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05060135CITY OF CUPERTINO BUILDING DIVISION PERMIT II�1Ff)RMATION"`. r4CONTRACTOR BUILDING ADDRESS: T D ROOFING PERMIT NCO 5060135 7579 WATERFORD DR OWNER'S NAME: PERMIT ISSUE DATE JAMES YEN 3540 MARGATE AVE. 06/21/2005 ONE: SANITARY NO. CONTROL NO. (408)892-8872 ARCHMECrIENGINEER: BUILDING PERMIT INFO BLDGELECT PWMB MECH (� t� t� t� LICENSED CONTRACTOR'S DECLARATION o Job Description y am that 1 am licensed under pmWaimis of Chapter 9 (command, I herobfsu with Section 70M) of Division 3 of the Business and Proforbros Code, and my ]let. is iinfull to= and affed 3C) S 4 S 5 q1 REROOF W/COMP. Lk.N Damen" f� � Contractor- ARCHITECTS DECLARATIO 1 understand my plans Nall be used u public records ffffjjjj yf _ !!!!1111 i I, JNl � F1 / L Licensed Prurient ... I OWNER -BUILDER DECLARATION I hereby .(firm that 11, exempt from the Com ew s License Law for IM ' - Professions oli Code: Any city or county followint reason. 7f0 Lb, Business and C ./,� anothmn wn. de m sig any which cooswcL open ImPam, demolish, which requires a permit -V "J/IRh$9000 t, unnam for such permit m files shad comment also re to the due e a re prior m ILL icreuff to the LaonsCodtm9 thuhetsccensN nfof Sq. Ft. Floor Area JJ R�1� .. "'� Valuation pursuam Provisions p teBusinmmand Prdf (commenting with S.dlmn 7000)of Divtsion Jaf the Bunneumd Profossiom Coda)or of Division LD �UJI(.j/ t Nat he is exempt therefrom and the bash for the alleged eumpUpn, Any violation of I ��Vb Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not moa Nan five hundred dollars ($500). ❑ 1,uowarofthepmpwy.mmyemployeorwithwagesutheirmica enudon. wllld0 Rm work, and Ilte a=mm If notimended or offered forsele (Sec. 7044, Businiss Required Inspections and Professions Cod.: The Convector's License Law door at apply m an owner of propenywh0 builds orimpmms thereon, and whodasauch work Mntulfor through his man emplayeor, provided that such improvements are 1191 intended anffrted forme. E. however, the building or Improvement its sold within aro year ofampletion, 0e owner Wilde'will Mw the burden of proving dust he did not Wild or Improve for purpose of . Asia.). ❑ 1. as owner of the property. Am exclusively contracting with licensed annabn to construct the project (Son. 7014, Business and Profns ions Code:) The Conuauu's V- caus Law does not apply m an owar of propertywha builds As knprom thereon, and, who contracts for such projects with A conuumr(O Ilumad punuam to the Contractor's . License Law. ❑ 1 Am exempt under Sec. . B k P C fa this reason Owner Dam WORKERS COMPENSATION DECLARATION 1 hereby Affirm under penalty of perjury one or Ne fallowing declantiow 1 ham end will msintsin aCmifium ofConsenl to self -insure forworkees Compo- ,an. As provided for by Section 3700 of due Labor Code, for the performance of the work for which Aria pemo is issued, ban and will maintain Wmk.r's Compnsedon Insurance. as required by Section of the Labor Coda. for the performance of the work for which Nie permit is issued. My Worker's Cmmpemulon humanac iuW Polity number Art: r 6 Cartier F Polity No.: 14'141 S CERTIFICA OF EXEMPnON FROM WORK COMPENSATION INSURANCE (This section rued not hecomplemd ifthe return is two= hundred dollar (SIM) m mu) 1 certify that in the performance of de work forwhich this Permit is loved, I shall ma employ any person in any meaner an as In become subject to the Workers' Compcmadon Laws of Califomie. Dam Applicant NOTICE TO APPLICANT: IL after making this Ceninam of Exemption, you shrub become subjccl to the Worker's Compcnsadon provisions of the Laber Code, you must forthwith comply with such ptmisiona or this permit shall M rimmed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that don is a commotion lending atom ler the prfamana of the work for which this Permit is issued (Son. 3097, Civ. C.) ' Lmdcfs Name , Larder's Address I «reify Nat I have mad this applicau.. and mm dust Ne above info..t un b correct. I agree As comply with all city and county ordinances and tum lawn misting to building construction. and hereby aothorix representatives of this city to enter upon the , shove -menti..— property for inspection purposes (We) agree In a.. indemnify and kap harmless the City of Cupertino againn liabilities. judgments. cam and expenses which may In any my me= Against said City in emurqunce of due grin ng of this permit APPLICANT U E NDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REG A Re -roofs 6 Signature of Appliam/Contrxmr Dam HAZARDOUS MATER DISCLOSURE Type of Roof Will she applicsnl m future building Pant moa m handle haurdom material as defined by the Cupertino Municipal Cade, Chapmr 9.13, and the Health and Safety ode. Section 15531(a)7 ❑Yes No All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove W111 the Applicant or future building occupant urs L'yuipmal at devices which Il hautdou air canmin Is dc0ned by due Bay Ana Air Quality Management all new materials for inspection. Diuuict7 ❑Yes u I have read the h Aromas materiel, requirementsunderchnic, 6.95ofthe Califon nice Healthik lyCada,Savoos 25.RI3,73537 uld26534.1uM:mmE duni(Arc building G'v1 /21 I 5 dos nol evtren Y a comm dual h k my msponalhillly m wtrfY de occuPmt of the •l7 - m nquinmemawieh IbemelpriorwlssumccmfaCerdRcamofp�A� p ere i Signature of Applicant - Date o ,VhLP 6/xt� All root coverings to be Class "B" or better owner m,mthmined ap.m _ oae _ _ _ _ I t Owner/Contractorature 6�z� Io5 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 Septic Tank Sheet Metal Sheet Rock . Tile Owner/Contractorature 6�z� Io5 Date Community Development.. 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department . JOB ADDRESS: ''l PERMIT # . - % 5 9 V'v «� � te o� 06X T U> U U U OWNER'S NAME: c, •n-) en N e v\ PHONE # og 414- G 3.6 ro _ GENERAL CONTRACTOR: T D AQo;,,Ivic- FAX # a I am not using any subcontractors: r Signature �/ Date Please check avvlicable subcontractors and comnlete the folio Q i formatinre I am not using any subcontractors: r Signature �/ Date Please check avvlicable subcontractors and comnlete the folio Q i formatinre SUBCONTRACTOR BUSINESS NAME BUSINESS -LICENSE # Cabinets & Millwork, Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum / Wood Glass / Glazing s Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting / Wallpaper Paving Plastering .; Plumbing Roofing Septic Tank �a Sheet Metal Sheet Rock Chvner/Contractor ature 4 1. 4 6d:.i,Q) Date W Tile Chvner/Contractor ature 4 1. 4 6d:.i,Q) Date W qa-ITYOF UPEkTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 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 IMPORTANT: 1. Flat roofs must have a minimum of " 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. r. Homeowner's Name: Job Site Address: S c1 w c�tc { C>Ir -A 1'x.+1 Roofing Company Name: I D i Applicant's Signature: r�(A Date: 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) In -progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. • 5. 6. If plywood is installed, a plywood nail inspection is required. 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. 7. NOTE: If 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 Raid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of " 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. r. Homeowner's Name: Job Site Address: S c1 w c�tc { C>Ir -A 1'x.+1 Roofing Company Name: I D i Applicant's Signature: r�(A Date: Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper alo CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN # 3 6 6- (T- T1 3 O Bldg Permit Fees Date: 6 I 5 Building Address: nn TS c) W c: -e-C �(Dv-ck Nir Owner's Name: e- vv Seismic Fee Res Phone #: (q o g) 4- 4 fo - 01. r fo 9l Contractor: Phone #: License #: T 40%) `ii /4—S 5 01 I Contact: �t:s l• e Noc��l Phone #: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Other (Specify) Cl Wood Shingles I IV- A Other (Specify) go -IV- Number 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: lob Description: e�„oV2 J%,c.,IQCS Shct%zz el��ace iin Soyv- Residential] Commercial ❑ e S; c eve Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: U Cost of Project: Type of Constructiot} Occupancy group: $ ci (Doo— r -e - n oo+ Qty. if Annlicahle Fee ID Fee Descrintion Fee Groun BPERMFEE Bldg Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING, BUSLIC Business License BUILDING "Il ST ”