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04070016
CITY OF CUPERTINO >r=w BUILDING Dfvlslory PERMIT sC0NTRACTOR INFORMATION BUILDINGADDRESS: OLD COUNTRY ROOFING PERMITND04070016 970-4 T,A MAR nR OWNER'S NAME: PERMIT LSSUE DATE FILOMENA B ONE: SANITARY NO, CONTROL NO, (707) 864-5557 ARCHITEC(ENGINEER: BUILDING PERMIT INFO �131.29 ELECT PLUMB MECH Lop LICENSED CONTRACTORS DECLARATION Job Descri IIO C I hereby affirm that I am licensed under,, visions of Chapter 9(Commencing p n with uun]IXq)of Division 3 of the Busime,(gdd Pm(essiuns Cock, nd myliecn"n _pN mm m amtle« e V XZZ �3 1 REROOF p�Z Lusts lass Lic.p n p Da¢ Court iim� As shallELTS �� i� AUG3 200 i 1 les c nd my pl ARCIfllheused&rx jnWi rtcmds tau A 3 o G Licensed Professional 1 `f OWNER-BUILDERat ..ereptfir DECLARATION /� <Z i hereby affirm Nat am exempt from the Contractors License Law for the 4Q/l hl r.� x 00 fullowing reason.(Section 7031.5,Business and Professions Code:Any city or county Cl I%U K 9 which requires a permit to construct,alter,improve,demnlich,or repair any structure prior m its issumm,alm requires theapplicant mrsuch permitm rile asigned statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Fl. Floor Area Valuation (corn reading wi to Section IIYq)of Division 3 rime B sexiness and Professions Cmk7 or that he is exempt Nemfmm and Ne basis for the alleged aomption.Any violation of Seeded 7031.5 by any applicant for a permit subjects the applicant ...ivil penalty of 3 6Q`VG ffiAbcr0 0 Occupancy Type nor more than five hundred dollars($50% P Y YP ❑Lasownerk.and property,ser is employees withwages as theirsole compensiness will dothe work,and the he Corms noes LntleJoralwt (ansate(Sec.too an Business and PrOfiessions Code:The improves; and Law dors not apply lf rt owner is Required Inspections propeny who builds or ed that thereon,and who docs such wed himself oor ffered his own employers,provided Nat such improvements see not intended m p«emd for sale. r. builder ,she building or den of pmcnlissoldwithinoneyear of completion,the owner. builder will have the burden of proving that he did not build or improve for purpose of ' sale.). ❑1,as owner of the propeny,a exclusively contracting with licensed contractors m hustmct the project(Sec.]Oaa,Business and Professions CWe:)The Contractor's Li. come Law does not apply to an owner of property who Wilds or Improver thereon,and. who contracts for such projects wish a eontracmr(s)licensed pursuant Ne Conoanor's License Law. ❑I sor eaempl under Sec. ,B&P C for this mason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby a(fsm under penalty of perjury one of the fallowing declarations: 1 have and will maintain a Cenifcam of Consent selGinsure for Worker's Compere scion,ex provided for by Section 3700 of the Labor Code,for the performance of the r mwi iehilia,probisissued. wo I have and will maintain Worker's Compensation Insurance,as onfored by Seetien 37 fMe Label Code.for the pcoPoornmerof the work for which this permit is issued. My Worker's perseti'on/lnsurancelc'�,Qer a�nit Policy number%�.SeQa'ld. mer. RTL (�p/!� Wiry No CERTIFICATE OF MITION FROM WORKERS' COMPETION INSURANCE (Tis YCLim meed not he completed film permil is for one hundred dollars($100) or less.) I coni fy that in the perPormance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject o the Workers Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Cenificate of Eaempth n,you should became subject to the Workers Compensation provisions or the labor Code,you must OQ forthwith comply with such provisions or this permitshall be deemed mw)ked. 'Z'"" CONSTRUC7DONLENDINGAGENCY l hereby affirm Nat there is a construction lending agency nor the Performance of X 7 the work for which this permit is issued sec.3097,Ci,C.) W 0 tcoda's Namc z , cr's Address J 0 1 anify Nal I have mad this application and sure that the above information is D, (--' torten.l agree to comply with all city and county ordinances and state laws refining to DV building Construction,antl hereby actinium representatives of this city to enter upon Ne W abovementionedProperty for inspection purposes. (We)agree to save.indemnify and tap harmless the City of Cupertino against F'h liabilities judgments. and eapenseawhich ma in an way ,secret against saitl City U Z in cunuquencc o(shc gmming of this per t� ^r APPLICANT ll ERSTANpS.A ID' ILL WIT ALL NO POI T Issued by: Date Z SOURC Cr TIONS: 2 z Re-roofs co Signuu Ap ImanUCgnm or �\ Dac HAZARDOUS MATERAIC b(SCLOSURE Type of Roof Will the applicant or future building dmidpanutore or handle hvadous material defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety ntle,section zs5]z(aR All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use ecemmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit hats docs air contaminants as defined by the Bay Area Air Qdality Management all new materials for inspection. District? ❑Yes rOr\N Ihavenndthchaaardnuamaurialsmqure umlerchapter6.'15ofshc Czli(nr. _ 1—a/z/ nix HralN&Safgt ode,Sceuom 1550,255 34, ndcrstmtl NmiftM Willing drys not curt tly a tenant. I� is hit y only the tccupsnt fen � rt tdond, - se t ane " ac atom!Occupancy. i _ Z L 1 re of Applicant SDate r amnorhnd agen, a,e 4 All roof coverings to be Class "B"br better a. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Cl OF Fax(408)777-3333 UPEki IN® JOB ADD /9 7�a 3 Lff /9.e-. IT # OWNER'SNAME>/ bore-k,+ # GENERAL CONTRACTOR: ©z,D 'Qq"DLX WoWlu,, FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin 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 Septic Tank Sheet Metal Sheet Rock Tile i e /Contractor Signature ate Community Development Department Building Division 1 City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 CITY OF Fax: (408)777-3333 OCUPEkTINO 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: O/'-7 c .-Vlj /5 t4 T7-_--r,-_f-1 Job Site Address: 1 q -3--0 J' L.1 A44->2_ I t/ c.` Roofing Company Name: OL�P C.ONnJTr:�q isODFIi✓ A plicant's Signature: /�//t+//L�tin� Date:�i- V? O - C)q \�1I�61ND�� Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO OREROOF CUPEF�TINO PERMIT APPLICATION FORM APN # Date: . to n o 30 - 04 Building Address: 3 L/1 M O net's Name: one #: O' aha 3 -4 5- Contractor: Phone License #: nZ-- CoU ,✓-r GQ-Z;? Contact: Phone#: Cupertino Business License #: c%ss y Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles X Wood Shakes ElWood 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''\&M Com 1 With Cu ertino's Tear Off Policy: Job Description: I0%/C. L%x 13 N or- ! r- H rZL_'k + V J y.L Going Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are an restrictions: 15 Cost of Project: Type of Construction: Occupancy group: L) D 0,0 1 Qty. if A li le 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 Licensc BUILDING a 7c