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09040096 CITY OF CUPERTINO BUIL,DINGDIVISION PERMIT �1}' TI�t� f? �' RI�lr ` PERMIT NO. BUILDING ADDRESS: 20135 FOREST AVE, ,ETERU PERMIT ISSUE DATE OWNER'S NAME: -ft#:fAi2At.2CONTROL NO. 1iJiA,D4P'13'B11TZ3 RG-.- 831) 273-1837 BUILDING PERMIT INFO ARCHITECr/ENGiNEER: BLDG ELECT PLUMB MECH v p z LICENSED CONTRACTOR'S DECLARATION Job Description UI hereby affirm that I am licensed under provisions of Chapter 9(commencing z with Section 7000)of Division 3 of the Business and Professions Code,and my license is 'may in full force and effect RE—RF T/0 WDSHKS FILL SHTNG AS NDED 40LB FLT z License Class G 3�l Lic.tY T F- Date Contractor I NSTL ARCHITECTS D R .� < I understand my plans shall be used as blic cords MTL TILE C L SA S Q �yU WI- Licensed Professional O 0 W OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the `t a o following mason.(Section 7031.5,Business and Professions Code:Any city or county .4m which requires a permit to convect.alter,improve,demolish,or repair any structure 4— prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation _Z r Ft.Floor Area that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq �y r (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of 814000 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). 31633070 . 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 oroffered for sale(Sec.70".Business Required Inspections and Professions Code:The Contractor's License Law docs 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 Code:)The Contractor's Li. cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec .B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 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 Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. have and will maintain Worker's Compensation Insurance,as required by Section I n 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carti � Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) I cenify that in the performance of the work for which this permit is issued,l 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 Code,you must ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z ► CONSTRUCTION LENDING AGENCY Fr I hereby affirm that there is a construction lending agency for the performance of �ithe work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name z Lender's Address I certify that I have read this application and state that the above information is LUL" correct.1 agree o comply with all city and county ordinances and state laws relating o 0 V building convection,and hereby authorise representativos 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 liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ►-r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b,': SOURCE REGULATIONS. Re-roofs — S' u t/Contrac °are Type of hoof HAZARDOUS MA ALS DISCLOSURE 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 roofE shall be inspected prior to any roofing material being installed. O Yes ° If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or 1.building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. LAstrict? Yes rrm I have read thehazarrials requirements under Chapter 6.95 of the Califor- nia Health&Sarety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the �r ;�n;or �authzcd must be met�to of a Certificate of Occupancy. Sig llrt:o Appl ieant Date All ro cov rings to be Class"�."or better agent Dam CITY OF CUPERTINO RF,ROOF 1 CUPEkTINO PERMIT APPLICATION APN # Date: Building Address: Owner's Name: R��{- Phone #: q 0 9 1 —Z-7 v5 HOA: Yes ❑ No ❑ If yes, provide letter from HOA Contractor: Phone #:jfCj� 3 Ga -�1 Fax #: Lfvi' 6-" /-3 Cupertino Business License #: Contractor License #: Type of hoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles -la- Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) 1W Other (Specify) .�+r�� t•S1.k- Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: -Pa.- o`ir wok Apkes -I;c� ckee: -i,..� .As nx�Z �E� %bc 4tc -1 ►+`'�'�`�� -c-4 1 �^It s�s�er. PC( Glass �- s 7 Residential C] 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 inclex. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: — 4 ��� Signature Revised 02/05/09 CITY OF C-UPERTINO REROOF CITYCUPEt�TINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg St�mdards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B :2, 7 1REROOFRES Re-roof Residential B 1SFDWLROOF / 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential 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 ag:•ee to comply with 2007 IBC Standards and manufacturers specifications on r:-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be apph2d 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 arty 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. 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 paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/ "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: �064 CA,,!Vk4,11 Job Site Address: ZJ - Roofing Company Name: Applicant's Signature: Date: _��� Greg Casteel Building Official C Revi ted 07/30/08 Community Development ;'. 10300 Torre Avenue - Cupertino CA 95014 Telephone(408)777-3228 CITY OF � ;UPE�TINO Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # 20l 35' ' fr OWNER'S NAME: ,�/ PHONE # GENERAL CONTRACTOR , A.(, S' ,,. FAX # I am not using any subcontractors: - Si Lle t Date Please check applicable subcontractors and com th ollowin information SUBCONTRACTOR BUSI14ESS 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 r Contr r Signature Date