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06100153 77777 CITY OF CUPERTINO I ' ' �N* BUILDIN6DIVISION PERMIT E BUILDING ADDRESS: R E ROOFING & CONSTRUCTIO 06100153 22311 JANICK AV PERMIT ISSUE DATE OWNER'S NAME: Z I GURS EDMOND E SANITARY NO. CONTROL NO, NE: 408 626- BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH p G LICENSED CONTRACTOR'S DECLARATION Job Description UI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is t<e in full force andeffectr I 'it:, ('� � ) REROOF- TEAR OFF EXISTING 1 LAYER OF COMP, tt2z License Class Contras - INSTALL NEW 30LB FELT & 40YR ASPHALT COMP. : 'In Date f ARCHITEC`T'S DEC LA CLASS A, 11 . 2 5 S QUARE S a< I understand my plans shall be used as pubhc records >yU H Licensed Professional : OWNER-BUILDER DECLARATION rn '>• 1 hereby affirm that I am exempt from the Conuactor's License Law for the I C O following reason.(Section 7031.5.Business and Professions Code:Any city or county 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 S Ft.Floor Area Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $5000 r that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number 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.7043,Business Required Inspections 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 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•die 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.7041.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. [3I am exempt under Sea B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Cl I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- satio as provided for by Section 3700 of the Labor Code,for the performance of the w for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section 00 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compel tion Insurance carrier and Policy number ate: Carrier. Policy No. CERTIFICA OF EXEMPTION FROM WORKERS' CO PENSATION INSURANCE (rhis 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 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.) W A Lender's Name 0 Z Lender's Address I certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction.and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. >"a (We)agree to save,indemnify and keep harmless the City of Cupertino against rn 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 ►A APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON POINT Issued by: SOURCE REGULA O' Re-roofs Signature of Applicant/Contractor Date Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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 ❑No' 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 ONO 1 have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.t understand that if Ute building docs not currently have a tenant,that it is my responsibility to notify the occupant of the mquitgmCpts which must met prior issuance a certificate of Occup - ' _ • Signature of Applicant 7Date !1 `- - - 2,)l All roof coverings to be Class"B"or better Owner or authorized agent Date Community Development Department Building Division City of Cupertino .� 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 t'UPEkTINO 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 material down to the sheathing, so a proper City inspection can be performed. 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 the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: �b job Site Address: 2 Z'� 9 Roofing Company Name: L� �'� i m Y A plicant's Signature: Date: , 07 Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO 2m 1 of 2 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN 35701019 . 00 DATE ISSUED. . . . . . . : 10/20/2006 RECEIPT # . . . . . . . . . : 36508 REFERENCE ID # 06100153 SITE ADDRESS 22311 JANICE AV SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA OWNER ZIGURS EDMOND E ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : RECEIVED FROM . . . . : R E ROOFING CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615 COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC ADDRESS 15230 CLYDELLE AVENUE CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE . . . . . . . . : (408) 626-9320 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - - - --- - - ---- ----- -- -- -- - ------ - --- ---- --- - --------- BPERMFEE VALUATION 5 , 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00 BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ----- ----- ---------- ---------- - ------ -- - TOTAL PERMIT 116 . 06 0 . 00 116 . 06 0 . 00 k . Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 :UPERTINO Building Department JOB ADDRESS: Z PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: -f,otiX FAX # �- I am not using any subcontractors: w=� ature 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 CITY OF CUPERTINO C�Dl CD I rD3 RE ROO F CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: 02 2 2511 _/ Owner's Name: / Phone#: , Contractor: Phone#: License #: �� ��r N 4��-�L� - 11VU . Contact: / /1 Phone#: n ` Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles )4�, Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: ` (' Move alsoi � I L�N uY�_ o-- .�1�' Y 4b-`(lL, \ . �DR F Residential Commercial ❑ iL'� 1 /1 11 .2 �j Fire Zone: Yes EJNo F1 ConfiTWed with P ng Det. if there are estrictions: LJ Cost of Project: ` '' Type of Cyst,ruction: Occupancy gro 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 BUSLIC Business License BUILDING