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06100130 CITE'OF CUPERTINO BUILDING DIVISION PERMIT � �� *` BUILDING ADDRESS: GUARANTEED ROOFING CO. PERMIT NO.06100130 F)100130 PERMIT ISSUE DATE )W NER'S NAME: BRENT & CHIKAK ) SAKTIRA �T -- SANITARY NO. CONTROL NO. NE: 408 48 - .418 1 ARCHLTECf/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Pr f csions Codc a license is �y in fullCorceandeftect ,�2,�T `� PEROOF-T/O APPLY 2" STYROFOAM INSULATION & t ? Liccnsc Cla Lic.ri iF,un Date r Contractor PLY SYSTEM. 20 SQUARES , ARCHITECTS DECLARATION a"< I understand my plans shall be used as public records :o. u.in Licensed Prhfessional h OWNER-BUILDER DECLARATION '> I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county m which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area t—$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $3999 • .. 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). ❑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 forsale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law dots 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 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 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 Workces compen- 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 number arc: Cartier. Policy No.: CERTIFICATE 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY H 4 hereby affirm that there is a construction lending agency for th perform ce of .7 the work a which thia�e�it' d; rc (Sec.3097 Civ.C.) l/� Lfa Q Lender's Name-!V-- 0., 77 az Lender's Address U 0 I certify that I have read this application and state that the above information is uL correct.I agree to comply with all city and county ordinances and state laws rclating to O U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date ►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: / SOURCE REGULATIONS. � Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE 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 shall be inspected prior to any roofing material being installed. ❑Yes es If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes 9.014— I have mad the hazardous materials requirements under Chapter 6.95 of the Califor- �� -61 nia Health&Safcty Code,Sections 25505,25533 and 25534.1 understand that if the building ` U71-0- 6L docs not currently have a tenant,that it is my responsibility to notify the occupant of the —.y.� requirements which must be met prior to issuance of a Certificate of occupancy. Signature Of Appl(Cant Date Owner or authorized agent / All roof coverings to be Class B or better CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 37538005.00 DATE ISSUED. . . . . . . : 10/17/2006 RECEIPT #. . . . . . . . . 36471 REFERENCE ID # . . . 06100130 SITE ADDRESS . . . . . : 6059 BOLLINGER RD SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BRENT & CHIKAKO SAKURAI ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : GUARANTEED ROOFING CONTRACTOR . . . . . . . : MARTY NUNES LIC # 26081 COMPANY . . . . . . . . . . : GUARANTEED ROOFING CO. ADDRESS . . . . . . . . . . : 2190 STONE AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (408)482-4183 _BE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 4, 000.00 104.76 0.00 104 .76 0.00 BSEISMICRE VALUATION 3, 999.00 0.50 0.00 0.50 0.00 BUSLIC FLAT RATE 1.00 105.00 0. 00 105.00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 210.26 0.00 210.26 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CASH 210.26 TOTAL RECEIPT 210.26 Community Development 10300 Torre Avenue t ; Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 'TPEkTINO Building Department JOB ADDRESS: PERMIT # � 0 - � iL ( 00 ( 70 OWNER'S NAME: PHONE # Z GENERAL CONTRACTOR L) — 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 Owner/Contractor Signature Date an CITY OFCUPERTINORLROOF CUPEkTINO PERMIT APPLICATION FORM APN# Date: / Building Address: - L Owner's Name: Phone#- V7 *;F* --2— / `Yt . Contractor: License'�� 2_- 41 ^ d`�► �4 / T Contact: Cupertino Business License M Type of Roof Covering: ExiProposed: TBuilt-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.B.O.Report# 1 To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: CSI' Job Description: jT_�r //►5 a dYl _-L--. Y?r k � Residents 1Co ercial ❑ Fir one: Yes ❑ No [' Confirmed with Planning Deft. i Z there are any restrictions: E Cost of Project: T e of Construction: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING 13USLIC Business License BUILDING