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09040159 CITY OF CUPERTINO �^r BUILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 10325 N BLANEY AVE WESTERN ROOFI PERMIT ISSUE DATE OWNER'S NAME: SA0 Tal CONTROL NO. 'INE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH RE-RF P/0 WDSHK FILL SHTNG C] O C7 D y c o LICENSED CONTRACTOR'S DECLARATION AS NDE 40[,B FLT INST Description inI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is e y in full force and effl,a. t-p2 Contrat!n Date t�c ARCHITECTS D I understand my plans shall be used as m �yU O H Licensed Professional OWNER-BUILDER I hereby Affrm that I am exempt fro in O following mason.(Section 7031.5,Business and Professions Code:Any city Of county 14$Pi which requires a permit to construct,alter,improve,demolish,or repair any structure 'a'r^ prior to its issuance,also requires the applicant for such permit to file a signed statementS Ft.Floor Area Valuation Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q FC (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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). ❑I,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 Cade:The Contractors 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves themon,and who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. B&P C for this mason ❑I am exempt under Sea Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I 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. have and will maintain Workers Compensation Insurance,as required by Section 00 of the Labor Code,for the performance of the work for which this permit is issued. y Workers Compensation Insurance carrier and Policy number am: Carrier. �lsul�►a/f y, 5+, r�PolieyNo.- — C FICATE OP 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY Hrw I 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.) W Q L.endces Name az Lenders Address V 0 1 certify that 1 have read this application and state that the above information is V.H correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes t a (We)agree to save,indemnify and keep harmless the City of Cupertino against nF.t C.4) liabilities,judgments,costs and expenses which may in anyway accrue against said City i V Z in consequence of the granting of this permit. Date y G, rti APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU REG TIO — .i- Re-roofs - gnaturc Appli t/cnn Date T of Roof HAZARD S M ALS DISCLOSURE Type Will the applicant or f ung 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)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes Will the applicant Or]f,�turcbuilding occupant use eyuipment or devices which If a rootis installed without first obtaining an inspection, agree to remove nil hazardous air contamin defined by the Bay Area Air Quality Management all new materials for inspection. .JisU1Cl? ❑Yes u 1 have mad the heard rats materials requirements under Chapter 6.95 of the Califor- nis 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 m notify the occupant of the Date myu' cnts ich In be to issuance of a Certificate of Occupancy.; gnatU;a Of A p ]I rooto be Class" or better f coverings wner r au rued Date - , CITY OF CUPERTINO 0q0 u C, ► S� A 4` RIE:ROOF CU CITY OF INO PERMIT �LPPLICATION 3 l e 3 oc5� APN # _ Date: --3�-0� Building Address: 103 t 5- N 6(awe Owner's Name: &,,., Phone #: Y Je:X4:9, q 3G I- HOA: Yes ❑ No ❑ If yes, provide letter from HOA Contractor: Phone #: gojr W.es+trea 5 t yC4e,- j Fax #: YJ f- Tit i s Cupertino Business License #: Contractor License #: Type of [goof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles -Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) 7 Other (Specify) r-e-6l +.Ie— Number of existing coverings _ ❑ Provide I.C.C.E.S. Report# 5-&2 ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: .�,e,,. .� ,�•( � s�e4�� A-r �,,n d♦a 40 /bs -C. 1-i- Residential Commercial El Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the E.pplication or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply win Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO REROOF "T`OF FEE SCF[EDULE CUPEl�T]NO Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B ICOMMLROOF 1BCBSC Cal Bldg Stz.ndards B ALL PERMIT TYPES Commissior.Fee 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof ReEidential B ISFDWLROOF 1BCBSC Cal Bldg Stindards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 1 REROOFMRES Re-roof Multi-Family B IMFDWLROOF 1BCBSC Cal Bldg S-.andards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC 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:-e-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 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 mil inspection is required. 6. Any roofing which is applied withot:t first obtaining an inspection, will require the removal of all new rr.aterial 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 1/1 "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: "d-°— Job Site Address: 103Z5– N 61'°'"-Qy - Roofing Company Name: f�Pin� w�r%� f ISI Applicant's Signature: Date: Greg Casteel Building Official Rev.sed 07/30/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 „CITY OF Fax(408)777-3333 -UPEkTINO Buildin De artment JOB ADDRESS: PERMIT #(� o , t Al ,0/swe "[ OWNER'S NAME: .o PHONE # 4,jr PPP -r3&L GENERAL CONTRACTOR: ,. Ie•+.r+� '� sJe, FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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 Date Contractor Signature