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04100157CITY OF CUPEATINO °kr v� �gy0PENT - BUILDINCDIVIsiON 1ONTACTQWr+-.ON rw?y k)'eS+:k'AF4tr.(lg��r3�.5 BUILDING ADDRESS: ARMSTRONG INSTALLATION PERMIT NO. 04100157 OWNER'S NAME: PERMIT ISSUE DATE ONE: SANITARY OL NO. ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH ip LICENSED CONTRACTOR'S DECLARATION - - -- ' lob Description 1 hereby affirm that I em liacnscd under visions of Chapter 9 (commencing with Sect'a� ]01�)of DivialonJof cite Bum Profesdom Code.andmylicwcis _ in full fake�d.CfftCl L REROOF F I - AL E jz ;� LieeneClask� Lk.R� Date AR HITECI' EC ARATION ■N � < 1 urtdcrsund my flare shall bo umd n PuNic records NnV 2004 IfLicensed Professional OWNER-BUILDER DECLARATION f 1 hereby olrrm that 1 oro exempt From the Contraemrs Lkenu Law for the III f j O rull.wing remoe. (Section 7031.3. Business and Profession Code: Any city in county eat IV which re,to. a Permit to c.,. altar, improve. demnlixh, or mpoir any sa9cmre :y Prionoits issuahec. alio requires the apPlicam for such Permitm fleaaignrA sutemem Sq, FL Floor Area VaIU 100 G imikislim=dpuavanito R,cpmvisimuor Nc ConmwesLiu=Uw(ehapV9 :$ (commencing with Section 700))of Dwision3oflhe Business and Prorusinmcode) or I. that kit exempt therefrom and the huts Fm u e alleged exampdon. Any violation of 37VTV*9*r00 Occupancy Type Section 7031.5 by any applicant fora Permit subjects the applicant to a civil family of not mom Nan five hundred dollars (5500). 0 L as owner of the property, a my employees with wages as their sole compcnsatins, will do Ne work. and thea.to.0an, boarWed aroffcrcd larval. (See 7044, Bualmst Required Inspections -' P and Profeaai.m Code: The Conuaetorb Liana Law dors not apply In sue owner of 9 property who Wilds orimprews thereon, and wW dasswh work himself ortNough his .we employers, provided Nat such improvements am node anded moRered for vIe. It, however. the Wilding m improvement is said within oro year of completion, the owner- Wilder will have the Wuhan of proving Nm k did not Wild or improv for Puryme Of sale.). 0 1, a owner of the properly, am exclusively convecting with licensed contractors to construct the project (Sec. ]Om, Business and Profession Code:) The Conlnculs Li- cents law does not apply to an owner of property who Wilds Or improves Nemo., and who contracts for such projects with a conuactnn(s) licensed Pursuant he the COouaet.e. License taw. 0 l am exempt under Sac .B& P C for this reason Own Dau WORKERS COMPENSATION DECLARATION 1 hereby aRrm under Mostly of perjury mu of the following declersduts: 1 bare and will commin aCaNhcate of Coment to self4rim. for Wmkcri Compen- " radon, m provided for by Section 3700 of Ne Labor Code. for the Perfomuhee of the work for which this permit is issued. 0 1 have and will maintain Workers Compensation Inururrs, as matured by Section 3700 of the Labor Code. for lk performance of New for wbieh Nis permitia issued. My Workers C�oQmypye"n�s�ation/-I-nsuranee panim end P0,_ mbcram: NOMWO CERTIFICA'E OF EX1EMPf10N KE----�� ' COMPENSATION INSURANCE md; scdim head not becomplcted ride pumit is far. hoodmddollars($1 W) or less.) 1 eerily Not in be performance of the work For which this Permit u issued. l star .1 employ any Nixon in my amour so as in become subject t0 the WorkmS Compensation Laws of Califomi& Dau Applicant NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become subject to the worker's Compensation pmvisiom of the tabor Code, you most ,Z forthwith comply with such Provision or this prrmit shall W dcemcd awaked. 0 CONSTRUCTION LENDING AGENCY I heathy alrrm Not them i... onstmx,dim leading gercy far the Perfurman¢ of ' 7 the wank for which this permit is issued (Sec. 3097, Civ. C.) C) Lenders theme Lenders Address iZ ) C I certify the, I ban mad this application and sou that the above imeor dun is , cancer. I agree to Comply with all aty and county on mamas and State laws misting to F V . W a y to building ..indemniyand repharmldru of this OfCaPnuruPon Nc show mammuc l property for impectim Pmpmes (we).,construction, and (We) agree m Saw, indemnify and keep harmless the City against to hiCupertino liabilities. Judgments, casts and expcmes which mryin any way accrue againnsaid City Z in consequcnec of the granting of this Pamir. APPLICANT UNDER ST SAND WILL COMPLY WITH ALL NON-POINT Issued by: Date � k� EOUCATIONS. J wbi o Re-roofs Appnrm n err °ale HAZARDOUS MATERIALS DISCrL061t9E TYP sof Roof the applicant or future Wilding occupmum dlc hvardous material y Ne Cupertino Municipal Coda. Chapter 9.12, and the Health and Safety on 25332(a)? rPP All roofs shall be inspected prior to any roofing material being installed. es ONo a roof is installed without first obtaining an inspection, I agree to remove the applicant or future building arupant use equipment or devices whichIf us air contaminants u fined by the Bay Area Air Quality Management all new materials for inspection. es I have read lk)ursndtmtrommals m,immc.mdo,Chapur6.95oflW Csifm- nu Health& Safely Code, Section25505,25533 and 25534. rundersma diatribe Wilding dies not currently Ww a NJiNL that it Ia my rGPomihilitY m aodl'y ft OCeam, Of NC - Date requircmcnu hw.thto W ormtsmenaar cenlrcateafOcr9 ey, gnatureofApplieant 0 All roof coverings to be Class "B" or better 0 miuNmircd agmu/� Data CITY OF aUPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: 03 PERMIT # L Op I OWNER'S NAME: (Zl ScLAAP PHONE # GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check aoolicable subcontractors and complete the following information: � � er/Contractor Signature �j Date P#? 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 f f Septic Tank Sheet Metal Sheet Rock Tile � � er/Contractor Signature �j Date P#? �CITY OF UPERTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Subject: Re -roofing policy for the City of Cupertino Telephone: (408) 777-3228 Fax:, (408) 777-3333 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: f t\ a 5 L ^U ( f - Job Site Address: Roofing• • . - r u .. / . A plicanYs Signature: Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper avr& CITY OF CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM �c � J--,Dt_-- APN # D Bldg Permit Fees BUILDING Date: Energy BUILDING BSEISMICRE Seismic Fee Res 6 Building Address: Seismic Commercial BUILDING BPLANCHK Io ; JAye . C S s -fl, Owner's Name: BUILDING Phone #: k2 1 I t S i42-lo'?)Asa-omf?v Contractor: Phone #: License #: Contact: Phone #: Cupertino Business License #: ,54ti- i6 -11S) -7 D -S - Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes Cl 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 Descri ption: / cvtsfu e f0 Ca Residential Commercial ftl Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LI Cost of Project: Type of Construction: Occupancy group: )1' 1 Q 5-019 _ = f,(_ 4,3 Q�' if Ar/nliri hle. Fee M Fee Descrintion Fee Grout) �7 s13 2- q5-377- Sb 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 �7 s13 2- q5-377- Sb