Loading...
05060005 CI'PY OF CUPER'fINO ONTRAC"TORANEORMATION W BUILDING DIVISION PERMIT BU ILDING ADDRESS: OLD COUNTRY ROOFING PERMITNo05060005 • OWNER'S NAME: PERMIT L45UE GATE ONE: SANITARY 90. CONTROL NO. (7n7) RfS4-r)S52 ARCHITELT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH uo0 LICENSED CON'MACTOR'S DECLARATION Job Description 1 hereby affirm mal I no licensed under provisions of Chapter 9(commencing i� with Icli.nl0 )cf Division3ofthe Businmi an ofCmaon d. ylicensci , Ll <a Nmutnrceander�a.3tj OOF W/ OMP . SHINGLES o t2E Licca.Class Li =� Dam -1 Can char ARCHITECTS DECLARATION I understand my plans shall he used as puhlic records DyU 3 0. Lkca.d Pmfcsaional OWNER-BUILDER DECLARATION <f 1 Wrchy.(Bens on I em exempt from dr Cssions Co Any c Law far Nc 2O followingmassa(section?o s5,Bualter. and ve de isru Code Any City orcounty m whim acquires n permit ne csres the altar,improve,h pimmsh or repair any Stracture umment priorm insissuance,also mqo the prevision of for suchpermitw Glcssigned atammem that me cccnsedpunuamtotheofDivision3meConuiness ndProflsonsCodmr9 Sq.F[. Floor Area Valuation FVFG (cat he is(commencingwithSection and or Division n 3 the me alleged cu and on.Any Cmk)Or i 5 that he is eumpt therefrom and die Dasa for Ire alleged exemption.Any violation of Section 7031.5 by any applicant far i permit subjects the applicant o a civil penalty of 351LFN3tM*gr00 Occupancy Type not more Nan five hundred della. ❑I.u sumer of Use propmy,m my employees with wages as their=]a compensation, will do Ne work and ammacmm R oat intended Or offered formal(Sec.7044.Business - and Professions Code:The Conlraators License low does not apply in an owner of Required Inspections /// property who sWilds oded that such unprved who are not chwork ended omulf ed W.ugh his own employees,provided that such impro old wit are not intended m.Rend for sale,if, howevrO the buildingvth or improvement is sold within one yeti of completion,Ne owned builder will have Um burden of proving Nm he did nm Wild or improve for purpose of sale.). ❑1,as owner of the property,am exclusively contracting with licensed convectors to ��j ma construct the project(Sec.7 a ,Business and Professions Code:)The Conuaclm's U. arae Law dors not apply an owner of property who sed personal m improves tremor,and w.., who cantor.for such projea cts wm ith a concmr(s)licenseduto the Convxtors V�\ LK[M1.IoW. 1 am czcmpt under Sec .B k P C for this moon Owner Dam WORKER'S COMPENSATION DECLARATION '- 1 hereby affirm order penalty of perjury one of the following declarations: 1 have and will maintain a Certi0cate of Consent o self-insure for WorkersCompen- arhion,as provided for by Section 370 of Nc Iobor Code,for Use perfor riance of the work for which this permit is issued. 1 have aril will maintain Wmkcr's Compensation Insurance,as mquined by Section 700 of the IODm Cad,for the Performance of the work for which this permit is issued. My Work��r/�t C�orygperfu�atlion lnsun`ns carrier and Policy number am:L Cartier: e L•^-� -r' ✓✓a'a�k.pkw� Policy Nr.:Lt 3(,J V CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the Permit is for one hundred dollars($100) less.) I anify thm in the pe,I,....of Ne work for which this permit is issued,l shall not employ any person in any manner an As to Dttonre Subject o the Workers'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT:IL after making this Ccnificala of Ea airai n,You should become subject to the Worker'.Campmmild n provisions of Ne IaWr Code.you mum �Z. forthwith comply with such provisions or this Permit shall W deemed rooked. .ziO CONSTRUCTION LENDING AGENCY Er Ihereby affirm thm then is a construction lending agency for the pcerformarm,or a Inc work fur which this permit is issued SCC.3097,Civ.C.) W A Lende,'s Name fL Lender's Addreas D z U O 1 certify that I have mad this application asW sale that the shore information is Is. roman.1 agree in comply with all city and county ordinances and some laws relating to 0U Wilding construction,and hereby maluaim mpmsenatinss of this city to env+upon the C anove-mentioned property for inspection purposes. (We)agree I.save,indemnify and keep bemnless the City of Cupertino against p3 liabilities,judgmenkv.eoats and expenses which may in any way accroc against said City U z in conse9ucge of grantingo his t. ^� APPLICANT ER 54 D TILL C LY W HALL NON-POINT Issued by: Date SOURC I/f� 5 Re-roofs Signature of Ap,limCVC...Um m HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant Or future building oceupeal more or handle hvallous mavrial Us dfumd by Ne Capetian.Municipal Cock,Chapter 9.12.and the Health and Safely GWL.Section 25512(.)? El Ye _ All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hv.ardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. lducs ❑YesIhavereadthehvaWnus ons 25%5.25533mmena untieChtand thtiftha Califonrfiaahn&rionlyhawasenam,dmitia5ty hempand 2553a.l undersmoodilnde occu,c Wilding \ � y / ps realcurtendy hoar a tenant Natitumy respartsihilihY mnrnifY IM oaupanlofWe oinmcrs which mum be mel prior w issuance ora CcrdGeme of Omtiprmy. Signature-of Applic4dt Date Owner or aamorizcd.gear Dam All roof coverings to be Class"B" or better 05/30/2005 09:20 7075287663 PERMIT SERVICES IMC PAGE 01 70*,j '",N10_ 1Co=um.,.Y DCvdvpE&w 10300-ED=Aveu� Cupe4tmo CA 95014 �, To1cpAcoo(403)777.3228 Fax(408)177"3333 Cl1PE�TiNO . astment BuildingDe pgltMn a 5 . 000-s JO s ADDRESS:�r OWt TER'5 NAMT: G3{nl� _ FAX a 9� x GENERAL COr1TRACTCR Q-5, 1( l e.tci nG!using Sry Sub c(mttaCtdrs' Date $ignalvre FZe&ye check a licab?e subco^`sactor$ and com tete thefollou'in 1MOMiahon SUBCONTRACTOR BUSIIvESS.N I BUSINESS LICENSE # Cabinets & NjjUwnrk Ceme.,t Finishing Ele-,M03 $xcacation FFencing --- rlo�r�g� CaiFetin$ - LS31GifllI:1 / Wood • ` Glass/ Glazing Iieating lnsTlation Landscaping r—'�—!�� L©thing --�---- ' ?VI3gGYt�' - O:namentsl Sheet Metal Painhngr Wafpaper PaVO Plasteristg Plumbing Roofing i Septic 1'a1Tk Sheet Metal Sheet Rock Tile — - . x Owner/Contactor Signature 1oi:8103 TO/10'1J T0£BEeLsor SNIJOO( j h v,nu7 om 91 .01 sone-TE-MW Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 CITY OF Fax: (408) 777-3333 SJPEkTINO 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: `���/>�p ,f/L.e c Job Site Address: ffs S > Roofing Company Name: 01 cP A plicant's Signature: - Date: S Greg teel Building Official Revised 1/30/03 Printed an Recycled Paper DIM CITY OF CUPERTINO REROOF Of CUPERTINO PERMIT APPLICATION FORM APN # Date: 354' - o3 — a z.� Building Address: Owner's Name: Phone#; q e7 Contractor: Phon #: License#: Olaf �oFl7S'z 8300 62 -273 / Contact: Phone#'A Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles & Asphalt Shingles �ti 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: �/ p /1 z „Cis S g. add _:�o L p /�_ _ mmO Residential Commercial w�J O�u� Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: 7 000 • �D Qty. if Applicable 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 License BUILDING 137Y