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05090204 CITY OF CUPERTINO '�•��a-r�- ,.S BUILDING DIVISION PERMIT OCLILVTRAC N)RINFORMATION BUILDING ADDRESS: LOS GATOS ROOFING PERMIT No,0 S 090204 ` 2118 OW NER'S NAME: PERMIT ISSUE DATE AGNES LEE _ 888 FAULST S NE: SANITARY NO. CONTROL NO. (408) 298-9399 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u00 LICENSED CONTRACTOR'S DECLARATION I lumby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description iN Section 70(X1 of Division 3 of Out Business and Professions Code.and my license is �„ in fullfrmcanAcff 9n --REMOVE SHAKE, INSTALL SHINGLES A? License Class .J-/ Lic.N �t�y psa eFp Dam a O �- Conaranar F{� /II Tyr "F ARCHITECTS DECLARATION Lplf PC 1 understand my plans shall W uuA u public amrds >in yUti.a� i11/ A Licensed Professional 0� k'1L, 5 OWNER-BUILDER DECLARATION I hereby affirm that 1 em exempt from the Contractors License Law for the a o following mason.(Section 7(31.5,Business ad nPniu dcssns CndC:Any city m county �3 K m which requires a permit m construct.alcor,improve,demolish,or mpair any structure � f(! 001 918 5 L_v,, prior to its issume...1su mail.to applicant forauch permit lr Tilcasigned sommem gY �.. < that he u licensed pursuant to the provisions nr On Common's U,xone law(Chapter 9 Sq.Ft. Floor Area p' J�Y h p"'t jj s\: Valuation xhi-$ (commencing with Section 7000)of Division 3 of the Business and Profession Cods)or `��� (j 1 r( t4 t y _ that W u exempt Ocmfsom and the basis for the alleged exemption.Any violation of r+---.n"."8��f1 Section 7031.5 by any applicant for a permit subjects On applicant to a civil penally ofa y�-Type not mart than hundred dollars($500). f O CUp N C T C n fin I,uowrmr oftM pmprnY•amy employee with wageu their solecmnpcnsnion, And Prone won,Cdthe he C mummue.Lt.edmaw does of 1,10 a4.CwMC1 of Required Inspections and Professions builds The ws thermfa Lt..Law docs trot apply to an owner is q P propertywhobuilds mimprawsthereon,and who Arcssuchwork himself dthrough his own employee,lding r improvement improvements arenot intendedaofompletied forsthe owner- Wilde, however.the building u improvement is sold within one year of mprove for the owner- builder will low One buNcn of proving that h<did not Wild or improve for purpose of sok.). ❑1,as owner of the progeny,am exclusively convecting with licensed contractors m construct the project(Sec.]OCC,Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who Wilds or improves damon,and, who contracts for such projects with a canto bou(s)licensed pursuant to that Contractor's License taw. ❑ I Am A.empt under See. .B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby Anion under penalty of perjury one of the following declarations: 1 ban and will maintain a Cenifcao of Consent to self-insum for WorkaraCompen- 703c", ion,as provided for by Section 37W of the Labor Code,for the performance of she rk for which this permit is issued. 1 have and will maintain Workers Compensation Insurance,as required by Section 00 of the Labor Code,for Ne performance of dm work for which this permit is issued. Worker,CCioncrena oAy,-Z. oorrr���Insuo,,,,,,.///.Cannot and Policy numberrtier. r__`C(E �Palic,NO.: 27 '-l-DOr CERTI CATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu acnion need not W CompleoJ if the permit is fm one hundred dollars($1041 nr les.) I certify Out in the colormance of the work for which this permit is issued.I shall nut employ any person in any manner so as to become subject to the Workcri Compensation laws of California.Date Applicant NOTICE TO APPLICANT:IL alter making this Certificate of Esemption.you should become subject to the Worker's CumMucation provisions of dice tabor Code,you must J Z fonhwith comply with such provisions or this permit shall W dcemed mwked. zO CONSTRUCTION LENDING AGENCY l hemby affirm that there is a construction lending agency lot he performance of CC > the work for which this permit is issued(Sec.3097,Civ.C.) LU A Lender's Namc 6. Lenders Addreas U O 1 coni!,that I have mad this application and sato Nm the above infmmuion is Iy corms.I agree to comply with all city and county ordinances and soon laws relating to 0 building construction,and hereby•uthmixe mprucmatives of this city to enter upon the r W .how-mendnrod propeny to,inspersion purpose. (We)agree to Ann.indemnify and keep harmless the City of Cupertino against F-' y liabilities.judgments,Cosa and expense which may in any way accrue Against said City U Z in consequence of ort granting of this permit .. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date S f- 5REG,LAS. Re-roofs lieuNCrummuLor Fi r` Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will On applicant or future Wilding Occupant atom or handle hazardous material az ticloved by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety ode,Section 25533(X)7 ❑Yes I All roofs shall be inspected prior to any roofing material being installed. .ra'Nu , Will the applicant or future Wilding occupant tic equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove nit hazardous air contaminants u defined by me Bay Arta Air Quality Management all new materials for inspection. .n it ❑Yea �tJu [ban mad meha7ar(iusmawrialsmquimmenuunder Chapkr6.95ofdm Califor. aFielth&SafotyCdc,$retorts 255(15.25573anJ35534.1undcrsuM thuifthc Wilding re Out currently haw a tenant.mat it u e ocmy responsibility io notify thcupant of megaimmenu v,lb moat W mel Pony in seance rfl Cen;111 '0'crpancr. Signature of Applicant Date r {� L ��� All roof coverings to be Class"B"or better Owner or authorised agger — Date Community Development Department + Building Division City of Cupertino ' 1.0300 Torre Avenue CITY OF Telephone: (408)777-3228 W PEkTIN® 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: p (� __ Job.Site.Address:_____ Roofing Company Name: A plicanfs Signature: e; Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO i REROOF ® CUPERTINO PERMIT APPLICATION FORM i APN# — � Date: D Oa f Building Address: .2 Owner's Name: / Phone #t Contracto 7 Phone#: License#: Yop 29f-9399 &07Q•7 Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles -;E� Asphalt Shingles 1* Wood Shakes ❑ Wood Shakes - ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) Other(Specify) /WOS �� SzQn Number of existing coverings 1 ���❑/// Provide I.C.B.O. Report# -aN- �d To be Removed y� Provide Mfe.Installation Specs�__l ® I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: Residential Commeteial ❑ y Fire Zone: Yes ❑ No Confirmed with Planning Det. if there are anrestrictions: LJ Cost of Prcj ct: Type of Constructio Occupancy group: SS �roa Qty. if Applicable 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� Iia .