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04070110 CITY OF CUPERTINO �` BUILDING DIVISION PERMIT CC11 '. iZA.CPO � rrl+' i. ZrION' �; BUILDING ADDRESS: C & C ROOFING PERMIT'00407 O 110 f. 0340 LOCKWOOD DR OWNER'S NAME: PERMIT ISSUE DATE Ag hk JOHN SU 1JbNE: SANITARY N0. CONTROL NO. (408) 298-1868 ARCHORCI'/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ] 0M Z, LICENSED CONRACIOR'S DECLARATION Job DeBCTI IIOn a.'�� U 1 hemby KinOp Kinn that 1 am licensed under provisions of Chapter 9(commencing ' with Smon 7").f Division 3m`thw BusiOca amd Professions Code.and my license is '414 �� © in full tome andeaect REROOF W q 5�z Lmm!n his Lk.g L /COMP. <oO4 F p Date Coalrato( Q ARCHITECTS DECLARATION g i undersand my plans shall be used As public awards w )uU ®S 3m Licensed Professional YY��ggggyl,, OWNER-BUILDER DECLARATION E I hereby mum .(firm that 11. exempt face du Comes oos License taw for the y p U which mt arcs .Icccdan?113..memo,, Business and Profcsaium Calc:Any city or county structure a�$ which requiaa a permit I.re cures tha ,plicalun.impmw,dearmit i or repair any ummerc fee prior urslitsimn nec,altantiot vheapplicanlfo Cwon oni lei's L!m asigned aammem �th that mencccnud pu.tion7")provision of the Co usines's License Law(,Code)9 Sq.Ft.Floor Area Valuation $ Oaths s memithSmfm 7 andtf basisofrelmceged cesmtProfessions Code)or .. Net he u eumpl therefrom and the bels for the Alleged eumpdan.My violation of Section 7031.5 by any applicant for a pemtit subjects the applicant to e civil penally of 3 41"PI�e10 0 Occupancy Type .at more Nen fiw bundmd della.(S500). ❑I,As owarofthe property,or my employees with wages As their sole compensation, will do Ihework,endo: he ComismesLndns Law Business and Prty who Code:The Com.nors Liana law dors mel apply to ea owner of Required Inspections propertywhobuilds provided nonsuch Am himselfmforsahbis awn employees,pmvided m improvement mid wit arc not intended mpich ed for mac If, however,the building or improvement is sold within one year of Improve far mop.owmar. of builder will have the burden of proving mat he did not Wild or Improve(or purpose of aa1e3. ❑1.as owner of the property,am exclusively contracting with licensed contractors to consumer the project(Sec.1044,Business and Professions Code:)The Contractor's Li- cense Law docs not apply to an owner of property who Wilds or impmws memon,and who contracts for such projects wits a conmctoKt)licensed pursuant to dm Conmctoh License Law. ❑I am mapt under Sec .B&P C far this mom. Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby starts under penally of perjury one of me following decimations: - I haw and will maimed.a Certificate of Cmu cat m self ince.for Warner's Campen- nation,As pmvided for by Section 3000 of the labor Cade,for the performance of the work for which this permit is issued. ❑I have and will maintain Workers Compensation Insurance,as required by Section 3100 of On,IaWr Code,for the Performance of the work for which this permit is issued. My Workers Cam.._Madan insurance carrier and Policy number are: Cartier. fi/ CERTIFICATE OF EXEMPTION FROM WORKERS' , COMPENSATION INSURANCE (This section mad nm becompleted if the pa.RIsfmmm hundred dollars(SIM) or rest.) 1 certify that in the performance of the work for which this permit is issued.)shall not employ any person in my manner an ae to become subject to the Workers'Compensation Laws of C.IiRmiA Dau Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption.you should Wcome subject Out the Workers Compensation provisions of the Le Wr Code,you must Z raMwith comply with men provisions or this permit shall be domed revoked. ZCONSTRUCTION LENDING AGENCY O F. I hereby am.mat then is a construction lending agency for the perromeamc of ai> the work for which this permit is issued(Sec.3091.Civ.C.) Q W� Lender's Name ] lender's Address U Q I certify that I have mad this application and set that the sinew information Is UL H coned.I agree to comply with all city and county ordinances and sate laws mating to 0U building construction,and hereby aarharim representatives of this city to enter upon the W shove-memimted property for impecimn puriwses. (yam, (We)agree to saw,indemnify and keep hmmless be City of C.Potum against L.t fajJ lobilidea.judgments.costa and expenses which may in any way acme against said City in conwqmnce of dus of his C) APPLICANT UNDERSTANDS tAND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOUR EGULATIO O ;2-Ro-oq, Re-roofs Signed..of AppaicmUCanuacwr Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occup nt at=or handle hamrdous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety ASOLC.de,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. E]Yet Nu Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hanicaus air conaminants As defined by the Bay Area Air Quality Management all new materials for Inspection. [0%�.n' ❑Yes rrd'NPI have mad the harallous materials mquimments under Chapter 6.95 ofthe Callfor. ealth&Safety Code.Sections 25505,25533 and 25534.1 undersand rot if the Wilding /1J ` 7Z not currently haw a taen4 Nat it a my rcspomibilily m nnul'y tW mcupmr of meas s which must be met prior m issuance of a Certificate of Occupancy. Signature Of Applicant Date All roofcoverings to be Class "B"or better er ter authorimd agent Dasc Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO Buildin Departent JOB ADDRESS: PERM # D Ck o 47110 OWNER'S NAME: , PHONE # GENERAL CONTRACTOR-: C . f o FAX # I am not using any subcontractors: /o% &f.,..._..— Signature Date Please check applicable subcontractors and complete the following information: 60 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 C r2w C,V G Septic Tank Sheet Metal Sheet Rock �yJTile Owner/Contractor Signature Date Community Development Department Building Division ' City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 Fax: (408)777-3333 CU PEI�TIN® 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: 1//Ult Xi S U J Job Site Address: G OC c v vii ® (Z Roofing Company Name: A plicanYs Date: reg Geel Building Official Revised 1/30/03 Printed on Recycled Paper 1 CITY OF CUPERTINO REROOF �CUPEE TINO. . PERMIT APPLICATION FORM APN # 7<?Z 15-J O / Date: Building Address: w OT/L/ �, A Owner's Name: Phone #: Contractor: Phone #: License #: Contact: Phone #: Cupertino Business License #: Of- 8'7 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles A Asphalt Shingles 4 Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) 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: ��d n41— Q4714 CcS Z q 5-k; FWI/W c !NP Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed lanning De t. if there ar n rest ' tions: LJ Cost of Project: Type of Constrticti ' Occu ncy gro Qty. if Appli ble Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING SEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING