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09040013 CITY OF CUPERTINO �T�+ �� BUMDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 09040013 20135 CEDAR TREE LN ARMSTRON3 INSTA L PERMIT I55UE DATE OWNER'S NAME: S A CONTROL NO. PHONE: (510) 777-1234 BUILDING PERMIT INFO ARCHITEcT/ENGINEER: BLDG ELECT PLUMB MECH p C LICENSED CONTRACTOR'S DECLARATION Job Description w;: I hereby affirm that I am licensed under provisions of Chapter 9(comm acing .zw withSection7 orl I on3oftheBrrsincs and Pr CcssionsCoQp,�ndmyli rnseis RE-RF T/0 EXT WDSHK & RPLC W/35 SQ CLS A CMPSHNGL `s in full force ani Lie= i L�.>r & 1/2 CL X y Date Contractor ARCHITECTS DECLA ATION I understand my plans sball be used as public records LO y Licensed Professional H rA OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractofs License Law for the in O following reason.(Section 7031.5,Business and Professions Code:Any city or county K m which requires a permit to construct,alter,improve,demolish.or repair any structure y "y prio'-i-- to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions oC die Contractor's License Law(Chapter 9 q zi- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $27000 .IR_ that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). 3163400-, . 00 ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner. 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 the project(Sec.7044.Business and Professions builds de)The roves tmtons U- cense cease Law does not apply to an owner of property P who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law' B&P C for this reason ❑I am exempt under Sec Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury One of the following declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn- .ion,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Workees Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Wo�s Co pensation Insurance carrier and Policy be r are: carrier\`Ct:si. .G� PolicyNo.: CER77FiCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (nris section need not be completed if the permit is for one hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption•you should become subject to the Worker's Compensation provisions of the Labor Codc.you must 2 forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY C/) I hereby affirm that there is a consuuctian lending agency for the performance of 5 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lendcfs Name 4r C.endees Address U C) I certify that I have read this application and state that the above information is LL H correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. W W (We)agree to save,indemnify and keep harmless the City of Cupertino against tri liabilities,judgments•co and expenses which may in anyway accrue against said City U Z in consequence of the ting of this permit. Date Z- 0-4 APPLICA UN STANDS AND WI C LY ALL N DINT Issued by: SOURC NS. �J Re-roofs -- Signa Applicant/Contracin are T of F-oof HAZARDOUS MATERIALS DIS OSURE Type Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All All roofs shall be inspected prior to any roofing material being installed. ❑Yes If a roof s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which , all new materials for inspection. mit harardous air contaminants as defined by the Bay Arca Air Quality Managcmcnl strict? ❑Yes ° s O 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code.Sections 25505.25533 and 25534.I and rstand that if the building docs not cu by h a tenant that it is my respoesibilit m notify the eecu ant of the Date / require hi ustbemetpriortoi oCa heat.ofO P y Sign re;ofApplieant //�/ All roof coverings to be Class' ''or better Own or authorized agent Date CITY OF CUPERTINO 0� Oq 0`2� 13 REROOF CUPCOF ERTINO PERMIT AINLICATION APN # Date: Building Address: t Owner's Name: Phone #: HOA: Yes ❑ No ❑ If es rovide letter from HOA 4 c'K- �C,�- � y Contractor: Phone #: —7-71, rl 5 Ju f VA C r� 1v�S J1 J_V� Fax Cupertino Business License #: Contractor <11 License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles , �tr, Asphalt Shingles X Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report # vS ❑ To be Removed ❑ Provide Mfgr. Installation Specs. L� Job Description: t�Sr Zk, s,V4, 1�/C��c✓" .�� ,t �►c� �'' �' ,c h � ' , lei S(/� 1 CJT l /G�s�\ �t31MJ� l/ � l Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: applicable, include in plan set & the sheet index. Valuation: I Have Read, Unde to d and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CIUPERTINO a REROOF CUPEkT1NO FEE SCUEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Conanercial B 1RER00FRES Re-roof Residential B 1SFDWLR00F �s 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Resl'dential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Res]'dential B 1BUSLIC Business License B 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 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 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 Citi,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 nai.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 per.*onned. 7. NOTE: If you call for a plywood nail:nspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. 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 abova stated policy on re-roofing. Homeowner's Name: 4 I Job Site Address: e' 35 C� �� L g�_kA� -- Roofing Company Name: Applicant's Signature: �� Date. Greg Casteel Building Official Revised 07/30/08