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04080104 CITY OF CUPERTINO BUILDING DIVISION PERMIT �t NTRACTOR•INFORMA.TION: BUILDING ADDRESS MANADA ROOFING• PERMIT N0.INC 04080104 . 191 S4 S A T)TITTT(,TI)AT rrl"OWNER'S NAME: PERMIT I SUE DAIS NNTR YRN(; 94717 F4TR IfTrW A.17 P44r2L 021 ONE. � SANITARY Ndd.''""�r ```"'�r ONTROL NO. (510) 881 -4727 ARCHITEC(ENGINEER. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u0o LICENSED CONTRACTOR'S DECLARATION i=CI1 1 hooky affirmNat1amTian rprovisionsofCh,pur91...on'ing Job Description <b with cu 70M)of Divumn3of�hc rmac aM ProfMOMCodc.and my license is n full and effect oq: Lk eclat: Lm.I g�077� REROOF W/ 1/2 IN. CDX ASPHAJ ING LES i�c Da Contract- 1 ARCHITECTS DECLARATION / -A UI ypden ted my ph"shall he used aavwal :7 eo 3 U.t,Licensed Prefcssmml ` / AUG O< OWNER-BUILDER DECLARATION '10p� Y I Wrehy affrm Nu 1 am exempt form the ConlncmYs License Law for the C a O following moron.(Secti on]1131 5,Business and Professions Code Any city or aunty ®pA� which reymres a pemw m emsmoct alter,improve,demolish,or repair any swemm ((t�� ,{A% �D.CC 17 n n n prior ro its iss uance..I.rogo,.the appbant for such permdso Rk a signed smmment - _ -yal( pl n H Z�s< 'hot he is licensed pursuant in the provisions of the Contractor's Uumic Law(Chapter 9 Sq.Ft.Floor Area -- - p�4 f-D (commencing with Section 70M)of Division 3 of the Business and Professions Cnde)or $ INt Ire is exempt tkertfmm and the Arise for IM alleged exemption Any violation of mS wT 1�, Section 7031.5 by a"applians fora permit subjects the applicant ro a civil penalty of 3 g1JSE is OI�YYI O O Occupancy not mom man im hundred dollar(gran). . ._ P Y []1,nownaoftmpropeny.wmyemploy nwimwagesas it oleeompewtion, I will do Me work and meawcsure is not intended uroffered forsak(Sm.7044,Business and Profrssmm Code:The Conoacrors Larose Law does net apply no an Owner of i Required Inspections property who Wilds onmpowes thereon,and whodoessuchwmk himselforlhrough his ' own cmployces,provided mat such improvements are not intended oroffered forsem.If, however.me Wilding or improvement is sold within are year of compmuon.me owner holder will have Me burden of proving dot k did not Wild or improve for puryuse of sale ❑1,m owner of the Property am exclusively contracting with licensed licensed co mom s to construct the project(Sec.7041,Business and Profoasons Code:)The Gontracomes U. come law dots not apply to an owner of property who Wilds or improves thcrton,and who contracts for such projects wed a conoacter(s)licensed pursuant in the Conoactofs Lim.Law. I am exempt under Sec. .B h P C for this moon i r Owner Ate WORKER'S COMPENSATION DECLAB•nfION I hereby alTnm under penalty of perjury Oa of she fallowing declarations: 1 bare and will maintain aCerlGcme of Comcnuo self-insure for WorkeesCompcn- sation,as provided for by Section 3700 of the Labor Code.for me Performance of me work for which this permit Is mood. ❑1 have and will maintain Wofker's Compensation Insurance,as mymrod by&CUOn , J]00af me Labor COM.(m me pedormmec of the work forwmch ors permnisissad i 'SMy Wmrkee.CompcmNon Insurance amer end Policy numWr arc: f faoier. eT/fjD pp try7o�—> CEfmRF ATEFOFEKEMA0 FROMW KERS' COMPENSATION. (Imhaecuannced notWCOmplemd drhe pumarl Is formic hundred dollars(SIM) r or lua) I 1 I certify mat in the performance of the work for which this permit o issued.l shall net employ any person In any mmner so as m become subject m me Worker.Cmmpcnmdon Laws of Cahfomiz Dar- A"Imant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should ' Wearer subject m me Worker's Cmmpcmauan PmvwOM of the La Wr Code,you muv � Z foMwoth comply with such provisions ormoPerrot00t tic mcnedrevoked z O CONSTRUCTION LENDING AGENCY IWmby affirm our Mort is a construction lending agency lnr me podurmarce,of l>: me Work for which this permit.Issued(see 3097,Cw.C.) (y Q Lender's Nam- _ Z) Z Lender.Ad --- i U Q 1 certify that I have Tad this apphamn and sate that me above information ts ly P correct.1 agree ro comply with all city and roomy omirences and sum rows muting m 'l�y�/I1II/•l�[JJ�a} //�/��� 1/'\ yp � ///) �U building e).&me to siod hereby indemnify and represenmiwsof City reenter upon the Y.(`r (. I /V7I_!/W./ T,fy above-mentioned property for inspection xtion es Purpose: F h liabihues.ludgmenu.costs andeaperyiscs whicch may in any way acrnx Cupertino against sod City U m comequcna Of gmodng of this permit. Dale ^ AP ICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b UR GULAIIONS _a Re-roofs S of ApplicmVC.n.., HAZARDOUS MATERIALS DISCLOSURE 'T Type of Roof Will me applicant or future budding Occupant store or handle hanrdous material u droned by do Cupertino Municipal Cods.Chapter 9.12.and the Health and Wety ' we.Seedmn us3x(,)+ All roofs shall be inspected nor to an roofing material being❑Yee No p p y g g installed. will me a Imantor future Wi If a roof is installed without first obtaining n inspection,I agree to remove pp rag aauWm use equipment or drnces which $ P $ ion hasardnus au cmnuminants caned by the Bay Ama An Quality Management all new materials for inspection. DisuteD ❑Yea ❑No it I have Saml C t.Ste. materials 533 and M under Chap distill Caking _ nu Heltht&SmctyCedc.Samos 25505, MY Ius sooty Me Wldmg /)+ dos ram currently have a moans mat is n sy cc oraccou ro notify ce sxeupant of the //_ Q yuirtm h¢hmusW pnonutss ccofaCeroOCamOfOCCUan CCC/- atureofApplicant V Date._ n raumori,<dagen� -- -� „c All roof coverings to be Class"B" or better f Community Development ° 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEI�TINO Building Department JOB ADDRESS: PERMIT A C- PHONE � OWNER'S NAME: P�J+iP f✓Pz # 5/©—'70a 7.5717 GENERAL CONTRACTOR: FAX# S6g—7 B`D-- 7-5-$7 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information ® SUBCONTRACTOR BUSINESS NAME I BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical fExcavation Fencing Flooring:Carpeting 1 .� Linoleum/ Wood Glass / Glazing { Heating 1I Insulation 1 Landscaping Lathing ` Masonry 1 Ornamental Sheet Metal ii 1 Painting / Wallpaper I Paving Plastering Plumbing Roofing h f.�/%J).S2 �/���iGl �077/ Septic Tank Sheet Metal 1 Sheet Rock �I Tile Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue ' Telephone: (408)777-3228 8CITY OF UPE ITT I N O 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 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: aC�19/�/� f✓P ti(, - Job Site Address: 2-,, 5V57 AZ --//7� Roofing Company Name: - A plicant's Signature: Date: \�l/P6lil1DC)C1 Greg teal Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOFn CUPERTINO PERMIT APPLICATION FORM APN# % � s� Da �7 j2C0� Building Address: ivC TI��C Cad/ us/ 2/5 V_57 c? Owner's Name: Phone#: { Contractor: Phone#:SJo-7&9-9S 17 License#: Contact: Phone#: Cupertino Business License#: 1�lCalr✓�3 �P>✓'/CE Z Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ asphalt Shingles q',"Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ 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 Cupertino's Tear Off Policy: 1 Job D scr iption: Residential Commercial ❑ ' Fire Zone: Yes ❑ No ❑ Confirmed with PI e if there are estrictions: I � DOa yp /Cost of Project: \ o Occ cup: Qty. if App a e/e / Fee ID Fee Description Fee Group � BPERMFEE Bldg Permit Fees BUILDING I BENERGY Energy BUILDING ( / BSEISMICRE Seismic Fee Res BUILDING I BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC I Business License BUILDING I ( 1 ? z ' 3z