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07080214 FBUILDINC. OF CUPERTINO PERMIT DIVISION i ERMIT PERMIT NO. TQ6ESTANTAU AVE STATEWIDE ROOFING INC 07080214 U(J PERMIT ISSUE DATE NAME: 08 242007 PLE COMPUTERS 5542 MONTEREY RD SANITARY NO. CONTROL NO. 4E: (408) 288-8680 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH ARCHITECT/ENGiNEER: 04 o LICENSED CONTRACTOR'S DECLARATION Job Description W 1 hereby affirm that i am licensed under provisions of Chapter 9(commencing BUILT UP ROOF AND REPLACE WITH TITLE y with Section 7000)of Division 3 of the Business and Profcssiuns Codc,and my license is REMOVE (E) UJ 41- in full force and effect. LicD 24 v�z License Class's--Contractor t-w Date S} si p Cz'—7 HITECTS DECLARATION CAP SHEET CLASS A 5 0 0 SQ FT i a< I understand my plans shall be used as public records iyU u.y Licensed Professional O a OWNER-BUILDER DECLARATION 3< I hereby affirm that 1 am exempt from the Contractor s License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county :m q which requires a permit n031.5,construct,alter,improve,demolish,or repair any structure Valuation prior m its,. also to the applicant for such permit to file a signed statement SL::F:-Floor Area $210 6 6 0 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 :MCIi (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or Occupancy Type 1 that he is exempt therefrom and the basis for the alleged exemption.Any viola on of �pN Number Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 31618027 `Cir not more than five hundred dollars(S500). 0 I,as owner of the property,or my employees with wages as their sole compensation, Required Inspections 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 dtrough 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 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)11te Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. B&P C for this reason 0 I am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLpRpTiON I hereby affirm under penalty of perjury one of the following declarations: l]1 have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers o ns tion Insurance carrier and Policynumber are: Cartier. '-`�`�' AW—- liry No.: CERTIFICATE EXEMrIiONFROM WORKERS' COMPENSATION INSURANCE Crhis 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 Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. z CONSTRUCTION LENDING AGENCY i— I hereby affirm that there is a construction lending agency for the performance of h C4 h7 the work for which this permit is issued(Sec.3097.Civ.C.) W Q Lender's Nam 04 Lender's Addrec ss [certify that i have read this application and state that the above information is i- correct.I agree to comply with all city and county ordinances and state laws relating to O U building construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. >' a (We)agree to save•indemnify and keep harmless the City of Cupertino against HCA liabilities,judgments,costs and expenses which may in any way accrue against said City Date in consequence of the granting of this permit C)z eSiawreofApplicant/ NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by REG(JLA O A Re-roofs antrac Date Type of Roof HAZAR US 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 All roofs shall be inspected prior to any roofing material being installed. Code,Section 25532(a)? 0Yes �'° If a roof;s installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment ordevices which all n W materials for inspection. emit hazardous air contaminants as defined by the Bay Area Air QualityManagement District? 0Yes �o _ 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 c ntly have a tenant,that it is my responsibility to notify the occupant or the Date require which must m prior issuance of Ccrti ale of l cup:L Signature4ofArpplicant OII— All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO RE;ROOF CUPEkTiNO PERMIT APPLICATION FORM APN# Date: Building Address: Wv Owner's Name• / Phoa • Contract License#d�� Contact: Cupertino Business License #: Type of It of Covering: Existing: Proposed: X Built-Up RoofBuilt-Up roof ❑ Asphalt Shingles ❑ 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: Job Description: Residential ❑ Commercial Fire Zone: Yes ❑ No ❑/` Confirmed with Planning Deft. if there are any restrictions: Lf Cost of Project: Type of Construi;tion: Occupancy up:ro Qty. if Ap icable Fee ID Fee Description Fee Group BPERMFEE I Ildg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING - Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS: PERMIT # � UO / �l �-c �✓� `7 � Z t OWNER'S NAME: 6z PHONE - GENERAL CONTRACTOR: � )o 6 � FAX # I am not using any subcontractors: `G��LZ /' S 4 ` Signatur Date Please check apphcable 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 SJ — Septic Tank Sheet Metal Sheet Rock Nile 6 Owner/C ntractor Signature Date