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04080148 CITY OF CUPERTINO BUILDING DIVISION PERMIT CQRt�. Q Tl 'C.1 .9t, I( i BUILDING ADDRESS: PERMIT NO. C & C ROOFING 04080148 i NER'S NAME: PERMIT ISSUE DATEONE: SANITARY4:8 OL NO. CHITEC(ENGINEER: BUILDING PERMIT INFO E MEC" I� u tjp LICENSED CONTRACTOR'S DECLARATION Sob Description U 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with esti n7CM)ofDivision 3 of Ne Busways and Professions Code,and my licevn is ^ yin fol antleffect. / y� Z REROOF W� COMP. SEP �� t,to Z License CI Lic.p 2004 n t- Data - Canammr A CHTECTS DEC \TION rmandmy OWma NER-BUILDER asp croAI BUILDING aU C Licensed Professional OWNER-BUILDER DECLARATION an Y I hereby.(Sent(Section 1. exempt from tie Contractor's Licenu Law for the i p 0 which mason Permit t 7ln LS,Buainess m improve,Prode moll Code:Anyepair y or s ante $ which requires a Permit m construct,ales fau-sudemolish, fi.pair any almdure F < Prior.itscensed palso mqo the thovisio of far tech permit roiense LneJstaemem D (Met he commencing edPun70WProvisision3 fMeBusinesssndProrlaw(Chapter9 Sq.Ft.Floor Area Valu hon $ Met he is exempt MotorSection and df basis rth Nlleged exempt on.M vi Code)or R., Nat he is exempt there(..and Ne baso far the alleged exemption.My violation of TT�a�.149M. Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of 3 WITO er0 0 Occupancy Type not more than five hundred dollars(5500). 0 1,u owner of the property,or my employees with wages as their sole eompenutlon, will do the work and the swnu.is notatende0 oroffmed(areae(Sec.7044,Business and Professions Calc:The Contra wither License Law does not apply to an owner of Required Inspections property who buil ds m improves Mercer.and who does suc h work himself or Nro ugh his own employees,provided that such improvements are not intended or offered forsele.IL however.the building or improvement is sold within one year of completion.Ne owner. builder will(lave the burden of proving Net he did not build or improve for purpose of sale.). 0 1,as owner of Me property,am exclusively contracting with licensed convectors to construct the project(Sec.7044.Business end Professions Cade:)The Carmines U. came law does not apply to an owner of property who Wilda or improves demand.and.and who conlowls for such projects with a eontrmlor(s)licensed pursuant he the Convectors _ License law. 0 I am exempt under Sec .B&P C far this reason Owner Data WORKER'S COMPENSATION DECLARATION I hereby aline under penalty of perjury ane of the following declaralio do I have and will maintain aCeniftcae of Consent to self-insure for Workers Camper. 7037."M ion,as provided for by Strewn 37M of Me Labor Code,for Me performance of the rk for which this permit is intend. 1 have and will maintain Workers Compensation Insurance,an retrained by Section of Ne Labor Code,for Ne performance of the work for which Nis permit is issued. y Wmkera Compensation Iramence carrier and P numberare: sT�'7'��vua {�Polic .. / z!5 rf¢_ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Olds section need not be completed if the permit is fmonc hundred dollars(SIM) at Mas.) 1 certify that in Ne performance of the work for which this Permit it issued.I shall not employ any person In my manner so as to become mbjaua the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should - become subject to the Workers CaTepensation Provisions of Ne labor Code,you must Q Z forthwith comply with such previsions or this Permit shall be deemed revoked. zCONSTRUCTION LENDING AGENCY [-i I hereby ruiren Net Nerc is a construction lending agency for Me forformanoc of D:7 Ne work for which this permit is issued(Sec.3097,Ci,C.) 04 A Under',Name Q z Leader'.Md.. U Q I certify that 1 have read this application and state that the above infomaMan is LL H comet 1 agree to comply with all city and county ordinance and state laws misting to Q V building construction, u ction,and hereby auNarim reprenladves of this city ro enter upon the Ltl shove-mcmioned property for inspection purposes. 6, (Wes)agree or save,indemnify and keep harmless the City of Cupertino against / is o-a cn liabilities,judgment,cosi and expenses which may in my way accrue against and City V r7 7 in consequence of the grading of this Permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SZ EGULATIONS. SZ &tua-e 0--a-o</ Re-roofs ,01[gra tort of ApplicarounCorturactor HAZARDOUS MATERIALS DISCLOSU RE Data Type of Roof Will the applicant or future building occupant store or handle harartious material as derined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. nta Nu Will Ne applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit havardmo air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Dislrict7 ❑Yes CfN. I have mad Ne hasaknusmamrials requirements under Chapter 6.95 ofthe Califor. //7 nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand Matilda building docs not currently hoe a grant Mat o is my responsibility to redly the occupant of th rcquiroment, It It sWmetPriormissuanccof ceni0ateofoccupmcy. ignatureofApplicant e All roof coverings to be Class-B W better Own mohm'sed agent N. Date Community Development S�4-- 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 ,#UPEkTINO Building Department JOB ADDRESS: PERMIT# !3CJ�% OWNER'S NAME: L 6-G PHONE # &1F• 217 e- / e GENERAL CONTRACTOR: K 0,1 G , FAX # 'IQ — 6a I am not using any subcontractors: ��,�� a—. -/�- o y Signature Date Please check applicable subcontractors and complete the following information: 60 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 C7 C �O oG Septic Tank Sheet Metal Sheet Rock Tile 10, Owner/Contractor Signature Date Community Development Department Building Division f 10300 Torre Avenue O, I pCCITY OF A Telephone: (408)777-3228 V E C kT I I�O Fax: (408)777-3333 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: r/yQ / S , 57T2 TG/iv i Roofing Company Name: ("__7 /Qa rf,yV A plicant's Signature: Date: Greg teal Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO U REROOF CUPERFINO PERMIT APPLICATION FORM APN# Date: O ^ � _ &rL Building Address: Owner's Name- , Phone#: Z . G v (2h Contractor: Phone#: License#: Contact: Phone#: Cupertino Business License#: O 0 - - 7 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof P< Asphalt Shingles 0,4� Asphalt Shingles ❑ 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. 6f/ c.vT 9 I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: i co P E✓roa�� -i E iDsvl�C <:!:avvt P Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with 1 mg t. if there are anestrictions: Cost of Project: Type of Construction: Occupan gr p: E200 if - lic ble 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 Z 2,1L - / �