The URL can be used to link to this page

09090072'?OC <ul rA v�2 3tt�� ?�U ny p0 e�y ih^N fFC i CHITECffENGINEER: I hereby affirm that I am licensed under provisions of vith Section 7000) of Division 3 of the Business and Profession n full force and effect ?� 3 .icense CW Lic• 0 Sam Conlrador ARCHITECTS DECLARATION I understand my plans shall be used as public records 9 (commencing Job Description and mx license is 7 v RE -RF REV EXT RF & INSTL "PRESDENTIAL".SHNGLS CL A 27SQ - ** CEDAR ROOFING RENWD BUS LIC 5/14/9 Licensed Professional OWNER -BUILDER DECLARATION 1 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 which requires a permit to construct. alter, impmve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file 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). 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 wort 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 pmject (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. B & P C for this mason ❑ I am exempt under Sec. Owner Date WORKER'S COMPENSATION DECLARATION Ft. Floor 3620802'-.00 I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain a certificate of Consent to self -insure for Worker's Compcn- <ation, as provided for by Section 3700 of the Labor Code, for the performance of the rk for which this permit is issued. J 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. My Worker's Com nation Insura�gxj �carrier and Policy num y � _ O carrier. � � / !�^� 4.licy No.: /L_ - -- CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (itis 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, atter making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ■�•. 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.) Q Lender's Name Z Lender's Address I certify that 1 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 Ubuilding convection, and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purpaus (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs and expenses which may in any way accmc against said City Z in consequence of the granting of this permit. �+ APPLICANT UNDERSTANDS N ILL COMPLY WITH ALL N -PO SOU CE L ONS. � � �� Sign ure f Applicant/ on tot Date DOUS MA AIS DISCLOSURE ill the appl' an or future building occupant store or handle hazardous material as defined by the C perimo Municipal Code. Chapter 9.12, and the Health and Safely Code, Section 25532(a)? 0 Yes No 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? ❑Yes �T6 I 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 currency have a tc t at it is my responsibility to notify the upant of ft mmuimmenis which must bqr gryjq issuanec oC a Certificate of Oyu; h � Issued b; Re -roofs Type of:toof "IIIV Type Required Inspections All roof:. 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. Signatur,_ of Applicant Date All roof coverings to be Class'A" or better a CITY OF CUPEkTINO CITY OF CUPERTINO REROOF PERMIT Y0PLICATION APNA k�) D�ate:o / Builring Address: Owner's Name: Phone #: �S -_�> -__? HOA: Yes ❑ No f es provide letter from HOA Contractor: Phone #: , /2 /44 )GoJ::�luCY Fax#: Cupertino Business License #: Contractor License #: 3 69B 712 - Type of -Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles �, w0C) L C� ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings / _ ❑ Provide I.C.C.E.S. Report # YTo be Removed ❑ Provide Mfgr. Installation Specs. Job Description: / Residential Commercial C,�j� 5� i w 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:.,6, - d-zro I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Sig ture/ Revised 02/05/09 S CM OF CUPEkTINO CITY OF CUPERTINO REROOF FEE SCHEDULE Number of Squares Fee ID Fee Descri;ation Fee Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 2I 1RER00FRES Re -roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards Commissio 1 Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Re:,idential 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 ap ee 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 applied without first obtaining all inspection and written approval from the buildir.g inspector. A final inspection and approval shall be obtained from the b-ailding inspector when the re -roofing is completed. 3. All roofs shall be inspected prior to arty 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 na:1 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 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/ " 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 abo•ie stated policy on re -roofing. Homeowner's Name: Job Site Address: Roofing Company Name: m Applicant's Signature, Greg Casteel Building Official Rev -sed 07/30/08 01 Date: r �w�4 CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 1CL) 1�5 PERMIT # �� u� � �--7 OWNER'S NAME: PHONE # '46 6 63 - >SS/ GENERAL CONTRACTOR: ri/�'- D /N FAX # // — ; ( — a 36 V- I am not using any subcontractors:,. Signature Date Please check applicable subcontractors and complete the following information: Owner/ 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 Owner/ Contractor Signature Date