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03120038 CITY OF CUPERTINO BUILDING DIVISION PERMIT COiTRACTUXixL ATIrU : '' BUILDING ADDRESS: PERM7NO03120038 3120038 OWNER'S NAME: PERMIT ISSUE DATE Ad DERSON CHEVROLET NE: SANITARY OL NO, IFI ARCHITECT/ENGINEER: BUILDING MRM71NFO BLDG ELECT PLUMB MECH 0 0 0 0 .�mo LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under previsions of Chapter 9(commencing with Section 7004))or Division 3.fNc BusiTvoul Forest..Carle.and my license is �n full f an of t. menaec - �- "�`I Lm,- 5'1!v r r REROOF i Date TSDEar + +s CONTRACTOR: KING ' S ROOFING \ ARCHITECTS DECL-Agdana W/A&.mad my plans shall he used u ph c records v. Licensed Professional 3D5 OWNER-BUILDER DECLARATION F I hcrchy.Keen Nal I am exempt from Ne Caelonmara License Law for she i O 4 following mmon.(Soctiun 703 1.5,Busirtess and Pofculom Cole:Any city m county X which enquires a permit to construct,alter,improve.demolish.or repair any structure tu > prior to itsirumme,atm require the applicant for such permit to file a signed statement FC�eQ that he is lierset pursuant to the provisions of the Conlracara License Law(Chaptm9 Sq.Ft. Floor Area Vahlat�09800 as $ (commencing with Section 7000)of Division 3 of the Business and Profusions Cade)tar 4 .. Nat he Is emmpt therefrom and the buts for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant he a civil penalty of APN Number Occupancy Type not more than Bve hundred dollars(S500). ❑I,a a owner ofthe property,or my employee with wages as their sole compensation, 32631020 . 00 will do the work,and the structure is notintandcd oronened r anile(Sec.7061.Business and Professions Cods:The Concentrates Liceme law dues not apply to in owner of Required Inspections property who Wilds.Improves dercan.andwho d.eaauch work himself.,through his own employees,provided that such impsevemenes art not intended proffered for sale.IL however,the building or improvement is sold within one year of completion,the owner- FINAL �� builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1.as owner of the property,am exclusively contracting with licensed contractors to construct she project(Sea.7064,Business and proposes s Cade:)The ConuuJ ter's Li- JAN'2 8 2000 come law does not apply wan owner of property who builds o,impmw thereon.and, who contracts for such projects with a contracter(s)licensed pumuant to the Chummier's I 'surLaw.m 0 BUILDING 1 em aept under See. .B&P C for Nis moon 1307CM wner .Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declamiam: 1 have and will maintain a Certificate of Consent to seIF Wum fen Worker'Compon- ian,as provided for by Section 3700 of the labor Code.far the performance of the rk for which this permit is issued. I have and will resistant Workers Camperenation Insurance,as required by Section of Ne Labor Code.for Ne performance of Ne work for which this permit is Issued. y Worker's Compensation Insurance carrier and Policy number are: rtier. srrly l n e) Polity Nin OOOO IN-)„003 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE section need not becomplemd lithe permit is faron,hundred dollen($100) at less) 1 certify Nat in the performance of Ne work for which this permit Is issued,I shall oat employ any Person in any mannerm as to become subject to the Worker'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should become subject to the Workers Compensation previsions of the labor Coda you must 0'y frrthwidr comply with such provisions or Nis Permit shall W deemed reward. „Z,i O CONSTRUCTION LENDING AGENCY [�r(4 I hereby affirm that Nem is a conslNctmn lending agency for the performance of ai> the work for which this permit is issued(See.3097,Civ.C.) QLandes Name z Lender's Address V Q I certify that 1 have mad this application and sate that the above information is F mrtect.1 agree to comply with all city and county aNinanmm and slate laws relating to 05742 0 building construction,and hereby mahatma representatives of this city m enter upon the G above-mentioned properly for impaction purposes. (We)agree to sive,indemnify and keep haemleas the City of Cupertino against F"y liabilities,judgments.cases and expenses which may in any way accrue against aid City V Z in consequence of the grunting of this permit. �•^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGyy��.TIDNS. ia/l,%�� /z-8-os Re-roofs Witte of ApplicanUCanuacmr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant more or handle haandous material asdefined by❑Yes the Cupertino Mu opal Code.Chapmr 9.12,and the Hcalth and Safety Coda.Section 25532(x)? No All roofs shall be inspected prior to any roofing material being installed. Will Ne applicant or ream building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mil examines air conaminan u defined by the Bay Area Air Quality Management all new materials for inspection. Dic m' ❑Yes IN. I have mad the huallous materials nquiamor aunderChapter6.95ofthcCalifar- amHealth&Safety Cede.Sections 25505,25533 and 25534.1 undersand tharifNc building 6 �� O � dens not currently have a mnan4 that it ts my responsibility a rmtify Ne occupant of the 01 O mquimmcros ' hmost be met ' r lar issuanceofa Cenifcamof Occupancy. SInes re of Applic V Date ac li o 3 Owner or audoorUmagent te All roof coverings to be Class "B"or better Community Development Department Building Division • #, City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E IST I N 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: Aivo rr%bd GAc„ olc% Job Site Address: — 14 9 5 SSI Fis,r� G--e.e-, Roofing Company Name-,/e). 4!6-5 ,r A plicant's Signature: D te: J 7- p3 • Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF 0� / L o CUPERTINO PERMIT APPLICATION FORM APN# Date: /02 0 /0-3 Building Address: l ,k 0 15 5 STV e' s Grwk N vol• GA Owner's Name: /�Lha 15� } Phone#: Contractor: Phone#: License#: . N125 P.%a Q�-., 3.09 �6S -33 (o _kt S1tq 5 i Contact: d Phone#: Cupertino Business License#: �rT CtM � 2o 41 RS- 4151.4 Type of Roof Covering: Existing: Propgaed: kf Built-Up Roof W Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) N her of existing coverings 'a El Provide I.C.B.O.Report# �To be Removed ❑ Provide Mfgr. Installation Specs. . I Have Read, Under !and and Will Comply With Cu ertino's Tear Off Polic ❑ Job Description: �- Residential ❑ Commercial 1 Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are any restrictions: LLJJ Cost of Project: Type of Cons ct' Occupancy grou oo , o Qty. if A li e 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 • 39