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03070131 C ITY OF CUPERTINO BUILDING DIVISION PERMIT �'-,CONTRAGTQ, RiINFOR ATIPT,'*A1 lul ILDING ADDRESS: WILLIAMS ROOFING PERMITNO 03070131 0 54 MT�Irp A.1, NER'SNAME: — 4921 CABRILLOPOINT PERMITMUEDATE 252-5120 ARCHITEC"DTINCHNEER: ]BUILDING PERMIT INFO BLDG MECH M I ff PLUMB .0, LICENSED CONTRACTOR'S DECLARATION I harch,01iont that I am licensed ad.,prm,ix.u,mrCh.plar 9 amemovic., Job Description ZZ With Scfort[ ctricce%71U (Division Sof ftflusi�xdl PoifeumnsCade andarrylicimmis ,u u d in fall Let REROOF Lie to as Lac a ;z Dare Dow Cmulw. q I niumdony 0: .'d�Z&O LL LicensedPndcasinn y- OWNER THALDISIR DECLARATION AUG 0 6 2003 b "'in exempt am Else Contract r's License Law far the I to—vtS That a 0 (allowing can action 7,l3'l�,,.umP.x:r.rd Proresimax;Oclatle:Any city or County which requires a Permit to construct.*)let,improve,dicrausish,car repair any IMUChare im a a aFiy a n n r) for emcm that he is licensed pursuant to Eye previsions of the Contractor's License LAW(Chapter 9 Sq.Ft. Floor Area "'ata"I'L.UING Valuation (commencing with Section 7000)or Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.AnyVialMian or �,:;42oop _ nn St 7031.5 by a,applicantfarapeneit,objew the applicant tax civil pismilly of APN Number Occupancy Type .at..Msn five hundred dollars(S5(KE. 0 1,as owner of the property,or my employees with Wages as their sale compensation, will do the Work,and ON,structure is not intended or offered rat sale(Sure.7044,Business 305 FRAME Required Inspections and Pardfiesecura Code:The Cumuli License Law it=not apply to an owner of property who holch;at Improves thereon,and who doessuch Work himosIfortimugh his 307 - INSULATION Own employees,provided that such Improvements me not intended ourciffereal fariale.If, however,the building or impumnationt is mid within am year memeactian.the owner. 601 - ROOF TEAR OFF bull.der will ban the burden of proving that he did not Wild at hir,orsve for purpose of 602 - ROOF PLYWOOD NAIL ) ❑1. a Owner of the propisty,am exclusively contracting with licensed crouscions in 603 - ROOF BATTENS construct me project7044,Business and Pretessomon,Code:)The Commuclou-S Li. 604 - ROOF IN-PROGRESS cense law docs not apply to in Owner of propeny who wilds or improws thereon,and who comment for such projects with A coniractor(s)licensed ruminant to the Contractors License Law. 0 1 am exempt under Sm. ,9&P C for this matter Owner Date WORKER'S COMPENSATION_DECLARATION I hereby Moire under pi of perjury One of the frillowing,declaration: I ban and will maintain a Certificate of Continua self-insure for Worker's Campion. anon,a provided for by Section 37W of she Labor Code,for the perforroamcc of the Work for which this carrit is luted. I have and will maintain W kc' Coal '"tion I "ex as required by Section 1371M' ofthe Labor Conic,Car th,"�rfisona, My Worker pe,sation Ins ran=a rand Policy rrK&,R.:.1 it., Pali[ 112ox? y� c L.� W CERTIFICA OF EXEM OM WO KERS' 'COMPENSATION INSURANCE 1. (This;section need not haimarpRUnd If the Examil I.for on hundred dollars(SIM) car less.) 1. I certify that in the perfammum of the work for which this permit is issued,I shall.'it employ any Person in any meaner m as it?become subject to that Workers'Cruarmsation Laws ofC,lifirmix.Data Applicant NOTICE TO APPLICANT.If.after making this Cenificate of Exemption,you should became subject to the Worker's Compensation provisions of the Uhm Codc,you must Z forthwith comply with such provisions or Nis permit mail the dimmed revoked. z CONSTRUCTION LENDING AGENCY 4 1 hereby affirm that fficre is a contraction lending a;cncy for me Performance of > the work for which this permit is issued(See.31 Civ.C.) 1� lender's Name D z Lender's Address U C I cenify that I have read this application and auto that the.1have oftsommi,in is IL,P COnatel.I 29MC to comply With 211 City and County Oadimm..a and mile law$painting to 0 U building construction,and hereby autharibe actireSembuive,of this city to Onto,olum the ation-roafflioncif property for inspection purposes. (Wc)agree to on.indemnify and keep lnarmtm the City Of CUrponimi against i;i,E liabilities,judgments.costs and expeasses,which may in any way Rccaaa against said City U2, in cmisit,scom Of the granting or this permit. D to APPLICANT UNDERSTANDS AND WILL Co WE Issued by:3 97 SOL CEREGUL ONSRe-roofs 1.11 Signs fA c,nUC.......... HAZARDOUS MATERIALS DISCLOSURE Type of Roof Wi the applicant or future building Occupant store or handle husadous material as lclncd by Ne Municipal Chile.Chapter 9.12,and the Haididi and Safety Code,Se. 'S 3, E? D te LA U CEREGU Signe 0,A `C' HAZARDOUS W,7 the .."Can. My., All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future wildingOccupom use equipment or dcvicas Which If 6 roof is installed without first obtaining an inspection,I'ree o remove 'pit hayardhor,air commain, by the Bay Arco Ali Quality Management all new materials for inspection. WIWI? 0 Yes I have read the holoodous materials mquiterecour under Chapter 6.95 of the Califer. .is ficslat&Safely Cmk.Sema,25505,25533 an x5 4.l unticmtentl thwif the huilJing does up,commit,leve.um.m,th*t it ism ility to nn' cup of Nc cquirclaylls which must be met Dat I F 1H $ ser pp Icon 11' 1 S C "B or r I Owq&9�..0mi,cul spent All roof coverings to be Class "B"or otter V GENT BY: WILLIAMS AOOFINO; 408 288 5165; JUL-16-03 12:17; PAGE 414 Community Development Department Building Division City of Cupertino 10300 Torre Avenue F Telephone: (408)M-3228 CU QEIkTI N© Fax: (408)7773333 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) Ftnalinspection 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 perforated. 1. Flat roof&must have a minimum of Vi'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: ;6)kAf.fN7PA,�ArtN T Job Site Address: `7 Sof IM t wase Avc 4fA�.gaw4wrs0 Roofing Company Name: lW i l.L t Axv S d + i A plicanesSigmture: �%—c , Date: '7 /6/0-3 Greg I Building Official. Revised 1/30/03 OMfIA.M F�IrI 4...• SENT BY: WILLIAMS ROOFING; 408 286 5165; JUL-1603 12:16; PAGE 2/4 CITY OF CUPERTINO CUP[ REROOF t�TINO PERMIT APPLICATION FORM APN# Date: Building Address: 64 MI'LL.eW— AVBi4U6 C'u tt+l +� ca . Gis'o1•¢ Owner's Name: Saha t N `�kk>kR�/ Phone#: Contractor, Phone#: License# vJI 1A;4,c Roar-Inq 474eR�i Contact7 Pone M.•"�'"to wr� _77— hCUpertina Business License#: wIL'L~j 409-Z2.I-1-72-a /v94 l Type or Roof Covering: Existing: Proposed: )' Built-Up Roof `(r Built-up roof ^7vae-. ma n ❑. Asphalt Shingles r Asphalt Shingles 0 Wood Shakes a Wood Shakes 0 Wood Shingles 0 wood 9 ' - Ins' ❑ Other(Specify)_ 0 Other(Specify) Number of existing coverings 2I Z 0 Provide 1.C.130 Report# rC To be Removed 0 Provide Mfgr.hustallation Spew.A'66 400 yse I Have Read,Understand and Will Coma]y With Cu rtino's Tear Off Polis' . � Job Description: • Tirf-app G Ic•f ' A.oO Cornu r l�fitcc Sak 4o t •s1r.-f6ss p..ri�u 2 -maaAdown Residential Tir Commercial ❑ Fire Zone:, Yes Q No Confirmed with Plannin -li them are an mstri ns: Costo' roject: T of Cons tru nn Occupancy group: ` R -ROOF Qty t A a le Fee ID Fee Description Fee GrouD BPER'vIFEB Bld Permit Fees I BUIE DING BENERGY Energy 1 BUILDING BSEISMICRE Seismic Fee Res I BUII DINC3 BSEb4MICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BURDING BUSLTC Business Licensc BUII.DINe aS- ' 7 J� Iq 7qo -