of Division 3 of the Business and Prafcauon,Code)or `C.. shat be u emmpt tb"efrons And the bur for the alleged eumpdrn Any violation of Section 7031.5 by any applicant fon permit subjects the applicant In a civil penalty of APN Number Occupancy Type hot mom this five hundred dollars($500). 36610135 . 00 ❑Luawmr of de property,or my cmploycu wish wagesu their cote eampensa0m, will dr the work.and the,WcmmisnotimmnmdwaRarodforsak(See.7W.e10dtess Required Inspections and Rofevicas Code,The Contractile,License law does not apply m an owner of q P Property who build,or improves shereon,andwho doessuch work himselfor through hi, Own cmploycu,provided lhatauch improvements an,not intended moRerW for Aaic.If. however,the building.,improvement i,mid within onto year of completion.the Owsmr- builder will have die Wmdan of proving Nat he did an,build or improve for l uryom of sale.). ❑1,As Owner of the property,am secluuvely controlling wish licensed contnemn to wnstnn:t the Poole"(See.7014.Business anes d ProfassioCode:)The Counselor-U cause law dies not apply b an owner of property who Wilds Or improves tlerton,and who contracts for such pmjecm witha crnuactorod licensed per,uant in she Conowetoh Litter law. ❑1 am axampt undo Sec. .B A,P C for this mason 1371(s) ner Data WORKER'S COMPENSATION DECLARATION 1 bemby,atom under penalty of pujury arc of tW following drelArWou: I have and will maintain A Cunmum of Consent to self-insure for Worker's ComPan- ars,u provided for by Section 3700 of des IoW'Code.for the Pesfomamc of the rk for which this Permit is issued. 1 nave and will mainWn Workees Compensation Insurance,u myuited by Section of IW labor Code,for she performance of the wank for which this permit is issued. y Workeerye,,�1C}.mpensati Iesuan canierand Policynumberrm: corer.CY Irk s ^o� Po"Zll4: �s 16 cERTIFICOATS FE EsvmuNLFROM WORKERS' COMPENSATION INSURANCE (7hlssectim need not W complemd lithe pemlt is forma,hundred dollars(SIM) Or Jr.) 1 certify that in Na performance Of Ne work for which this Permit is issued,l shall not employ any Paton in any mannerm u In become subject to IW WorketecinspaesNm Laws rf California.Data Applicaat NOTICE TO APPLICANT:If,after making thus Cen riesm of Exemption,you should become subject to the Worker's Compensation provision of no LAWr Code,you mum Z forthwith comply wish such lotw uou or do.Permit shall W deemed toweled. z O CONSTRUCTION LENDING AGENCY (.. 1 hereby,Rima shat Nem is A.ansurnom lending agcmy for Ne perfum,mtce of 7 tW work for which the Permit is issued(Sae 3047.Civ.C.) R] Lenders Name 6. Lmdces Addnaas U 0 I cenify that 1 have road this application and sum III*, the above inrimnauun is IL f" comet 1 agree to comply wit JI City and county ordinances and sok laws relating in 0U building (We)A,=1.,and nearbymennify And keep hoomseese Nis cityroOf erimm-cnmr &lite r W AWve-mcndmned Property rot Inspection putpmes. r fn%3 Itabilities,judgmanu,costs and expenses whhich may in any he y accrtm againstsaid City U in cottscquc^ce of lW grandee of this permit Date ' ► APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE R UL IONS. 3 Re-roofs ignewm of p o HAZARDOUS MATERIALS DISCLOSURE collector Date Type of Roof Wit Lha applicanon- t or rutura Wilding occupant mom m handl hatrdou mamuAl As defined by Ne Cupertino Moore' 1 Code.Chapter 9.12,and the Health And Safety me,Sectir^z55320A All roofs shall be inspected prior to any roofing material being installed. ❑Yns Nu Will the applicant or future Wilding uccupael tic a laqurcot or devices which If a roof is installed without first obtaining an inspection,I agree[o remove emit hazartlnns oir conuminanu u ncJ by the Bay Arta Air Quality Management all new materials for inspection. Dismal? yrs ❑ a 1 have road the bavardousmaterials requirements under CluPmre,95 of the Califor- nia _ no Huish k Sefety Code,Sections 25505.255331x125534.1 undersand thaifshe Wilding docs mt�rely lb. O t n nsihility,ro ooufy the\cupan v require nuwhichm tW "/It Orta m« nceniBeamrroaaP,ncr. ' nature fApplican[ Date ow m,rra>tianrodAg / All roof coverings to be Class "B"or better te Community Development * 10300 Torre Avenue y ' ; Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building De ent JOB ADDr5,3 '�t yZ j°l S `row PERM114 00 ci d j© -2- 3 �7 OWNER'S NAME: A/li PHO �l D GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation 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 �(�/i ase �14�1✓�G Septic Tank Sheet Metal Sheet Rock Tile e Contractor Signature Date { Community Development Department (� �I Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408) 777-3228 4UPEkTINO 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 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: `�`� Job Site Address: J/�AX>� �o W r. DIC,UK Roofing Company Name: L 44,50 e4ef " / A pee licant s Signature: Date:�X Llp� Greg tl Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO a 2-Z-� REROOF CUPERTINO PERMIT APPLICATION FORM APN# Date: 0.6,& 161 l 3,� Building Address: � /��✓ � �— J I�f 4t4 tom' 7Ds?ry/ ,t/l Owner's Name: I-1'D Phone#: hilteh,�, Contractor: Phone#: License#: 5`165' z, g Contact: Phone#: Cupertino Business License#: S K,r,7 S—,os— Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles � { C3 Other(Specify) C3 Other(Specify) �a Ar1 tfP V q4 TUi� Number of existing coverings ❑ 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• ;�(A ^r-'' f1W,6'F 141,,e r?u, IsSB 30� l Zr 4-v Ylte Residential Commercial ❑ r �^ Fire Zone: Yes-[] No a Confirmed with Planning De t. if there are any restrictions: LJ Cost o roject Type of Construction: Occupancy group: I Qty. if A l a Fee ID Fee Description Fee Group / BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING ^ O ZSR 3 I