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06100154 7BUILDING OF CUPERTINOy� nDIVISION r ERMI l C. RM O. BUILDING ADDRESS: R E ROOFING & CONSTRUCTIO EI 06100154 PERMIT ISSUE DATE OWNER'S NAME: Z I GURS EDMOND F SANITARY NO. CONTROL NO. )NE: 4 0 8 6 Z5= BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECTPLUMB MECH © L (� p p LICENSED CONTRACTOR'S DECLARATION Job Description Ur I hereby affirm that I am licensed under provisions of Chapter 9(commencing z with SccLion 7000)of Division 3 of the Business and Professions Code,and my license is !=y in full force and effeci7; - '�( _ GARAGE- TEAR OFF EXISTING 1 LAYER OF COMP, v�Z License Class Lic. o Date Contracts INSTALL NEW 3 OLB FELT & 4 0YR ASPHALT COMP. pRCHITECI S DEC RATION ---- CLASS A, 8 . 5 S QUARE S i a< I understand my plans shall be used as public records �yU u n Licensed Professional :O< OWNER-BUILDER DECLARATION w-4 3<2 1 hereby affirm that I am exempt from the Contractors License Law for the :00 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 SFt.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 $2000 r that he is exempt therefrom and the basis for the alleged exemption.Any violation of PN 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). 0 1,as owner of the property,or my employees with wages as their sole compensadon, 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 docs 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 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. 1 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: Q I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the wovk for which this permit is issued. 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 Workees Com nsation Insurance carrier and Policy n i ber are- Cartier. �� �0, V1 Policy No.:1�1 I I6" 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 certifv 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 Ccni(icatc 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 E~•t►-� I hereby affirm that there is a construction lending agency for the performance of (x> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name 0 z Lender's Address U 0 I certify that 1 have read this application and state that the above information is Lt. correct.I 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 aganst s against rF- CA liabilities,judgments,costs and expenses which may in any way accme against said City V in consequence of the granting of this permit. Date Z APPLICANT UNDERSTANDS AND WILL COMPLY WITH A L NON POINT Issued by: soURct' EerLnu�(s, Re-roofs Signature of Applicant/Contractor Dam T Of Roof HAZARDOUS MATERIALS DISCLOSURE Type 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 Cole.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. Yes IeNo 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 Area Air Quality Management all new materials for inspection. District? ❑YesNo 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor. nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant Of the Date rcquiremcnt�wh h must bc'met pn�r to issuarf of a Ccrufncatc of Gt�upan Signature of Applicant All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO �m 2 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 # . . . : 06100154 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 2 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BSEISMICRE VALUATION 2 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 ---------- ---------- ---------- -- -------- TOTAL PERMIT 83 . 66 0 . 00 83 . 66 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - -- - - - --- -- ----- - - - ---------- --- ---- - ----- ----- CHECK 199 . 72 10406 TOTAL RECEIPT 199 . 72 cqoooiv,9 4- aft- CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: \ r Owner's Name: Phone#: _(12 Contractor r, License C T4 Contact: -- Cupertino Business License #: � 1-C � Type of Roof Covering: Existing: Proposed: ❑ Built-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# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read,Understand and Will Comply With Cupertino's Tear Off Policy: Job Description: 5��s�..w'�- u\i��E:a r� �_/(a 'ot �w C�U►'t f - l��', ��� t t �� Residential Commercial ❑ t Fire Zone: Yes ❑ No Confinnec th NanWit. if there are any restrictions: LJ Cost of Project: .") Type of Construction: Occup ary grup: �i,u 1L 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 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 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 1/4" 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: Job Site Address: Roofing Company Name: ` r Ic Applicant's Signature: Date: Greg Casteel Building Official Revised 11/2/04