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09020076 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: PERMIT NO. 19866 BE F r.'ER OF OWNER'S NAME: PERMIT ISSUE DATE gg-�yAL�yU.2CONTROL NO. 408) 74:--490Q-. ARCHITECT/ENGINEER: BUILDING PERMrrINFO BLDG ELECT PLUMB MECH 0 � 0 900 LICENSED CONTRACTOR'S DECLARATION Job Description m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 70(IV)of Division 3 of the Business and Professions Code,and my license is 'may in full force and effect. �� RE-RF RiN TAR&GRVL INSTL NEW BASE SHT&2PLYS W/CAP j License Gass Lie.* t �F.o Date Contractor SHET CLS A 19 SQ 4 0YR COMP ARCHrn:CTS DECLA T70 I understand my plans shall be used as public records gyri U.y Licensed Professional 0 OWNER-BUILDER DECLARATION MI hereby affirm that 1 am exempt from the Contractor's License Law for the following reason.(Section 7031.5,Business and Professions Code:Any city or county to Pi which requires a permit to construct,alter.improve,demolish,or repair any structure n Zy prior to its issuance,also requires the applicant for such permit to file a signed statement r o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area Valuation F- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 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 APN Number Occupancy Type not more than five hundred dollars(5500). 3 16 3 012;? . 00 ❑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 Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q P 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's L;- 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. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSA71ON DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Conscnt to self-insure for Worker's Compen- .,ation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. vc and will maintain Worker's Compensation Insurance,as required by Section f the Labor Code,for the performance of the work for which this permit is issued. My Worker's Co pen ion ns zone carrier and Policy number am: Cartier. �r Policy No.:2' a /CErMCATE 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'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 O 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 p4 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lender's Address V 0 1 certify that 1 have read this application and state that the above information is LL"" correct I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Hto liabilities,judgmcnts,costs and expenses which may in any way accrue against said City U Z in consequence the granun'of this permit Date APPLICANT DERS44_12� STANDS AND WILL COMPLY WITH ALL NON-P INT Issued by: ' SOURCE L NS. Re-roofs Signatu fApplican ntractor Dire Type of Roof HXZARDOUS 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 Safely Cole,Section 25532(a)? All roofs;;hall be inspected prior to any roofing material being installed. ❑yes ko If a roof i:; Will the applicant or future building occupant use equipment or devices which installed without first obtaining an inspection,I agree to remove ,it hazardous air contaminants as defined by the Bay Area Air Quality Management all;newfte0als for inspection. ,tstrict? `,t l ❑yes Jf-]t/�r / 1 have read the ardcws materials requirements under Chapter 6.95 of the Califor- /1 }/� nia Health&Safet�g� �i's,'o d 25534.1 understand that if the building (JC/ docs not cuncndypgpstbility to notify Utc occupant of the rcquircmcnts w ' 6f aCcrtificatc of Occu cy, �0 ant Dat�./ J7 Owner or awl rizc a nt Date' _ All roof coverings to be Class'W'or better Q:�03-7 QP u CITY OF CUPERTINO ` RE,ROOF CUPEkTINO PERMIT APPLICATION APN # 3)b _ 30_ ZZ Date: 11 Building Address: 11 ,000 £ I A Owner's Name: Me, �_j o Phone#: HOA: Yes ❑ No ❑ If Yes, provide leiter from HOA a i I ` Contractor: Phone #: LiqzlU Fax #: 1� Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: Built-Up Roof Built-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.C.E.S. Report# IK4To be Removed ❑ Provide Mfgr. Installation Specs. YID 14j_ VL_f Job Description: Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: I Have d, n erstand and Will mply with Cupertino's Tear-Off Policy: r r ig j Revised 02/05/09 CITY OF CUPERTINO ` RF;ROOF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLR00F / 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee r 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 BUSLIC Business License B 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 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be appli 2d 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 arLy roofing installation. 4. To receive a final sign off from the City,the following steps are required: 1) Pre-inspection and/or tear off app:-oval. 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 fe,� of$176.18. The re-inspection fee must be paid before another inspection cal be scheduled. 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 or the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: '� p Job Site Address: Roofing Company Name: JC �� A Applicant's Signature: DateA / ul Greg Casteel Building Official Revis=d 07/30/08