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07010166CITY OF CUPERTINO BUILDING DIVISION BUILDING ADDRESS: 1 n 1 a 1 PASADFEN OWNER'S NAME: A CALDWELL ONE: ARCHITECT/ENGINEER: ?0O m a<LUc L1 ❑Z 9E'w a �yU �p0 � � y –Za fro Y[c� iS5 .7 Q Z � PERMIT LICENSED CONTRAUCUR'J UtLLAKAt tun I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect `j Q License Class I Lic. k Loo Date �– '2 Contractor ��� RCHiTECTS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter. improve, demolish, or repair any structure prior w its issuance, also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). 0 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 or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does 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.). 0 I, 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 Contractor's License Law. 0 I am exempt under Sec. B & P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a Certificate of Consent to self-insum 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. 1 have and will maintain Worker's Compensation Insurance, as required by Section 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: I Carrier. _,J;WfK / niA Policy No.: 2 7-7 9 — �4 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 certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensadon Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 888 FAULSTI (408)293-9399 PERMIT NO. 01/26/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description REROOF-REMOVE (E) SHAKE, INSTALL OSB/ROOFERS SELECT DELT/LANDMARK 30 YR COMP -21 SQUARES CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (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 in consequence of the granting of this permit. APPLICANT UNDER TANDSAND W COMP ALL NON -POINT SOURCE REGULAT S. f Signature oApplicant/Contrraactor Date HAZARDOUS MATERIALS 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)? 0 Yes d4 Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? �r 0 Yes J.,� 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health &Safety 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 requirements whit n issu c of a Certificate of Occupancy. Owner or authorized agent Date Sq. Ft. Floor Area 3571704,-). Issued b,,: Re -roofs Type of ]roof $4316 Required Inspections Type Date /- 2. d1-� 7 All roofE shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signature; of Applicant Date All roof coverings to be Class "B" or better Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 CITY OF Fax: (408) 777-3333 CUPEQ 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 cn re -roofing. 2. New roof coverings shall not be aFplied without first obtaining all inspection and written approval from the buil ding4nspector. A final inspection and approval shall be obtained from th a 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 t e at-o^v%e stated policy. on re -roofing. Homeowner's Name: L ._- ---_ =:_--4-obSite-Addr-ess:-- Roofing Company Name: A plicant's Signature: I A &� (-0�9 Greg Q-1/teel Building Official Rwised 1/30/03 Prin; ed on Recycled Paper CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Buildin De artment JOB ADDRESS: 1b1111�.� // PERMIT # OWNER'S NAME: PHONE # , X — r " < G GENERAL CONTRACTOR. © FAX # I am not using any subcontractors: Signature Date Please check avvlicable subcontractors and complete the following information G.V/ / er/Contractor Signature Date 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 Tile G.V/ / er/Contractor Signature Date CITY OF CUPEkTINO CITY OF CUPERTINO REROOF PERMIT AJ?PLICATION FORM a ;�� IAX�,6 APN # .js 7 yD / Bldg Permit Fees Date: 2L 7 Building Address: /0/ Ll CISH / Owner's N e: �BSEISMICOM Phone #: Seismic Commercial Contractor- ZZ q67 Phone #: Ll ox License #: �OOY07 S 2!qs-9399 Business License Contact: L,/ Phone #: Cupertino Business License #: S�� 358 Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles Asphalt Shingles A Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) Other (Specify) Number of existing coverings 1 ❑ Provide LC.B.O. Re ort # To be Removed ' Provide Mfgr. Installation Specs. :5 I Have Read, Understand and Will Comply Willi Cu ertino's Tear Off Policy: Job Description: *7l, Residential Commercial ❑ Fire Zone: Yes ❑ No Xthere Confirmed with Planning Deft. if. are an restrictions: Lf Cost of Project: Type o Cojistructi Occupancy group: 1 --Lqdu LIN Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Ener BUILDING �BSEISMICOM __ _.�eicm�c.F.eeRes___�..,,.._ Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING