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03100180 'CITY OF CUPERTINO BUILDING DIVISION PERMITX0NTRAC�TORaINF0R,MATION BUILDING ADDRESS: EUSTACIO BELTRANO PERMIT Nc03100180 f1103 GARDENA DR OWNER'S NAME 21103 GARDI'.-'NA DR PERMIT ISSUE DATE alkEUSTACIO BELTRANO 10/24/2003 VI NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 0 0 100 LICENSED CONTRACTOR'S DECLARATION 2 w G 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing .lob DesC 1 tion U With Scaion7000)ofDivnion3ofdteBusiness and PrufnesinrtCode.and mylicense is tion ±Zno, in mu force and effect. REROOF Jud? License Class Lie.0 -Fp Dalc DE "iHITENOV 2 0 2003 sQ ARCHITECTS DECLCLARATION I2< 1 understand my plans shall W used as public records JyU oG LicenudPmfcuional BUILDING g OWNER-BUILDER DECLARATION X 1 hereby affirm that 1 ram exempt from the Contractor's License Law fur the 00 following reason.(Section 7031.5.Business and psnfealons Code:Any city or county m which rcquitm a permit m Consumer.slur,improve,demolish.or repair any animism $450 z6prionu its menace.also requires the applicant for such permit to rile a signed statement that he is licensed pursuant In Nc previsions of the Contractor's License lAw(Chapuni? Sq. F[. Floor Area Valuation $ (commencing with Section 7")of Division 3 of the Business and Professions Code)or 32608086 . 00 that Ise u exempt tbemfmm and do buts for the alleged exemption.Any violation of 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 doll..(13()0). 1,as owner m the property,or my employees with wages as Weir wle compensation, will do Nc work,and the structure is not intended or offered for sale(Sec.]Ora.Business and Profcrritns Code:The Col.,.,a Luxens,taw docs not apply m an owner of Required Inspections property who builds or improves thereon,and who does such work himself or through his own employees,provided that uch improvements are not intended or offered for salt.If, however,We building or improvement is sold within one year of completion.We owrrer builder will have the burden of proving that he did not Wild or improve for purpose of sale.). ❑ 1.as owner of We propcny,am exclusively toms cling with licensed comencmrs to combuct the project(Sec.7014.Business and Professions Code:)The Contractors Li- ccose law docs not apply to an owner of prope tty who Wilds or improwc demon,and. who contracts for such projects with a contracter(s)licensed pursuant in de Contractor's LlRnae Law. (T�I am exempt de c .B&P C for this reason WO CER'g COMPENSATION DECLAR O I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Cotillion,of Consent to ulDinsurt for Workers Cumpe n- moon,as provided for by Section 37W of to labor Code.for the performance of the work for which this permit is Noted. ❑1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of We Labor CedC.for NO performance of the work for which this permit is issued. My Worker s Compensation Insurance carrier and Policy number am: Cartier: Policy Ho.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not W completed if the Permit is for one hundred dollars RIUM) Icas.) I terrify that in the performance of the work for which this permit is issued.I shall not employ any Person in any manner so as In bccumc subject to the Wmrkeri Compensation Laws of Cshfomia.Data Applicant NOTICE TO APPLICANT:If.after making this Cenificaoc of Exemption,you should become subject to the Worker s Compensation provisions or the labor Code.you must �Z. forthwith comply with such provisions or this perm it shall be deemed mvokcd. ZO CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for de,performance of x Ne work for which this permit is issued(Sec.3097,Civ.C.) S7 Q Lender's Name L Lender's Address D Q 1 certify that 1 have read this application and suite that the above information is y Fconed.1 agree to comply with all city and county ordinances and soma laws relating to C.J building construction,and hereby authorim mprconutives of Nis city to enter upon the above-mentioned property for inspection purposes / LL (We)agree w move.iodcmni fy and keep hafmless the City of Cupertino against h liabilities,judgments,costs and expenses which may in any way accrue against mid City �S .-) Z in consequence of the granting of this permit ^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU E ULATIONI 0` - L Re-roofs i so.m. ApplicanVConuaco" te HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne applicant ser fuwrc building occupem wort or hand c hasaccous material u defined by the Cupertino Municipal Code,Chapter 9.12,and Re,Health and Safety Adw,ode.Section 25532N)? All roofs shall be inspected prior to any roofing material being installed. ❑Yis )jfNu .,Will the appli,.mor future buildingdecupant use equipromor devices which If a roof is installed without first obtaining an inspection,I agree to remove it hmardous air conlamiwnts u defined by 3(c Bay Area Air Quality Management all new materials for inspection. i...my \/ 0Yce ft[Nu I have mad Nc haranitus maerols requirements under Chapter 6.95 of the Cable, his Health Code.Sections 255115.M533 and 25534.1 understand Nu if the Wilding Iter no,currently hoc a Cram.that it is my resptmihility to noufy the occupant or We reyvire cot rM1ichmusoWmrypmywrsstaneetraceniria¢orQctpme. gnatureofApplicant ate �0 1 0 All roof coverings to be Class or better cr ser authorised agcm Ome Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 CUPEkTINO 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: Job Site Address: Roofing Company Name: f� // y`— �D-lam Z A plicant'sSignature: � Date: o00� _Q-B,- � \�IIKWD�J� Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO 03 o c,X 80 REROOF CUPEkTINO PERMIT APPLICATION FORM APN # O (a Date: b Building Address: •y���� G��GEn/�i �/� Owner's Name: /C Phone - Contractor:� Phone #: License#: oc..d P ratenv Contact: GEO/26� /"/ c6,,, Phone#: �fr7�/S� 9310 Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof )9( Asphalt Shingles A 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 Cu ertino's Tear Off Policy: t Job Description: XEr1Zvc E►iTin fJr�/�9ti f//in>dLfS i9� �F c.i9Ct G✓/i7/ ResidentialP" Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if there are an restrictions: LJ Cost of Project:yJ Type of Const cf n Occupancy gr" r Qty. . A ca le Fee 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 77. s� .