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07030154
_. _ . CITY OF CUPERTINO BUILDING DIVISION PERMIT C� LGTC�iR IFfIIATIEIN BUILDING ADDRESS: PERMIT NO. 7539 DONEGAL DR SHELTON ROOFING 07030154 OWNER'S NAME: PERMIT ISSUE DATE MITCHELL JAMES 0 AND LILLIAN 1988 I,EGHORN ST STE C 03/21/2007 )NE: SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITECT/ENGINEER: TEAR OFF EXISTING ROOFING BLDG ELECT PLUMB MECH D D O C7 p PLYWCOL) 0 Q LICENSED CONTRACTOR'S DECLARATION O Description W PI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing ^^----^ ^----- Z U with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force and effect. o Z(p i O—1de : y License Class �— Lic• :y p Date -z Contractor ARCHITECTS DECLARATION i a I understand my plans shall be used as public records )A.0 U.y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the _C0 following reason.(Section 7031.5,Business and Professions Code:Any city or county �i which requires a permit to construct,alter,improve,demolish,or repair any structure ?Z} pnor to its issuance,also requires the applicant Cor such permit to file a signed statement Valuation =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area t— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L 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($500). ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business "'Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q p property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.if. however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: �]1 have and will maintain a Certificate of Consent to self-insure for WorkcesCompcn- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy 14 number are: (�/ Carrier. �'f C. Fah� Policy No.: Z11D O 10 f CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($I00) 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 Workeri 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 1 hereby affirm that there is a construction lending agency for the performance of CYi the work for which this permit is issued(See.3097,Civ.C.) W Q Lender's Name 2 z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is [L correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the 0. ahove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rA liabilities,judgments,costs and expenses which may in any way accrue against said City n U 2 in consequence of the granting of this permit. Date �._ l� �—+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by' SOURCE RE T NS. Re-roofs Signature ofAppIfcanL94tractor Dale HAZARDOUS MATERIALS DISCLO RE Type of Roof 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 Code,Section 25532(a)? �'" All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes r�vo Will the applicant or future building occupant use equipment or devices which If a roof i;installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials fokA District? ❑Yes Nu \ I have read the hazardous materials requirements under Chapter 6.95 of the CaliCor- r /) � " �/ �.i nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand thaz iCthe building / t.! does no have a ten E.that it is my responsibility to noul'y the oce an f do reyu' ent�whi must be' l t pnor to issuance oCa Certificate of Oc cY. Signature of Applie ate 3 gs to be Class "B"or better Owner or authorized agent tc CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN . . . . . . . . : 36616064 . 00 DATE ISSUED. . . . . . . : 03 '21/2007 RECEIPT #. . . . . . . . . : BS000000744 REFERENCE ID # . . . : 07030154 SITE ADDRESS . . . . . : 75. 9 DONEGAL DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MITCHELL JAMES O AND LILLIAN ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5200 RECEIVED FROM . . . . : REC'EIPT INTERFACE CONTRACTOR . . . . . . . : WRI.Y, RICHARD LIC # 20755 COMPANY SHE,LTON ROOFING ADDRESS . . . . . . . . . . : 19E8 LEGHORN ST, STE C CITY/STATE/ZIP . . . : MT VIEW, CA 94043 TELEPHONE . . . . . . . . : (6E0) 961-7699 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPERMFEE VALUATION 30, 363 .00 375.84 0 .00 375 .84 0.00 BSEISMICRE VALUATION 30,363 .00 3 . 10 0.00 3 .10 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 378. 94 0 .00 378 . 94 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 378. 94 17923 --------------- TOTAL RECEIPT 378 . 94 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 MY OF Fax(408)777-3333 CUPEI�TINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: PHONE # GENERAL CONTRACTOR: 5 k-e-I 4o,,� 24)f,, C c> Tc- FAX # I am not using any subcontractors: Signature Date Please check applicable 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 Septic Tank Sheet Metal Sheet Rock Tile -3/-2-/ 0 '7 Owner/Contractor Signae D e 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 1997 UBC Standards and manufacturers specifications on re-roofing. 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 nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new matE rial 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 1/4" per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on tlte job site at the time on inspection. I understand and will comply with the above :Mated policy on re-roofing. Homeowner's Name: s i Job Site Address: Z5 3 I Do e7 Q a Roofing Company Name: e/1"du��h ' �o• cl 17 C_ Applicant's Signature: f�iL - Date: > o 7 Greg Casteel Building Official Revised 11/2/04 CITY OF C'UPERTINO REI.00F CUPfRTINO PERMIT APPLICATION FORM © 70301.E APN# Date: 66 -/(� -0b � 3 z ( /0 7 Building Address: Owner's Name: Phone#: S= [ cUX l �/b Z5 7- 275 ? Contracto : License#: Contact: Cupertino Business License #: Sj -e. tl 0 `7 � Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles g Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# �I To be Removed ❑ Provide Mfgr.Installation Specs. THave'Read,Understand and Will Comply With Cupertino's Tear Off Policy: El Job Description: -T-��..r r' Ek r�;t... 5�.�.. r� F,,. , i +w Residential Commercial ❑ _.--__ Fire Zone: Yes ❑ No g,-' Confirmed with Planning Devt. if there are any restrictions: ET Cost of Project: Type of Construction: Occupancy groin So 3c4:;, �Z Qty. if Applicable Fee ID Fee Description Fee Group BPERIMIFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING