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05030094 (2) CITY OF CUPERTINO BUILDING DIVISION -PERMIT ,CONRACTOR INQRMATTON BUILDING ADDRESS: MONKS ROOFING PERMITNO 05030094 W NER'S NAME: PERMIT ISSUE DATE ONE: SANITARY CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG EO PLO MECH LOp LICENSED CONTRACTOR'S DECLARATION '/ - "//i1 ' F 1 hereby affirm Nat I on lica sed under Income.of Chapter 9(commencing Job Scription with Section lIXlU)of Diviaio of NC Buuneas an Pro(essiumC de, dmylicevcu U� inmummeamerr 2 Cj REROOF W Liccn Iw Lk.Y AA 4 ARCHITECTS DECLARATION �C �O o W U I unontanJ my plans shall W recd u public n,cnrm GLin O (//`/v///ry V ✓ censed Professional qy OWNER-BUILDER DECLARATION i<X 1 hereby aRnn that I am exempt from Ne Contractors License Law for the opo following reason.(Section 7031.5,Business and Professions Cade:Any city or county a�$ which n;ximms•person to construct,altar,improw,demolub.or repair any swetum Fi< prior w its issuance.also requires the applicant for loch permiuo file a signed statement ppm that he is licensed pursuant otieprovinces ofde,Cormier'sLicense Law(Chapmr9 Sq.Ft. Floor Area - Valuation yF$ (commencing with Section 7000)of Division 3 of the Business and Profusions Com)or Wt W u exempt therefrom and the basis for the alleged eaemption.Any violation of �AA--yysswwnny1a9�s��i4,, w1 Section 7031.5 by any applies¢for a permit subjects thc applicant w a civil penalty of 3 d9T1e/41 W 1a3�e V 0 Occupancy not more Inas five hundred dollars(MM). P Y Type ❑1,as owner of Ne propmy,army employees with wage ss Thew sole compensation, will da tie.,it.and the.e w.u not intended oraRered forsale(Sm.7O4a,Business and Proressiam Cade:The Contractors License Law does not apply in an owner of Required Inspections property who builds o,improves theman,and whodoes such work himself or through his awn cmployeu,provided thmauch improwmem arc not intended moRcred forsale.If. however,the building or improvement is mid within om,year of mmplcdm,Ne owner- builder will ban the burden of paving that he did not Wild or improve for purpose of Me.). ❑1.as owner of Me propeny am exclusively contracting with licensed contractors to construct the projem(See.TBad,Business and Profcssiom Code:)The Counselor'.U. come law does not apply to an owner of property who Wilds or improves Marmon.and who contracts for such projects with a eomramm(s)licensed pursuant w the Contractors License law. O 1 am exempt under See. .B&P C for Nis mom wmr Date WORKERS COMPENSATION DECLARATION 1 hereby affirm under penury of perjury mese of the following declaration: I have and will maintain a Certificate of Consent w seifdnsum for Workers Cumism. ration.as provided for by Section 3700 of de Labor Cade,for the performance of the work for which Nis permit is issued. 1 have and will maintain Worker's Compensation Insurance,m required by Section of the Labor Coda,fa�of the woh for which this Permit u issued. My Walters Cnmpemation lnwnnce 'mond Palisy numb(e��are(� �/�r�� Cartier Policy No.:7QQvv t CERTIFICATE OF MON FROM WORKERS' COMPENSATION INSURANCE (Thu section wed not Mcompleted if the permit is formic hundred dollars(SAID) or lua.) 1 certify that in Me it.1mmence of the work for which this permit is;issued.I shall not employ any prem ymanc ae,ulaboc Ice Um IM Workeri Compensation Laws of Callfor ate n rae�u L✓9�J Applicant [Z'L NOTICE TO APPLICANT:If,afar making this provisions of of FLabor o d you u most Obecome h comp y the Workers Compeor this pmwisions of the Labor Code.you must forthwith comply with such provisions or this permit shall he tlacmcd revoked. z'` CONSTRUCTION LENDING AGENCY I Wmby aRrm that then,is a construction lending agcnry]or the performance of FL Ne work for which this permit Is issued(Sec.3W7,Civ.C.) QLendcra Name = z finders Addmvv U 0 1"miry Nat 1 have read this application and rues that the above information is D,F correct,)agree to comply with all city and county ordinances and sum laws relating w 0 U building couuunion,and hereby suthorim mpmacnutines of this city to enter upon tie shove-mentimncd properly for inspection which on _ H 4 (We)agree to saw,indemnify and keep harmless the City of Cupenioo against ti Iiabili0es,judgments,Costs and upempeork.hmay in any way accrue against said City U z m come ee of Ne granting of this permit. APPLI UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOU REGUATI LSI Re-roofs Sgnawn,of ApplscantfConummor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tins applicant or forum Wilding occupwt store or handle husrdous material o0wd by tie Cupcnino Municipal Code,Chapter 9.12,and tie Health and Safely ode.Semon zss3z(a? All roofs shall be inspected prior to any roofing material being installed. ❑Yea ❑Na Will tie applicant or(umn,Wilding aceupam taw equipment or denims which If a roof is installed without Errs[obtaining an inspection,I agree to remove mit horardnu air cwtaminants u defined by the Bay Arta Air Quality Management all new materials for inspection. District? is do? P ❑Yes 01 No Ihawale thohuaNwsm 55()5,25533 ad25534. 55 under understand ifthe Wilding �C ,O!//, ✓ O� Ids Hcal Safely Coo,Stttiom2et It and 2553a.l Wmidlnde OccocWilling Jmcs n c rtentiy how a¢none that it u my spansihility w nvtily the occupant of the myui m uwhichmu W i u ofaCerdficamoraccomarcy Signature of Applicant Date Owner or authmrircd agent 33 ��Date All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPERTINO Building Department OB ADDRESS: PERMIT # N-e.w Ct3+1 e rz 19 OWNER'S NAME: c4 A ' L ocank PHONE # Z^ 0 GENERAL CONTRACTOR: p N t4o M FAX # I am not using any subcontractors: 3 - U S Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS 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 Mr Tile f2z�� Owner/Contractor Signature Date Community Development Department Building Division 5' City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 Fax: (408) 777-3333 UPEQ INO 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. 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 2/4 " 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: m a tK e k Q ry-\ 1 Job Site Address: 17567 Roofing Company Name: S Applicant's Signature: o'A Date: U Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO v3 REROOF CUPEI�TINO PERMIT APPLICATION FORM APN# -� C / I -) 07 DaterlL ^ � S Buildin Address: // X156 N2 W LuS 1 /2 Owner's Name: Phone #: rl °Nk eg �. m Zs0?1- 0 Contractor: Phone#: License#: o N Ro t`� 3.-U 6 a�5 Contact: �I� Phone#:� Cupertino Business License#: �( c I Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 4K Asphalt Shingles c�Ei Wood Shakes ❑ Wood Shakes -B. Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings Z ❑ Provide I.C.B.O.Report# '8k To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: 6Z 0 -F� CSS ice, JZop-� :S�Sjg11 S 4T 5 %b6S� Residential cgj Commercial ❑ Fire Zone: Yes ❑ No 'Q Confirmed with Planning Det. if there are any restrictions: LJ Cost ofProject: / Q Q� Type of Construction: Occupancy group: Qty. if Applicable 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 J S �� . 4(,6