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03060083 (2)
CITY OF CUPERTINOR'- BUILDING DIVISION PERMIT WONTRAC"TOR TNA'URMATION " BUILDING ADDRESS: PERMIT NO03060083 3060083 s OWNER'S NAME: PERMIT LSSfff9'/'1 1/2003 ,q PARK NE: SANITARY NO. / CONTROL NO. ARCHITECffENGINEER' BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �Op� LICENSED CONTRACTOR'S DECLARATION I wmhy.rfirm that I amam licensed anger Provisions of Chapter 9(commencing Job Description with Section 7")of Division 3 of the Busincvgnd Professions Code,and my license is FONw�LE© qs intauransud n ^VI/-� p yV �j REROOF � uccn=Clams" t.ic.t " < D'ta RCHfECS EC"{`y ATIO ' TN CONTRACTOR: RAY DAVIS CONST. JUN 1 3 2003 M1 dry plena:ballbousedu1�61icrecwds�H/�f�f/' AVley ,wad Liccnud Pmfessionel OWNER-BUILDER DECLARATIOICBk�5 BUILDING £ 1 borehy affirm Net I am eacmpt from the CcnuactoYs Liam.law for the O O following recon.(Section 7131.5,Business and Pmfessiom Code:Any city at county 3$ which requires a permit tit construct,also,,improve,demolish,or repair any stmaum prior o its issuance.also mquires the applicant for such Permit o rile a signed statement < theaheislicensedpuresentsotheprovisionsofMeConua:wr'sU..Law(Chip.9 Sq.Ft. Floor Area Valuation els-$ (commencing with Section7000)of Division 3 of the Business and Professions Cade)or that he u exempt therefrom and Ne hub for Ne staged exemption.My violation of 6 5 0 0 Section 7031.5 by arty applicant for a Permit subjects the applicant to a civil Penalty of APN Number Occupancy not more than five hundred da1Hss($500). P y�Pe 1,ss owner of the pmpcny,or my employees with wage u their sole compensation, 35919040 . 0 0 will do the work end Nesounure Is not intended oroReted f.,mile(Sec.7W.Russ. and Pmla s"s Code:The Contractors Lt..Law does not apply in in owner of 305 — FRAME Required Inspections property who buildsor improves thereon.and who dmisuchwork himself orthmugh his Own employees,provided that such impremmenta art not intandcd oroReted forsaM.If, 307 - INSULATION however,the building or improvement is cold within one year of completion,Ne owner- wilder will hams the hurdeen of proving Mt W did not wild m improve for purpose of 601 - ROOF TEAR OFF tile')' 602 - ROOF PLYWOOD NAIL I,u owner of de property,un exclusively convening with licensed convectors to cunstmct the project(Sec.70W.Business and Professions Cade:)The Contractors U. 603 - ROOF BATTENS come law does not appy to an owner of property who wilds orimprow,s Motion,and 604 - ROOF IN-PROGRESS who contracts for ouch projects with a eomme or(s)licensed pursuant to the Commences Lt.=Law. ❑lameaemptundet See. ,Bk PCfarddsmdwn Owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby aRmm under penalty of perjury,ane of the following declaations: 1 have and will maintain a Cutifiaae of Consent w elf-inure for WmIao'.Comiam. cation,u provided for by Section 37M of the labor Code.for Ne performance of Me work for which this Permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section MYWf ee-C-r Codc.fm deperfarmanceoathework muck, this permit isisseed. - My Wohcrs Compeyns�ation Inwnnce ca et and Policy number are: � Policy�00 Cr$` � CERTIFlC OF FXEMPf10NtA0M 0�� COMPENSATION INSURANCE (This motion need not becamplea:d if the Permit isfarooe hundred dnllan($lml) or Mss) 1 unify that in the performance of Ne work for which this permit is issued,)shell not - employ any forum in any manner u as M become Subject 0 the Workeri Compensation Laws of California.Dae Applicant NOTICE TO APPLICANT:IL after making this CcniOcae of Esemption,you should become subject to Ne Worker's Compensation provisions of Ne Lahm Code,you most �O faMwith comply with inch Provitian or Nu permit Nail be deemed revoked. Z y CONSTRUCTION LENDING AGENCY I hereby affirm that them is a construction lending agency for the performance of Y> M wart fur which this pmmit is issued(Sc,.3057,Civ.C.) A Landers Name z Lender's Address J O 1 certify cost 1 have read this applieadea and stag that Me above infamatiun is i;: correct.)agree so comply with all city and county consumers and state laws relating In �U building construction,and hereby mthmice elpreamn3iws of Nis city to enter upon the awvc(W tion re in ertysaw,for inspection amify an k.P hs ,S LQ (We)agrees.scut,indemnify and keep harmless the Clay of Cupertino against h in consequence of thecostsand of this may in any way eccme against said City Jz in conuquencc a(thc grenaing of Nis permit gl)/ SOURCE E UNDE ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date mer _ d Si um fAp can connectorRe-roofs pace HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will applicant or future building occupant store or handle huardous match as dc0ned by Ore Cupenina Municipal Code.Chapter 9.12,and Me Health and Safety Iiiet.SSecNanYm Na:ss3z(a)7 All roofs shall be inspected prior to any roofing material being installed. Will the milliC na ar future wilding occupant uta equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove ? hemdans air contaminants u defined by tin Bay Arca At,Quality Management all new materials for Inspection. ❑Yes \Q n — I have mal the hauNtwsmaerials mquiremenss un lcrCwper6.95 of Ne Califor. ,is Health&Safety Code,he I,that my and 35530.1 undersande occupant Me wilding docs not currentlyY halt a anent that it u my rmponsibiliy m nmilj the occupant of the [ Tquiremcnu nllfdh mustb tpiorwissuance of a Cm was,o(Oc se Date VVVV � 11 6 Lgnature f Applicant own ram onee agent ��' per— All roof coverings to be Class "B"or better JmtCommunity Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 Fax: (408)777-3333 U P E�T I N O 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: 71/15 Pa K K, Job Site Address: /S c Roofing Company Name: Rif X 0415 ' - ,- ) A plicant's Signature: 641 v14 Date: f- 03 Greg teel Building Official Revised 1/30/03 Pnnted on Recycled Paper CITY OF CUPERTINO o REROOF CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: ' All S / Owner's Name: Phone#: .2d k9e Contractor: r Phone#: License#: 4__-S 70 7 ( 9, 9 3 Z `1 Contact: Phone#: Cupertino Business License#: �. zleo8'9 �F_= � Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles __,�Asphalt Shingles ❑Wood Shakes ❑ Wood Shakes 6 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. — • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: / Job Description: Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning De t. if there are an restri Cost of Project: �SoU Type of ns;ruction: Occupancy gro S E-- —i Qty. if A li e Fee ID Fee Description Fee Grou BPERMFEE Bld Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING