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05020022CITY OFCUPERTINO .fnls BUILDING DIVISION PERMIT F Cs.ONTRACTQRNF)RMA'TO',-,,. ,CITY ADDRESS: 4n c;mzknr­)wT.TTT.T IN PERM" N%502 0 02 2 OWNER'S NAME: PERMIT ISSUE DATE TONE: SANITARY NO, CONTROL NO. ARCHITECTIENGINEER: BUILDING PERM" INFO BLDG ELECT PLUMB MECH 17-71 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm utas 1 am licensed under pmWn voof Chapter 9 (commencing o with Swam 7000) of D(vidan 5 of the Boa em, and Professas Cade. and my license is f untew as `-" REROOF W/COMP. Lh1 f.m.g Dam Ceram CONTRACTOR: DIAZ ROOFING ARCHITECTS DEC RATION 1 understand my plans'hill hen used an public ram& Licclued Professional OWNER -BUILDER DECLARATION 1 hereby afnrm Nal I em mu mpt from the Commerce, License Law for the following mason. (Section 7031.5, Business and Profession Clam: My city or county which requires, a Permit to convect. alter. Improve, demallah, to repair any stratum prior mins issuance. also requires the applicant fm such Permit to file a signed moment met tan is Hansal purauanl In the provisions of uta Conuacmm's Lhcnc Law (Chapter 9 Sq. Ft. Floor Area Val L$tiq>p640 (commencing with Section 7000) of Division 3 of Ne Business and propositions Code) m Nat he u esempt twafrom and the basis (a the alleged assumption. My violWun of APN Number Occupancy T P y yl� Section 7031.5 by any applicant for a permll subjects the applicant in a civil Penalty of nal mart dun Rve Wedued &am (M). 36224024.00 01,uawmrafthepmpmy,mmyemployeeswMwpsnthebwlecampcaudon, OI veld do IIICwart. end mC 1. Com Imes Licarmelf and Pm, cage: The law data . Required Inspections an mwar of al apply damns almram apply emlobo b,l&camimpmt who who wsthermes, anddors,north, nimvlredNrosak ns, . saaminnn,meaveno Own own employees, provided Nawenim for ale If, the is sold itinnal year of coroRued Improvement li within ort )ear or camoWion, the flag Wildehownevor' a buil&r WE low dm burden of proving Nal he did not build m improve (m purpose der haw that pose of asm.). ❑ 1, as contracting n, with Eared can i. property, am uness I / Conusemfs construct the ui Code:) moo's t the Project (Sec. 7041, Business and ct and ts ower of property who builds or improves Hereon, and. es not property who pro d law dons not apply who whocontractsLaw. for such projects with a contractor(s) licensed pursuant m One Gnuwmea e Licence Law. ❑lam eaemPl undm 9s,. ,Bk PC (m thin moon Owner Data WORKER'S COMPENSATION DECLARATION' I hereby Alam under penally of perjury aro of the following dediumdoas: 1 ham and will maintain • Cerdficamo(Camseni to self-Wure for Walin es Compen. _ titian, u provided for by Section 3700 of the labor Co&. for the performance of the ' wart for which this Permit is island. ❑ 1 have and will maim i. Worker's Compensation Insurance, u acquired by Section 3700 of the labor Code, Ise the pemfman. mf the work fa which this permit u traded. My Workeh ami nutigg.lnsunnce 'u and Policy numbberr aam::����7'��� 5 Grriv. Polity CEirfl • C FROM WOD—� N FROM ORKERS OF %TION COMPENSATION INSURANCE O I (rho action ace not becompleted Rthe permit Isforode hun&ed dollen (SIM) ' or less) 1 certify that in the performance of the work for which this Permit is issued. I mail am amploy any person in my manor an as m became subject to the WDrkari Compensation Laws of CAlVmdL Data APPlicml NOTICE TO APPLICANM If, after making this Certificate of Exemption, you should became subject he thc Workcts Compensation Provision{ of Ne Labor Cock, you must forthwith comply with such provisions or this Permit NAI be deemed ranked. CONSTRUCTION LENDING AGENCY I hereby affirm that Nen m a construction Loading agency for Ne performance of the work for which this permit Is issued (Sec. 3097, Ci, C.) Undch Name Lander'[ Address thisapplicationa 1 haw mud coup and sum Nat the above information 1 ttnee , c and miming 1 agmen m comply with all city and coaly odtnamua and sou taws all building e and hominymutonsrepresentatives a(Nucity to enter upon Ne r upon buildingontimod property above-mentioned to saw. fln Wpnctian camp hu (We) sag to saw, in&mn(y and keep hay uta Cay of Cupertino against a in an aquencamenu. coiled tapensesmit. mryin any way amede againlaid Clly inof - �" � C) APPLICANTPLUNDERSTANDS ANDWILLWILL COMPLY WITH ALL NON -P INT Issued by: Date � SOURc�REcpI,ATIONS./1 Re -roofs `�I �l 1 t 61 (� 1121`Y1Q.( fl 0', x DS Signuu of APplianUConuacmr Dau HAZARDOUS MATERIALS DISCLOSURE Type of Roof RSII an applicant or future building occupant slam m handle haamdoas material as defined by the Cupertino Municipal Code. Chapter 9.11, and the Health and Safety a&. saYon sss31(a)7 / All roofs shall be inspected to any roofing material being installed. ❑Yes E No prior If a roof is installed without first obtaining an inspection, I agree to remove Will the'PPticanl or future Wilding occupant taw equipment or devices which It haudou air contaminants a derrcd by the Bay Am Air Quality Management all new materials for inspection. D(WIc17 6N. ❑Yes I have mW Ne haadou mamdals requirements under Chapter 6.95 of the Califor. ria Health @Safety Code, Salon25505,15533 tad 25534.1 mmucand NU lfam Will ng (• y (./ v Ci dura al currently ham a tenant, that IL is my responsibilitynoul'y tis seta ant n the mqulm mwhl hmuslbc met 'r m Issmaccofa Cord aloof Occupan V Date M ,Sign tureofApplicant (.'CA 2)�IbZ All roof coverings to be Class "B" or better Owner Authorized agent Dale I\ -J �CITY OF UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # 125��0002�. OWNER'S NAME:. M2 PHONE # 6 • / GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: -aaia/ k "Z:) , z —1 Owner/Contractor Signature z Z Date 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 ) I 2 - Septic Septic Tank Sheet Metal Sheet Rock Tile -aaia/ k "Z:) , z —1 Owner/Contractor Signature z Z Date ,. Community Development Department Y Building Division City of Cupertino 10300 Torre Avenue 4pCCITY OF Telephone: (408) 777-3228 UrC TINS Fax: (408)777-3333 " t. 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 IMPORTANT: a.'. 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 com 1 with the above stated policy on re -roofing. Homeowner's Name' � lob Site Address: 9-(QZ2 Roofing:Company Name: Applicant's Signature: 6,dU'rV4 n Date: 1� . Greg Casteel Building Official Revised 11/2/04 . Printed on Recycled Paper 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) ln-progress'irispection approval. -'-,3)--Final inspection approval' a) Spark arrester installation. 5. _ .,If plywood is installed, plywood nail inspection is required. 6. • Any roofiii is zpplied without first'obtaining an " ,wtucli ;inspection, will iequire'the removal -'of all new material downto the sheathing, 'L ' • so a proper City inspection can be performed:: - , • ,. _ . 7:. > , -NOT&,lf you call,for a plywood nail inspection and the job is not ready, you will be charged a re -inspection fee of $176.18.. The re -inspection fee must ._ be paid before another'in'spection can be scheduled. IMPORTANT: a.'. 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 com 1 with the above stated policy on re -roofing. Homeowner's Name' � lob Site Address: 9-(QZ2 Roofing:Company Name: Applicant's Signature: 6,dU'rV4 n Date: 1� . Greg Casteel Building Official Revised 11/2/04 . Printed on Recycled Paper V SCUPEkTINO: CITY OF CUPERTINO REROOF (� S PERMIT APPLICATION FORM APN #. . ,3 (D 2.2. b Bldg Permit Fees BUILDING Date: '�2 Energy BUILDING Building Address: Seismic Fee Res BUILDING s C�Uihl �� BUILDING Owner's Name 1 Plan Check Fee .BUILDING • Phon #: - Business License r1 Contractor:. Phone #: ZS ice e #: 2 - .� Contact: Contact: Phone #:. Cupertino Business License #: t -D Type of RoofCovering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑/Asphalt Shingles _ _ ©/Asphalt Shingles t7 Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) ",--Number of existing coverings ❑ Provide I.C.B.O. Report # Q1' To be Removed- ❑ Provide Mfgr. Installation Specs. 1C" I Have Read, Understand and.Will Comply With, Cu ertino's Tear Off Policy: JqbDescrpti -: :; _ l.r MAI tr C>�l res� Residential ©!' Commercial ;•❑ s Zone: , ---Yes El No [I_ _:_'= - —`y Confirmed with Planning De I. if Fire there are an restriction's u C t of Project: 6 Type of Construction: Occupancy group: Qty. if ADnlicable Fee ID Fee Descrintion Fee Groun 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