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04030149 BUILDING DIVISION PERMIT #ice TNF© Ma rnW BUILDING ADDRESS: PERMIT NO. 04030149 10339 MCKI-INTOCK OW NEWS NAME: PERMIT MUEDATE FOK MABEL NE: SANITARY NO. CONTROL NO. AR CHITECTENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Y00 LICENSED CONTRACTOR'S DECLARATION u 1ionby )of Net1amlianxdunder ndPraomof Chapter,Code, 9(commencing Job Description with Section]IXIO)of Division 3 of the Business and Prokmions Code,and my license i¢ H in full force and cffea 5qz Llcensucass Lk.p `022 k, REROOF, TEAR OFF SHAKE, INSTALL OSB, INSTALL Dam o Contruror zan .ar,s 30# FELT, 40 YR. COMP ARCHITECT'S DECLARATION �i 1 understand my plans shall Im used m public rtcnrds D U c Creamed Professional S OWNER-BUILDER DECLARATION Coni eto .0 0 I Mmhy esso ¢farm Nat 1 1. exempt from Ne Conlns Co License Law for the OO which ac mIlaOa.Permit 7(ALS,ct,Business mpr ve.deiolih,or Any city list County cture $ which requss a a permit re ennswn.palux.plic improv,demolish,rest emindir4 sig any structure y pdanoi6censed e.also PUMMILLto the res roepionsof for themchpctor's Uumse Law(ned hapten that he iccnsedpurmect 7010)of Division of theeuacmr'a License Law(Chapter Sq.Ft.Floor Area Valuat 845 F❑$ (cat he ing ptthenian7a00)ndM Waisofrth alleged Business pt Profesnians Code)or 3.. Net he is exempt Nert(rom and Ne baso for Um alleged exempdon.Any violation of ' Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy e not mom than live hundred delta.($5M). 29624004 . 00 p yTyp El 1,an owner of the property,w my employe.with wages as Meir sok compensation, will do Ne work and Ne structure is not intended mortared for aa4(Sac.7004.Business and Professions Cade:The Contractors License Law docs Out apply to an owner of Required Inspections property who Wilds ser l m pmws Nemon,and who does such work himself or Nnugh his own employees,provided Nnauch improvements en out intended oraEered for sale If. 1N�� however.the building or improvement issold within one year ofcompletion.Ne owner- builder will have the burden of proving that he did not Wild or Improve far propose of e sale.). ❑1,as owner of Ne property,am exclusively contracting with licensed..net..net.m APR 0 71004 construct the project(Sec.7044,Business and Professions Cotler)The Connector's Lt- came Law docs not apply to m owner of property who Wilds or Improv thereon.and, who contracts for such projects with a contractor(,)licensed pursuant to the Cmtranor'3 B�I�DIN License Law. ❑I am exempt under Sec. ,B A,P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby.5.under penllty of perjury one of Ne following declantimee 1 have and will maintain aCeruficate of Consent tuml6insum for Workces Comere p satim,as provided far by Section 3700 of Ne labor Cade.far Ne pertormma of the work for which Nsu is permit is Ised. C I have and will maintain Worker'&Compensation Imumme,m required by Section 3700 of Ne Labor Code,for Ne performance of the work far which this permit is Issued. My Workers Compensation Insurance carrier and Policy number am: Cartier: Policy No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (TMs section need not be Corona difthe Term isforonchundreddollan(S100) ser less.) 1 artily Net in th)per(nrmance a work for, ich this permit is lamed.I Nall nut employ any pe m map. to he m subjccuo Ne Work)n'Compcnsatlon - Laof Cati a in - Applicant NOTICE TO APPLICANT:IL after anditfill this Cmtiacam of Exemption,you should become subject to the Worker')Comp)nsettan provisions of Ne Labor Cabe,you must .J O forthwith comply with such provisions or this permit shall k demand revoked. z y CONSTRUCTION LENDING AGENCY [� Ibmthy aRra Na,them is a construction lamingag)ncy]or the imforrmnec of Ni 7 the work for which this permit is issued(Sec.3099,Civ.C.) QLenders Name r7 z Lenders Address U Q I certify that 1 have read this application and state that the above Information is 7.P cmrteet.1 agree to comply with all city and county ordinances and man taws relating m O U Wilding construction,and hereby amhorim«posaamatives of this city to color open the W aWM-memianed property for inspection purposes. g� (We)agree to ave,indemnify and keep It Ism the City of Cupertino against rFi fnIiabilides,judgments,egm;and expenses which in any way acme against mid City in his U^ APPLICANT UfNpN) rsRSTANDStAND W t COMPLY WITH ALL NON-POINT Issued by: Date SOUR Y.If IONS. Re-roofs Sigmturao Applicmi/Comracmr ` Dam HAZARDOU ATERIALS DISCLOSURE Type of Roof Will the applicam ser(umre Wildin6 occupant amrc lir hentlle hanrdaus memdal as deanctl byNe Cupertino Municipal Cade.Chapter 9.12,end Ne Health and Safety ode, wa e zss3zfa)] OAll roofs shall be inspected prior to any roofing material being installed. Ye Will the applicant or future Wilding occupant use equipment lir devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hassumus air contaminants as defined by the Bay Arta Air Quality Management all new materials for inspection. Dixaict7 0Ycs )<No limemadthehmardousmamrialsoqui mntsuaderChmtcrh.95cfthm Califor ria Health&Safety Code,Sam..,.7505.25p5 and25534.1undersrwd NuifNc huilding Jocs nota rte tl have a ren nl ret it i¢ respomihility m notify Ne rceupant of th) rtyui ichmusr m priors muatccoraCcrdaemeorOceupancg Signature of Applicant Date Own)rornuthntmdagcat 3—fro pate All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 i #UPEkTINO BuildingDepartment - JOB ADDRESS PE # 3,3 <1;, -/cc v `� 3 z G s OWNER'S NAME: i is ka,to c To PHONE GENERAL CONTRACTOR: FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin information: 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 S a oS� Hai, aai, Septic Tank Sheet Metal Sheet Rock Tile ontractor Si lure Date Community Development Department Building Division 110M City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408) 777-3333 qUPEkTINO 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: 001 b[/e-1 / O /< Job Site Address: 0339 A& /i✓1-1oGk Roofing Company Name: -Q4 OS • o' A pliant' 3-16-0,V Signature: -- Date: Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPER INO PERMIT APPLICATION FORM APN # 9 6 a g o o C/ . o o Date: Building Address: it j nl<a qz_ 033 Owner's Name: Phone#: Y© s7i-773 Contractor: Phone#: License#: S'n -TV_Q, - o- n a- 568' Y- 76(03 822_760 Contact: Phone#: Cupertino Business License#: fat he 0 393-91-0S Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles )<Asphalt Shingles )8r,Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# X To be Removed ❑ Provide Mfgr. Installation Specs. . I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Descriptii : - 0- 511Q kP— 1-h fa// OS _T17 5-1a 38'Pe-14 Residential Commercial Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: Ze Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg-Permit Fees BUILDING BENERGY En;rgy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING