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09030229 CITY OF CUPERTINO PERMIT BUILDING DIVISION PERMI1 PERMIT NO. BUILDING ADDRESS: 20277, 20287 , 20297 NOR FOUR SE1,SONS ROOFING PERIvflTISSUE DATE OWNISQNI AME: PMT SA R CONTROL NO. SNE: (408) 27f;-0330 BUILDING PERMIT INFO ARCHI7ECr/ENGINEER: BLDG EQ PLUM MECHO y C LICENSED CONTRACTOR'S DECLARATION Job Description U 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 m cense is RE—RF R?L C EXT RF SYS W/NEW GAF GRND CNYN A S PH LT e H in full force an9��iRCHrrEC' r`S 41 Code.and License ClanCo mor ROOF SY3 CLS A 35SQ a y Dam DECLARATION -� 1 understand my plans shall be used as public records 5yU k.C y Licensed Professional r < OWNER-BUILDER DECLARATION n r I hereby affirm that I am exempt from the Contractors License Law for the '�p O following reason.(Section 7031.5,Business and Professions Code:Any city or county m which requires a permit to conswct alcor•improve,demolish,or repair any structure Valuation y' ti prior m its issuance,also requires the applicant for such permit to rile a signed statement jq Ft.Floor Area Z< that he is licensed pursuant to the provisions of the Contractor's License Caw(Chapter 9 $21142 3 of the Business and Professions Cade)or Y F=- (commencing with Section 7000)of Division i R E that he is exempt therefrom and the basis for the alleged exemption.Any violation of APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). 3 16 3 9 0 6 2 .NRTHBRK 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 Contractors License Law docs 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 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 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 Contractors License Law. B&P C for this reason ❑I am exempt under Sec Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: have and will maintain a Certificate of Consent to self-insure Cor 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. 0 I 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. r U Ca Workers ompensation Insurance carrier and Policy Cartier. Policy No tic r CERTIFI OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he 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,l 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY F^'.,her I hereby affirm that there is a construction lending agency for the performance of tx the work for which this permit is issued(See.3097,Civ.C.) W Lenders Name =z L endees Address - I certify that 1 have read this application and state that the above infortnatiun is LUL cortcct.I agree to comply with all city and county ordinances and state laws relating to Vbuilding construction,and hereby authorim representatives of this city to enter upon the above-mentioned property for inspection purposes >4 W (We)agree to save,indemnify and keep harmless the City of Cupertino against rF-tliabilities,judgments,costs and expenses which may in any way accrue against said City6( V Z in consequence of the granting of this permiL Date ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N -P Issued by: SOURCE RE TIONS. 00, _�---- Re-roof S' ore;f;ipiplicant/Contractor °ate Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP Will the applicant or future building occupant store or handle haiardotu material `---- —�� as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? J All root s shall be inspected prior to any roofing material be' installed. �Yes �iJo If a roo'is installed without first obtaining an inspection,I agre to remove Will the applicant or future building occupant use equipment ordevices which all new materials for inspection. L hazardous air contaminants derhned by the Bay Area Air QualityManagement .strict? [3 Yes o 1 have read the hazardous materials requirements under Chapter 6.95 of the Cahfor- r - / �� nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the Date pi imfrt�s White h must no iss ecru icate of Occupan �,� Signature of Applicant All roof coverings to be Class';."or better O er or authorized agent ate 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 r�-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 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 b gilding 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 Ciiy,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 na d inspection is required. 6. Any roofing which is applied withou: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 e 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 1/ "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: Applicant's Si ature:�— C?l -Date: rr sn Greg Casteel Building Official Rev sed 07/30/08 TI CITY OF C UPERTINO VZ11 REROOF CUPEkTINO PERMIT APPLICATION APN # , � C)kp c� - A[L-To-�_ Date 3/ Building Address: q // Owner's Name: f" m /Z�j �� Phone #: (4/OV y lc-- 3737' HOA: Yes V No ❑ If yes, provide letter from HOA Contractor: Phone #: ct- �; ) ' S- v Fax #: y e c-,-S 3 3 Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles �^1 ❑ Wood Shingles X Other (Specify) o Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report # To be Removed o Provide Mfgr. Installation Specs. Job Description: XeeAee c c� � `1�,�v (1,•�� Y%A6-k-4- c-c c.*s 4 <vj%+cK'*,- - 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: _2/ / yl- I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF CUPEkTINO Buildin De artment JOB ADDRESS: PERMIT # OWNER'S NAME: L PHONE # GENERAL CONTRACTOR �,y r S e 4 FAX# � I am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSIP ESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass / Glazing Heating Insulation ELandscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile owner/Contractor Signature Date