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03080165CI'CY OF CUPER'I'INO*��"` Sd'--? BUILDING DIVISION -PERMIT CONTRACTORiINFORMATION BUILDING ADDRESS: VENTURA CAL -PRO ROOFING "'"""03080165 OANG140 ST WNER'S NAME: 2335 PRICE WAY PERMIT ISSUE DATE NE: (408)377-0241 SANITARY NO, CONTR0I, NO. ARCHITECT/ENGINEER: UILDING PERMIT INFO BLDGELECT PLUMB MECH 0 � LIR�ENSED CONTRACTOR'S DECLARATION Job DCSCrlptl0 1 Wmcb res that 1 am licensed under provuiou of Chapter 9 (commencing with5¢tio Bur Division 3 ofthe Business and Professions Code, and my Income is in to a and re 7 7 7 g o REROOF ".a Lic. X m Cmupmehir c G INAL O �CTc TION ■ lEC�R I dcrtunJ my pi nssha SEP 3 0 2003 Licca mfcssione OWNER -BUILDER DE CLARATION .c.DER I achy alum License Law for the 1 am exempt from Ne Cssione following mason. (Sccuun ]1131.5, Business and o on inks Code: Any tiny or county n, de which requiresa permit m construct, elteq improve, demolish, or repair any awclum BUILDING poor u, is issuance, also requites the applicant for such permit to rile a signed statement that he is licensed pursuant m the pmvisfnns(if the contractors License Lew (Chapter 9 Sq. Ft. Floor Area - Valllat On - (commencing with Section 700(1) of Division 3 of the Business and Professions Calc) or that he is exempt therefrom and the basks for Be alleged exemption. Any violation of Ar)7njn nn APN. Number Occupancy Type ' - " --- — - - _ - Section 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of " not more than five hundred dollars ($500). iD I, as owner of the property, or my employe" with wages as their sole cempenaoon, 305 - FRAME Required Inspections q p will do the .,it. and the structure is not intended ter offered fa ... 1.(Sec. 7W, Business and Procession& Code: The Conmmors License Law does not apply m an owner of property who builds or improves thereon. and who does such work himselfor through his 307 - INSULATION - ownemployees, provided that such improrsmenuare not intended oroffered fioultelf. 601 - ROOF TEAR. OFF however, Ne building or improvement is sold within mm )ear or completion, the owner. builder will have the burden of pmving that he did nor build or improve for purpose of 602 - - ROOF PLYWOOD NAIL .0. 603 - ROOF BATTENS_..- ❑ 1, a owner or the property, am "elusively convening with licensed contractors m conswntheproject(see 7044, Business and Professions Codn:)Tho ConuacteriU. 604 ROOT' IN -PROGRESS come law does not apply to an owner of property who Wilds or improves lhemon,and , who contracts for such projees with a co dracmr(s) licensed pursuant o the Connor's License U- 0 I . erupt under Sec. . B h P C for this named - Owncr Data - WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one or de following declarations: I have and will maintain a Certificate or Consent no self -insure for Workers Cumpen. scion, u provided for by Section 37W or the LaWr Code, for Ne petformamr of the ,it for which Of, permit is issued. ❑ 1 hats and will maintain Worker's Compeunlon launncc, as requited by Section 3700 of the Labor Code, for Ne performance or the work for which this permit is Weed. M Workers Compensation lnsumntt carrier and Policy number am: mer: Policy No, ,. CERTI FICATE OF EKEMPfION FROM WORKERS' , COMPENSATION INSURANCE (This section stood not be completed if the Tcrmit I, rmme hundmddolfart ($I010 ar leaf.) I candy Nat in to performance of the work for which this permit is issued. I shall not employ any person in any manner an um become subject to the WormW Compensation Laws or California. Date Appilum NOTICE TO APPLICANT: IL after making this Certificate of Exemption, you should become aubjeet to the Worker's Compensation previsions of the Labor Code, you must forthwith comply with such provisions or this permit shall W deemed revoked. CONSTRUCTION LENDING AGENCY I hereby aRrm diet there is construction lending agency for the Performance of the work for which this permit is issued (Site. 300, Civ. C.) Lender's Name Lender's Address I certify Nat I have read this application and sum that the above oromurion is correct I agree m comply with all city and county ordinances and state laws relating to building cmuuuctian. and hereby authorize represrnurires of this city to enter dram the ahove-mentioned property for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities,' 6mcros, cost sad upcnses which may in any way ...c .,.lost said City in eon once of the granting of this permit.-2�/G� i7 APP CANT UNDERSTANDS D WILL OMPLY WITH ALL NON- DINT Issued by: Date So EREGULATIONS. CT Zl V - reA Y Re -roofs Type Of Roof ign A plsanUConu¢tio Da 14 HAZARDOUS MATERIALS DISCLOSURE - Wil cvpplicam arfuwmluildin, uccupmume or handle harallous materiel u defined by the Cuponino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? All roofs shall be inspected prior to an roofing material beim Installed. P Y g ❑Yea ❑No P g If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupol use equipment or dcvica which it hanardous air conuminanu u defined by the Bay Area Air Quality Management all new materials for inspection. imin? ❑No the hmaNcus materials requirements under Chapter 6.95 of the Ca r- t y n+p -2 Cl.lc,s.dI,.25505,25533.d25534,lundcmmnddutif Or Wildin L hors a Rpant. thatitisTy respouihility m muty the occuph &Mffi.6,46 mustW met IF iaaen u a cnifieue or 2y5 yZ. J2A gnatu of Applicant Date - All roof coverings to be Class "B" or better 4d agent Date Community Development Department f7 + Building Division a ' City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 CITY OF Fax: (408) 777-3333 OUPEkTINO 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: ) Aly )J Y ! �' V A x Job Site Address: 123 .9 (, I Roofing Company Name: Aplicant's Signature: Date: *_7 2Y Revised 1/30/03 Printed on Recycled Paper Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper -.1 1% CITY or CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM I APN # • 5 BPERMFEE Bldg Permit Fees Date: 16 BUILDING BSEISMICRE Building Address: BUILDING 1 QA Seismic Commercial BUILDING BPLANCHK Owner's Name:�� BUILDING BUSLIC Business License Phone #;- '/ O V T7 Y3 Contractor: (, , J ^Phone #: .- LJ Sy Zl f? � 17� License #: g O Conta\1 . M S Phhonne #. ) / 0 1 , 6 Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles `V Wood Shakes ❑ Wood Shingles ❑ Other (Specify) ❑ Wood Shakes ` ❑ Wood Shingles L3�� 1Y • �'L` Other (Specify) � i "V e � 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 tion: p ll i - e Residential R Commer ial MoNjkk # e t Fire Zo Confirmed with ning Dept. if there are an striction • LJ ostt of Proojec :� Type of Constructi p Occupancy oup: �_ — K,3 O 14 ADDI• abl Fee ID Fee Deccrintinn Fee (:rnnn BPERMFEE Bldg Permit Fees BUILDING BENERGY BUILDING BSEISMICRE —Energy Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING