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04110073 CITY OF CUPERTINO d 's»a ,aw. �' �. �' "'§°'�� "�°' �"- BUILDING DIVISION PERMIT CONTRACTOR,INFO•,RMA'�ION - - a;✓ ,v . BUILDING ADDRESS: PERMIT NO. YORKSHIRE ROOFING 04110073 OWNER'S NAME: - PERMIT ISSUE DATE ONE: SANITARY OL NO. AR CHITELTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 Lap LICENSED CONTRACTOR'S DECLARATION U F Inc y erre Inn I,m licensed under provisions of Chapter 9(minnuman.9 .. Job Description `uj wiNSe do f Division 3 of cite Business and Profession Code it mylimnseis - 5,�z in L:an a�J Lm.x w. REROOF W/COMP. ,� 1 p 3is=3 Dam ARCHITECTS DID EC.A ATION o J � / l \1 'Iy IunMR Yplans shallW it az Public reear e/ •I`'_�/ 1 - -.. DaU \ I JJ LICCM1Md PNfCV1aMl G5 OWNERexemptRDECLARATION <E 1 hereby aRa a nI 1 1. exempt from the Contractors License law for the p O following rcamn.lSec6on 710L5.Business and Professions;Critic:Any clay or county K @ which requires a Permit to cmuvoek altar,improve,demolish,or mpair any structure r 1 prior m its issuance.also requires the,pplirantforsuch Permit m file a signed summenl < that he is licensed pursuant m the provisions of the Contracmrs Limnse law(Chapter Y - Sq.Ft.Floor AICA '�` f/Value On QFC Commencing with Section 7")of Division 3 of the Busimensand Professions Cwk)w a Nat he u exempt therefrom and the basis for.the alleged exemption.Any violation of v Section 7031.5 by airy applicant for a peal,subjeeu Nc applicant m s civil penalty of 3 y I2Ilfjtt e10 p - Occupancy Type not more Nan five hundred dollen($500). wi Lo the works. rifdm property,or James with mgataslh'v sole mmpewdess will do the work,end Ne.hecto¢u noI intended Lice or ancrod f .1 apply in aa,Burin... and property wh W ldsor The improves domain, ndwho law does ret apply lf an owner is - - Required Inspections - proPenywhobuildsorimprovcsdmreon,endwhotloesaucn work himself or Nmugn his - ownemployea,ping oriprowmimps mid wivarenot year the owner. however,the building or improvement is sold within rete yen of mmPlve for the owners builder will Mere the burden of paving that he did noI dtiW or improv for Purpox of sok.). I,as owner of the propcny am exclusively convecting with licensed connecters m construct the project(Sec.7000,Business and Professions Cade:)The Conunwrs Li. . came Law does oat apply m an owner of Property who builds or improves thereon,and who contracts for such projects with a conuactor(s)licensed pursuam ro the Canmctars -- - - - License Law. - ❑Iameepmptundv5ce. ,BkPC four this reason owner�l:toW1-11�J,(tyA Data ✓ WORKER'S COMPENSATION DECLARATION I hemny nffitm under pe.ahy of perjury ooe of Inc following decimal...: 1 have and will maintain a Certificate of Consent to elf-insure for Workers Compeo- 737W pirin,as provided for by Section 3700 of the labor Code,for Ne performance of the rk for which this permit is issued 1 have and will maintain Worker's Compensation Insurance,as required by Section mf the labor Code,for the perfum mance of the wok for which Nu Pcair u issued. yWorkers CnmPensad nlnsunnoe artierand Polity numncrr�I 2.tAC. - Poli CERTIFICATE OF E% PITON FRO RKERS' COMPENSATION INS URA E (Dia section nmtl not be completed if the permit is formic hundred dollars(SIM) or tesa) 1 certify that in the performance of the work for which this Pw rf is issued.I snail not employ any person in any manner so az w become subjem to the Workers Compensation Laws of California.Data Applicant NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you should - become Subject in the Worker's Compensation provisions of the labor Civic.you most .,O forthwith comply with such provisions or this Permit shall be domed mokcd. Z p^3 CONSTRUCTION LENDING AGENCY F+ I hereby affirm Nat Nero u,arnsum hm lending agency for the paoaamm of fk the wish for which this permit is issued(Sec.3097,Civ.C.) !Td Lender's Name 0. z Lenders Address U Q 1 cenify the,I have read da,application and sum that the above infoaauon is Hmoral.l agree to comply with all city and county ordinances and sum laws relating to DU building construction.and hembyauNoma representatives of this city to corer upon the move mentioned imnms,iatycost for inspection purpowhich ms. W (We)agree tri vera,indemnify and keep harmless the City of Cupertino against Z inconsequia,ofts.g.ti.g of this is which may in any way eccme ageirulsaid City U�', in eonuyuencc of the Sranting.f this permik ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC EppULgIONS. ��)�� &paw r piicm R nm o)Ql , Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will dm applicant or future Wilding occupant mar handle havardom metrial az defined by the Cupertino Municipal Code.Chapter 9.12,end Be Health and Safcry Code,Section 25532(x)? Oyer 0"o- All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future building occupant us equipment mar devices which If a roof is installed without first obtaining an inspection,I agree to remove mil hazardous air commute us at defined by dm Bay Arca Air Quality Management all new materials for inspection. Disvict? ❑YYak es 1havemoltheI mH"sm=dalsm uimmenuunder ,Chapmr6.95ofthe Califnr, Hcalthgr SafctyCo@.Sodas.25505.25533 and 2553a.IundcrsuM Wtif Nc building / /3 v\P� �/)A pg! / //J _!, docs not curmnlly have:a mono,out it u my possibility m nod fy IM.asuPant of the t _ ll\) U/llf 1�1 ( `! V fey'mmcma which tun be eI 'ono issuance of a Ccmficam of Oc army. �. atureofApplicant Date ww,athori.assent Date 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 �UPEI�TINO Building Department JOB ADDRESS: PERMIT # C4- 7 OWNER'S N PHONE # 2Qp GENERAL CONTRACTOW # 115 Q I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followin information: 65 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 L v',3 Septic Tank Sheet Metal Sheet Rock Tile �1i.2/• Va Oil Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 Fax: (408) 777-3333 %UPEkJ1N0 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: / Job Site Address: Roofing Compan Name: y7✓ A plicant s Signa Date: Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper IS A \ / CITY OF CUPERTINO (53 REROOF CITY OF CUPERTINO PERMIT APPLICATION FORM /l Z_3 APN # Date: Building Address: _ /57 3M �Ai p Owner's Name: �� JS Phone///)?- / — 9ff 7e Contractor: Phone#: License: Contact: Phbne#: Cupertino Business License#: } A /-e� 9 c25'-604—1070 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 1Asphalt Shingles Wood Shakes EIWood Shakes ❑ Wood Shingles ❑ Wood Shingles C3 Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# XTo be Removed ❑ Provide Mfgr.Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Descri tion: Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with P De t. if i�-�� there are an strictions: Cost of Pr e e of Construction: �., �� P \ Occupanc up: Qty t ica le Fee ID Fee Description Fee Grou BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPL CHK Plan Check Fee BUILDING BUSLIC Business License BUMDING 277 ` 3 746