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03060115:1 J4 CITYOFCUPERTINO?��'y'^°�^�`"+rTTM TUR INF O BUILDING DIVISION PERMIT ,C"ONTR . TAT . BUILDINGADDRESS: ARMSTRONG INSTALLATION PERMIT NO 03060115 OWNER'S NAME: YOUNG P141T 774 HARRISON ST '""69717/2003 NE' (415)777-1234 SANITARY NO. CONTROL NO. ARCHITECr2NGINEER: BUILDING PERMIT INFO BLDG 61ECT PLUMB MECH 0 LICENSED CONTRACTOR'S DECLARATION 1 hereby dorm that 1 am licensed under Provide" of Chapter 9 (interns Job Descripti n Q_,r Rel 4 .Opit m vis o NeStresnAM�rI.Wnn3C and non neem is 3xd.1010An, _ with A)OD �Lot,� `L- REROOF `.,.0 `�� Dew arm JUN 2 7 2003 t. Mand 1 and rwd my plane ahalll u public recnnL BUILDI BUILDING NG Licensed ftmeemal OWNER -BUILDER DECLARATION 7 1 hereby aOlrm Nal 11. exempt from the Contra, License Law for NCfollow ' noon. (Section 7031.5. and Co o county Profession, Code: My city w. de my nructuro •permit re ennattmL slop improve, demolish. s which Lalun. which mefile a i prierm.lcened paimunotherequires the visio or tin Coninch permit Meese Law miscreant its mi that he punuml no the of the ComrecmAnd!Proflaw (ChapterCook) Sq. Ft. Floor Area $13�ty�ion womawsilanecd of Division Cnde) or (commencingwith Section70M)of the BmincuaWon. basisf3of Any vi chatk la varmpt therefrom and Ila buts for the alusW eaemption. Any violation of 3 AGIN4MH-1@ex 0 0 Occupancy '7Pe Section 7071.5 by any Applicant for a permit ubjects the applicant An a civil penalty of .1 mom than five bundmd&It=(5500). 0 I,aownerof Nepmpmy.mmymplo withwagsutheirmlemmpenuoan. — Re� dlns eC[IOBs willdo the"kand the structure ianotimended orortelW falcate (Sec. TIMI. Busircu Add Percentns Cade 71. C mmew's Llteme Law Ones net apply w an owner of 307 -' I NSULARe. P property who but Ida ar improves thereon, and who don such wad himself m through his owoemplay=.p.AdWthnavehlmptmemmuarenotinwWWoroRemdfm We.IL 601 — ROOF TEAR OFF however. the building or improvement is mid within one year of impletion. the owner. he did not build Impress, far puose or builder will have W burden of proving our he rp 602 — ROOF PLYWOOD NAIL sale')' 603 - ROOF BATTENS 0 1. as owner of the property. Am exclusively eommurting with licensed inlrutma le 604 — ROOF IN—PROGRESS instinct the project(Sec.70". Business and Professions Cade:) tee Contractors U. ccom law does not "ply to an owner of property who Wilds at improves thereon. and . who inuacu for such projects with Acontmcw*) licensed pumunt An the Canhmwls - Lkense Law. 0 lamuemptunderses. .BRPCrmthurramn Owner Dau WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of we following declarations: 1 haw and will .4h nin a Ccofie w of Consent w ulf-i...m fm WorterACompen. .no.. u provided rue by S.cti.n 7700 of dw labor Code. fm the Performance of won, work for which this permit is issued. 0 I have and will maintain Workers Compensation Iwrance, an required by Section 3700.f the Labor Cede, for the performance Of the work for Which this Permit is Issued. My Workers mime sedan Insurance Polity number art: Carel oliry Ny O CE TIFICATEOFEXEM ONF� r ORKERS' COMPENSATION INSURA 6 (Tse se<ti.n need wtbccomplc W iflh permit is fmauchundrtd dollan(SIO) or leu) I unity that In the performance of we work fm which Nin Permit is issued. I shall not employ any pawn in my amener an at an become subject IO RC Wodens C'OmperWdM Laws of c jir..Ik. Dau Applicant NOTICE TO APPLICANT: If. after making Nu Cenificaw of Exemption, you should become subject ro we Workers Compensation provisions; of No Leben Code, you most forthwith imply With such Provhimu AT this permit shall be deemed remkcd. CONSTRUCTION LENDING AGENCY I mmby affirm Nat Nem is a construction lending agency forte Performance of the work for which dust permit la issued (Sce. 3097, Cih, C.) Landes Name Lenders Address 1 certify that I have read this, application mutation war the show information la' conett 1 agree to comply with all city and county ordinances and sum, laws minting be building construction. and hereby authmtID RpremnUdw3 Or this city he valet upon the above-mentioned property fan inspection purpoWL (We) agree m save, indemnify and keep barmlw the City of Cupertino against iiabiiltica,j Wgmenls, costs And expenses which may In my way airuc against said City in consequence of the starting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WIT ALL NON -POINT Issued by:9 Dat SOURCE RE N5. Re -roofs Type of Roof ,o MIurtO Anlnmor ave HAZARDOUS MATERIALS DISCLOSURE Will the applicant m future building occupantenoro or handle hazardous material As defmcd by the Cupertino Municipal Cade. Chapter 9.12. and the Health and Safety Ade, Section 15532(4)7 ❑Yca ]�No All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove RIO the applicant or future building occupant rue equipment or devices which hazardous ail citsminants ss dcMW by the Bay Area Air Quality Management all new materials for inspection. Di'dm7 ❑Yes I have mad the Awardousmateriau requirements underChapwr6.95 of Ne Califon. nialkalN&tions SafctyCode. Sm25505,25533 and 2553/. l understand then if Ne Wilding O dean not curmolly have A N.mt, that It ts my rcsponslhill 'f Nc oce.panl.f Nc rogaln(!mants we mer piarwissueue ora rtirw a Igff r Gf pplicant -� Date All roof coverings to be Class "B" or better ag Dam • I"ammiase, CITY OF UPEI�TINO 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 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. YTHomeowner's Name: k' may© C",& -I Q -P7a A Job Site Address: Roofing Company Name: A plicant's Signature: Date: 0 Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper s • 11 Q O CUPERTINO __7117 i CITY OF CUPERTINO 2 REROOF d 7 PERMIT APPLICATION FORM // n2ez APN #O/ 00 � BUILDING Date: / a3 Buil 'ng Add res 10 BUILDING SEISMICRE Owner s Name: BUILDING BSEISMICOM Phone #: BUILDING BPLANCHK Plan Check Fee BUILDING Contractor: Phone #: BUILDING License #: Contact: — Phone #: Cupertino Business License #: v (r d Type of Roof Covering: Existing: Proposed: 1 Built -Up Roof ) Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) -:�O a,61 ❑ Other (Specify) �&Qd&a 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 Polic : Job Description: l ctc,vtil O Residential Commercial ❑ Fire Zone: Yes No Confirmed with Planning Dqt. if there res fictions: LJ Cost of P Iect-" stmction- Ocagroup: S e t f c p V�. nc1 ` Qty. if! ADDHGHUla Fee ID Fee Descrintion Fee Groun BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING SEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING 145W,r