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05060062CITY OF CUPERTINO+� BUILDING DIVISION PERMIT CONTRACTOR INFORMATION . aU1LDINGADDRESS: DAN ELLIOTT'S ROOFING CO PERMIT NO 05060062 OWNER'S NAME: PERMIT ISSUE DATE NE: SANITARY AG. CONTROL N0. ARCHITECTIENGINEER: BUILDING PERMIT INFO g Ilk BLDG ELECT PLUMB MECH la A OI iSs O o LICENSED CONTRACTOR'S DECLARATION mw a -a' Gi "js G - Job QCSCflptlOrY�s�S^, 1 hereby affirm that l am licensed under provisions of Chapter 9 (commencing p ftav gkks with Section ](MMI) of Division 3.fffim Business and Professions Code, and my license is Skmmm io full fort, and 1. Lim ,ata tic.. REROOF W/SHINGLES an - - — ctxumctor JUN 2005 ARCHITECTS DEC A 0 w I understand my plans shall W used As public records � T BUILDING"' /t\G\' Licensed Pntfcuinnal OWNER -BUILDER DECLARATION N 1 hereby al&m Nm I am exempt from the Contractor's License Law for the following reason. (Section AD 1.5, Business and Professiom COO: Any city or county which requires a permit to construct. alter, improv, demolish. lir repair any suunure prior no its issuance. also requires the applicant for such permit to rile a signed statement Nat W is licensed pubonito Ne provisions of Ne Conuacwr's license Law (Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section]000) of Division 3 of the Business and Professions Cods) or Our he is exempt Ncmfmm and the basis for the alleged exemption. Any violation of vs,�wr.wn�s�vk, 3 Sim IL JlYDV9er0 p Occupancy Type Semon 1031.5 by any applicant for a permit subjects me applicant to a civil penalty of not more Nan It. hundred dollars (5500). ❑ I, as owner of the property, or my emplomea with wages as their sole compensation. Required Inspections will do Ne work, and tim iWcIYR Is nut Intended of offered for sale (Sec. ]oda, Business and Professions Code: The Contractor's Liame Law docs not apply o in owner of property who builds or impmvs thereon, and who doessuch work himself or through his own employees, provided that such improvements are not intended oroRered for me. If, however, Ne building or improvement is sold within one year of completion, Ne owner, builder will ban the burden of proving Nat W did not build or improve for purpose of sal..). 0 h as owner of Ne property am exclusively contracting with licensed conacmrs m construct the pmjen (Sec. 7044, Business and Professions Cdde:) The Conuuwr's Li. come Law does not apply to an owner of property who Wilds or improve themdn, and who contracts for such projects with a contractor(c) licensed puodant to the Contneeh License Law. Glom/�$/pt titin/dy/J�S�cC� Bk P C for this mason Owner • ( JGG�dL- Dare WORKER'S COMPENSATION DECLARATION 1 hemby aMo. under penalty of perjury on, of the following declantimuc I ham and will maintain a Cenirmate of Consent to self-insum for Worker's ComNn. cation, as provided for by Section 3700 of the Labor Code. for Ne performance of Ne work for which Nis permit is issued. 0 1 have and will maintain Worker's Compensation Insurance, as required by Section 3700 ofthc labor Code. for the performance of the work for which this permit is issued. My Weska/as Compensation Insurance artier and Policy number art: Cartier: A -Ca a n S K 4-6 vi G�olicy No. {a ��%%,91/%II) 7/1/3! CERTIFICATE OF UEMPTION FROM WORKERS' COMPENSATION INSURANCE TITh section need nm W completed if the permit is for one hundred dollam (SIMI lir less.) I certify that in Ne performance of the work for which Nis permit is issued, I shall not employ any person in any manner an u in become subject to IN WorkersCompensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject an Ne Wader's Compensation provisions of Ne IaMr Code, you rosea forthwith comply with such provisions or this permit shall W deemed evoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm Met then is lending agency for the Performance of s (vection Me work for which this permit is issueded (Sec. 309], Civ. C.) Le Name Lender's Addrtsi j 1 cenify Net 1 ban mad this application and sum that the thea, information is correct. I ago:, a comply with all city and county ordinances and suite laws relating to building construction, and hereby authorize (Opresernathma of this city to enter upon the - ahove-meeioned pmperty for inspection purposes. (We7 age to sav, indemnify and keep harmless the City of Cupertino against j liabilities,judgmreents, costs and expenses which may in any way ammc against mid City in consequence or Ne granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATIONS. Re -roofs Type of Roof Signazum al ApplicanVCamracmr Dam HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wilding deadpan, ream or handle haum ous material u defined by Me Cupertino Mum ' al Code. Chapter 9.12, and the Health and Safely Cw..Scit255320)+ All roofs shall be inspected to any roofing material being installed. ❑ yes prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or Room Wilding occupant use equipment or dcvicu which it hazardous air contaminants as defined by Me Bay Area Air Quality Management all new materials for inspection. ,strict, `' 0Ym [�N. I have read the haaMws materials requirements.rude(Chapter 6.95 ofthc Califor. lila Health k Safcty Curie. S.eume MY)5.25533 it 25534.1 understand Nat fte building does not currently hate a tenant that it is my respontihility to nouly the occupant of the O 7 requirement% which mustW met prior to issuance of a Cemficme of acupency. Signature of Applcant Date roof coverings to be Class "B" or better ' Owner dradmdrfndagent DateAll _ Z40 CITY OF �UPEkTINO JOB ADDRESS: OWNER'S NAME: GENERAL CONTI I am not using any subcontractors: Community Development 10300 Tome Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department PERMIT # 0.S'06ov �-Z PHONE # yB SS % 73,2 7 FAX#YOB 73d7 Signature I Date Please check applicable subcontractors and complete the following information: Owner/ ontractor Signature 1�6- /�- -e) 5--- Date Date 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 Septic Tank Sheet Metal Sheet Rock Tile Owner/ ontractor Signature 1�6- /�- -e) 5--- Date Date iCITY OF CUPEkTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-328 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. 7 NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re -inspection fee of $176.18. The re -inspection fee must be paid before another inspection can be scheduled. 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: Ko t t Y -s e, lob Site Address: _LLI 2 % 2 6J y,�-!� Roofing Company Name: go Applicant's Signs Greg Casteel Building Official Revised 11/2/04 Date: 6-2-o S s 01TYOF CUPEkTINO CITY OF CUPERTINO REROOF v S d PERMIT APPILICATION FORM APN # -3 Building Address: 102-12 Owner s Name. , 1 � 1 `M S 'C�r 1Y� �/V Contra NAA, �'�`o is Rob �/ Phone#: Contact 4�g0 % SSCt -13Z1 Phone #: 1�at� or Cul qoX ssei �3'z7 Type of Roof Covering: Existing: ❑ Built -Up Roof ❑ Asphalt Shingles 12 Wood Shakes ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings ❑ To be Removed G�I Have Read, Understand and Will Com With t Job Description: YnOV� g a SI 1A's Yti41JJ cl s s ` Or,Residential LA Commercial F1 Fire Zone: Yes ❑ No Cost of Project: t ?Zi`0 Qty. if Fee ID BPERMFEE BPLANCHK BUSLIC Date: (9 X-hpne #: IOA License #: Cupertino Business License #: Proposed: _ ❑ Built -Up roof ® Asphalt Shingles �O �Ea ❑ Wood Shakes ❑ Wood Shingles fcbTm r ?jC 1 ❑ Other (Specify) ❑ Provide I.C.B.O. Report # ❑ Provide Mfgr. Installation Specs. Deertino's Tear Off Poll p��wcod z t ti ?0 Type ofConstruction: +r0.vho Fee Permit Confirmed with Planning Dept. if there are any restrictions: Occupancy group: Seismic Fee Res Seismic Commercial Plan Check Fee Business License Fee Grou BUILDING BUILDING