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03070209CITY OE CUPERTINO BUILDING DIVISION PERMIT CONTRACTOR INFORMATION 6, BUILDING ADDRESS: "'"""03070209 ERMITNO030%0209 OW NEWS NAME: PERMFrISSUE DATE PHILLIPS 'NE : SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed ander pd Chapter 9 (commencing ]Ob Description O to with Scmion]Ukl f_Divisiop3oL's�lyusi v nJ Prufcssiun COJe. dmyliccnu is Fortuitous m ton tome r L� t(t l./�pa 7 3tl'76 License Cl Liwrt REROOF Dale Cantnemr eA , CONTRACTOR: UNITED HOME EXTERIORS AR HWuse ¢s DEC ATION 1 understand my plans shall ll be used public records F's _ALE® N Licensed Profcssi mol OWNER -BUILDER DECLARATION 1 botchy affirm that 1 am exempt from the Contractor's License Law for the ,\ �� I 11 q ^004 following reason. (SocU n ]0)L5. Business and Professions Code: Any city or county which rt4uircs a pmarit to consumer, ober, improve, demolish, m repair any ameture Prim units issuance, also rc hams the applicant for such Permit o flea signed statement that he is licensed o the of the Comrxcmr's Liccnu Law (Charier 9 Sq. FL Floor Area pursuant previsions 000 (commencing with Section ]U00) of Division J of the Business and Pmfcssi... Calc) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Saturn ]011.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3 �ffi3�Iif8$er0 0 Occupancy Type not more than fin hundred dollars ($500). _ El I, az owner or me property, or my employees with wages as their sole compensation, will do me work. and the awctum is not intended or offered for sale (Sec. 7004, Business Add Profcssiuns Code: The Co.=,.h License Law does not apply m an owner Of Required Inspections prolcny, who builds or improves thereon, and who duessuch work himself., through his 305 — FRAME own employ=, provided that such improvements me not intended orofferrA for al,. If, 307 — INSULATION however, me building or improvement is sold within one year ofcomplefion. the owner - wilder win haw the named of proving that he aid not wad or improve Tor purpose or 601 - ROOF TEAR OFF salt.). 602 - ROOF PLYWOOD NAIL 0 I, as owner of the property, am exclusively conuar ing with lirenud contractors to ect construct Mees not(Sec.]onownBusiness; Cu Li- 603 - ROOF BATTENS ceniwhoclawdocsnsuch plyman ofpro,rty who Wilds or impcmthamor'a orpropeny who memos.and 604 — ROOF IN—PROGRESS with who contracts for such projects with a comnnar(s) licensed parsuam m me C.nuaerors sed mrrimpro me Lim Liccnu Law. - 0 sat nempt under Sec. , B & P C for Nis moon Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under pantry of pe,jury me of the following declarations: I bas and will maintain a Cenificae Of Consent to self -insure for Worker's Comped- nn. as provided far by Section PI00 of me labor Code, for the performance of the rk for w i,h this permit is issued. IV 1 has d will maintain Workers Compewtion Insurance, as myuimd by Section 0 ofN bot Cwle. for Ne performance of the watt for which Nis permit is issued. Work, Com ion Bunn nrricronaP nugmhcr am: er. Polley. B 0 RTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu acetum coed not b, camplemJ Have frrmit is f amm hundred dollars($19)) err It.") 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner sn az or become subjem to the Workers' Compensation taws of California. Dam Applicant NOTICE TO APPLICANT: If. arm, making this Cenifcate of Exemption, you should become subject to the Worker'a Compo nation provisions of me labor Code, you must ' foMwith comply with such provisions or this permit shall be deemed powder. , CONSTRUCTION LENDING AGENCY I hominy alarm that mere is a construction lending agency for the Performance of tM work for which this permit is issued (Sec. 3097, Co, C.) lender$ Name ' Lcnde'A Address 1 certify that 1 have read this application and stmt that me ewve infcmmom is - 1 agree to comp with all city and county ordinances and sum laws relating to g construction, hereby authorim representatives of this city to order upon me uncd Pro iof (We) agree co indemnify keep . and harmless see City of Cupcna, against thisPnputlwus. es bdgmcnu, sts end expenses which they in any way accsuc against aid City s, ntin eq race of the anting ofmis permitCA UNDE STANDS AND WILL COMPLY WITH ALL NON -POINT GU -NS.rcof 4"C� Issued by: Date Re-roofsH bean OmnmW Dam ARDOUS MATERIALS DISCLOSURE Type of Roof Will applica ser future building Occupant score or handle harafdous mammal ed b c Cupe an u icipal Code. Chapter 9.12, and Nc Hcal , and Safetye,ti. ssa2(a)+ ❑Ycs All roofs shall be inspected prior to any roofing material being installed. tact a, If a roof is installed withni t firer nhraimfnrt on i.,e..o,..:,.., T ....___ ._ ____ _ t -- hazardous air conmmim u ucbncJ by the Bay Arca Air Quality Management vier? ❑ Ycs )gic eharardn m ialsrequiremenmunJ rChapmr6.95cftheCalifoniliaHcaode, s 15 ,5.25557 and 25534.1 undersand mm if the wilding ve nano that itis myreapadihility to noulytheaeupamofarcsettle ton prior Or issuance ora Ccoir, to ofocccupancy. 7/) ;ign Pture erials for inspection. 7/ alo Applicant Date All roof coverings to be Class "B" or better alM CITY OF UPEkTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 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. p7C*Homeowner's Name: GG�ry 1 t -p `,:,to 1 // Nr11w job Site Address: 2 Z Roofing Company Name: A plicant's Signature: . Greg eel Building Official A Revised 1/30/03 57f Printed an Recycled Paper Date: • CITY or CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM o3, ->7o? -07 APN # Q BUILDING Date: Ener BUILDING BSEISMICRE 7 Z S G Building Address: BSEISMICOM Seismic Commercial BUILDING Owner's Name: C�f(dI f �4Yi / t 01,9yPhone {�l BUILDING #: Contrc r: / FX -60'r5 Phone #: License #: mi tet KWIC GL' -55I 7 0 Q 1-73970 Contact: Phone #: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles * Asphalt Shingles 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: !MOVE Fkt56 l 1 54.1,5411 [ / / //L d,514.. �j �uli SGjrn C2 : Residential ❑ Coniffiercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planni Wit. if there are any restric ' ns: LJ Cost of Proj Type of Construe i G Occupancy grou ao� Qty.//i�f Ant>711le Frr TTl BPERMFEE Bld Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING 447