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03080184 (2) CYfY OF CUPERTINO r tat " r��g'..r,*re �a�y4 ^gip SsY"�:rr BUILDING DIVISION I'I;I2MIT IQ0N 'RA4TOR INFORMATION BUILDING ADDRESS: PERMIT NO WILLIAMS ROOFING 03080184 422 RTA iRC NERSNAME; NRORD 4921 CABRILLOPOINT PERMITISSUEDATE NE: SANITARY NO. CONTROL NO. (408) 252-5120"AHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 o t� a X00 LICENSED CONTRACTOR'S DECLARATION in I hereby of ion Net I am licensed under provisions of Chapter 9(commencing ]Ob De rlpt100 h Section 7Bfk)of Division 3 of NC Busincvs)gd Pmfmsinna Codc.end my liccnm is -�Zi �nr.i�ond effect Li /� �f--�(f�Cf REROOF INA�Ei� > y ( T Dau Cummnor ARCHITECT�DECI��ATION f e I un castand my plana shall be uuda paMc records S EP 5 2003 you e LLo Licensed Professional OWNER-BUILDER DECLARATION <S I hcrchy,from that I am exempt from the Camuctors License Law for rW BUILDING 00 following mason.(Section 7031,5,Business and Prfeasions Cade:Any city or county 3$ which requite u Parrot um cnnmrc,alter,improve,demolish,or repair any struaum -Zt_^ prior to its issuance.also requires the applicant forauch permit to rile a signed statement -m< that he is licensed pursuant Sq. Ft. Floor Area Valuation Z�n (commencing with Section 7000)ofDoosion]ofine Businmsand Professions Coodur $ at he is mmmpt than(rom and the basis for the alleged emmpti.m.Any violation of 3 5932044 . 0 -_ Section 7031.5 by a"applicant for a Permit subjects one applicant toacivil Penalty of APNNumber Occupancy Type. ..I more mane hundred doll..($500). -- '- - -- P Y YP ----- ❑I,as owner of the property,or my employees with wages as their sole compensation, will do me work,and the swewrt is not intended or offered for sale(See.7044,Business FRAM and PmWsiona Coda:The Contractors License Law does not apply to an owner of -1 115 — Repre' Inspections property who builds or improves thereon.and who doessuch work himtilfar tbmugh his 307 - INSULATION own employees,provided that such improvements am not intended or offered for tele.If, 6O1 — ROOF TEAR OFF huwevcr,the Wilding or improvement is sold within one year of completion,the owner- builder .will have me burden of proving Nat he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL eale.). ❑ L as he,of the prapeny,am exclusively contracting with licensed cOrmamoa to - 603 — ROOF BATTENS _ comuuct the p.jcet(Sec.7W,Business and Professions Code:)no Cmduacmr's Li. 604 — ROOF IN-PROGRESS cease law does not apply to an owner of prnpeny who builds or improves thereon,and who contracts for such pmjccu with a conuacmra)licensed pursuant to the Contractor's License aw L . ❑1 am caempt under Sec. ,B k P C far this moon Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following ilmlamions: I have and will maintain•Cenificmm of Continua rel Ninsure for Workch Compcm ishan,m provided for by Section 3700 of the labor Code,for the iterfarmance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance.m required by Section 3700 of tha labor Codc,for one Performance of the work for which this permit is issued. My Workerrs•.�Csnm�P.ensalion lnsunna anicnnd Polkynumbcr re 'ens: ^'7rt'afr r`^..`r Sponiicy No.: VqW :-'OB,a3 CERTIFICATE OF EK EM PTION FROM WORKERS' COMPENSATION INSURANCE (Thlssection need not becompleted IOhe Permit is future hundred dl(SILO) or It I certify that in the Performance of the work for which this permit is issued,I shall not employ any permn in any manner in as to become subject o the Workeri Compensation Laws of Celifnmia.Date Applicant NOTICE TO APPLICANT:II.after making this Cenifcau of Eaton prion,you should become subject to the Workers Campenutinn provisions of the Labor Codc,you must forthwith comply with such provisions or this permit shall W deemed revoked. 7-0 h - CONSTRUCTION LENDING AGENCY I hereby affirm ma them iv construction lending agency for the performance of x me work fur which this pens it is issued(Sec.3097,Civ.C.) QLeader's Nam. z Lender's Address J 0 1 cenify Nat 1 have read this application and sum that me above infmmatiun is y correct I agree to comply with all city and county oNinances and sate laws missing to DU building construction,and hereby authome repremotatives of this city to enter upon the W ,hove-mentioned property for inspection purposes. -w (We)agree to save,indemnify and keep harmless the City of Cupertino against N X;A Iiobii tie 'udgmenis costa anduPensea which may in any way accrue against mid City Jz inc tiquencc of the graining of this permit. ^ AP ICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:91w�ko Date U E EGUL IONS. syn �.i a3 ✓/ a Re-roofs Signature ofApplicanVConvmmr Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building Occupant store or handle havaNum material u dcrned by the Cupenino Municipal Corm.Chapter 9.12,and the Health and Safety CodeSection 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ' 104e,r ❑Yat �o Will the applicant or fwurc buildingdoeupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove It hmardnm air common..nu m defined by the Bay Area Air Quality Maier cnt all new materials for inspection. trict? Yea �Nu I have mad the haeadaus materials requirements under Chapter 6.95 of the Calier- Hcal Safety Code,Ssu..MM5.25533and25534.lundenu muifdm Wilding g[__ �j/�`03 s n a rte sty hat a moan,mat it is my armansihility m notify tW occupant of 1m 1 uim nu whichmustbe met p.or tuiuuanceafaCcaufcamof spans Signature of Applicant Date orauthorimdagent Ste -�e3 All roof coverings to be Class "B'•or better Community Development Department Building Division (( J: City of Cupertino �3 10300 Torre Avenue CITY OF Telephone: (408) 777-3228 I NO Fax: (408) 777-3333 UPEkT 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: `�s -44 /I Job Site Address: -7 f-'8 3 541x ,454a Liu r Roofing Company Name: A plicanYs Signature; L'' Date: $� �- 3 Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOFCITY 0 • CUPERTINO PERMIT APPLICATION FORM APN# 2, -- 6 ( Date: 512-f I '13 V Building Address: r '7f-S3 �► KKc>js� �L. Owner's Name: Phone k ::T70, k b kh 4+ S8 Gy Contractor: Phone#: y�Z. t� L� License#: (�t-I.CcMn-S 414 041 - Contact: .. Phone #: Z2 t 7 20 Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles )&67 Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings 2— Cl Provide I.C.B.O.Report# u )a To be Removed ❑ Provide Mfgr. Installation Spec�9 I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: Wyk. 3 t� car+ Coo Residential Commercial ❑ Fire Zone: Ye .©-,. o Confirmed with Planning Det. if there are any restric 'ons. Cost of P ject: Typ fist ction: Occupancy gr Qty. if ApplicFee 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