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07020123 CITY OF CUPERTINO 'BUILDING DIVISION PERMIT OR IURMTIEIN "" '430 UIL I G AD KESS: PERMIT NO. 0430 OAKVILLE AV CUPERTINO ROOF, INC 07020123 OWNER'S NAME: PERMIT ISSUE DATE STEVE ALBRECHT 1052 KELLY DR. 02/26/2007 SANITARY NO. CONTROL NO. ,NE: (408) 973-9427 ABUILDING PERMIT INFO RCHITECT/ENGiNEER: BLDG ELECT PLUMB MECH © 0 0 0 i cc LICENSED CONTRACTOR'S DECLARATION Job Description V 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ;z� with Section 7000)of Division3oftheBusinessandProfessionsCode,andmylicenseis REROOF—`�/O EXISTING & INSTALL 1/5 INCH OSB 30LB ? y in cuts louse and effec z License Clara t, Q Lie* F ELT/T 11,E 26 S QI TARES. t w Date ;Z Date Contractor ^ a AlkCHITEcr,DECLARATIO i z< 1 understand my plans shall be used as public records )yU a , Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's Liccnsc Law for the :00 following reason.(Section 703 L5,Business and Professions Code:Any city or county ,0, which requires a permit to construct,alter,improve,demolish,or repair any structurc Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation =G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq:Ft.Floor Area o— (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $13000 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 [b�Number Occupancy Type not more than five hundred dollars(5500). 36913009 V V ❑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 for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does trot 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.). 04 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 docs 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: ❑1 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 work for which this permit is issued. F1 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 Ir¢gafancc carrier and Policy number arc: Cartier._73tl_k'2 �) Policy No.: I t-z--4 6 V3-0 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 Oforthwith 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 �i the work for which this permit is issued(Sec.3097,Civ.C.) ALeadcr's Name 0 z Lenders Address V 0 1 certify that I have read this application and state that the above information is LL correct.I agree to comply with all city and county ordinances and state laws relating to OU building construction,and hereby authorise representatives of this city to enter upon the W 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 V Z in consequence of the granting of this permit. AEPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOOWE REGULATIONS. Q— 2—2 to .L Re-roofs •� r .� , Signature of Applicant/Contractor Date 9 Ij 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 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 IT aterials for inspection. District? ❑Yes �u I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building not currently have a tenant,that it is my responsibility to notify the occupant of the rcyui cots which t be met prior to issuance of a Certificate of of t upancy. Signature Of Applicant Date L&-6 All roof coverings to be Class "B"or better Oi-n—cr or authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36913009. 00 DATE ISSUED. . . . . . . : 02/26/2007 RECEIPT #. . . . . . . . . BSO)0000533 REFERENCE ID # . . . : 07020123 SITE ADDRESS 10430 OAKVILLE AV SUBDIVISION . . . . . . . CITY CUP3RTINO IMPACT AREA . . . . . . OWNER STEVE ALBRECHT ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4519 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR DAVE SMITH LIC # 25701 COMPANY CUPERTINO ROOF, INC ADDRESS 1052 KELLY DR. CITY/STATE/ZIP . . . : SAN JOSE, CA 95129 TELEPHONE . . . . . . . . : (408) 973-9427 FEE ID UNIT -` QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- -------------- ------ BPERMFEE VALUATION _ _ 13, 000. 00 201. 96 0.00 201 . 96 0. 00 _ BSEISMICRE VALUATION 13, 000 . 00 1.30 0 .00 1.30 0. 00 - ---------- ---------- ---------- ---------- TOTAL PERMIT 203 .26 0 .00 203 .26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 203 .26 2074 --------------- TOTAL RECEIPT 203 .26 Community Development 10300 Torre Avenue Cupertino CA 95014 . ' Telephone(408)777-3228 CITY OF Fax(408)777-3333 '"WEkTINO Buildin De artment JOBID ,D}� S: l PERMIT # OWNER'S NAME: -:::3+e-irk 7. PHONE # GENERAL CONTRACTOR C v FAX # 2 L -- .? 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 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 r?-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 b-zilding inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to ar.y roofing installation. 4. To receive a final sign off from the City,the following steps are required: 1) Pre-inspection and/or tear off app:•oval. 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 roofrrrg which is applied without first obtaining an inspection, will require the removal of all new mE.terial down to the sheathing, ----so-a proper] •ity nspection can be per Formed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, s 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: O-L_ 6 iz:P c- � f` Job Site Address: Roofing Company-Nang Applicant's Signature: Date: Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO R�`,ROOF CIIY Of CUPERTINO PERMIT APPLICATION FORM APN# 36!z /' � � DateZ — 2�o —C) � Building Address: .� Owner's Name: Phone#: Contractor: License#: �'�,S^ S Cont Cupertino Business License #: .-� o? SSD/ Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes --'---El Wood Shingles ❑ Wood Shingles k ❑ Other(Specify) ---UOther(Specify) +(1 br1 Number of existing coverings ❑ Provide I.C.B.O.Report# ) ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read,Understand ar d-WilMo-mpty-With"-CeYtirro's Tear Off Policy: ❑ Job Description: -i-��e o4+ ►-tea 14 h S-j 1 � l� z e l 0 SIIP\ S 1 q0 Residen 1 :Commercial ❑ Fire Zone: Yes ❑ No--n Confirmed with Planning Dept. if there are any restrictions: U Cost of Project- Type of Co tr.iction: Occupanctgroup: 1 GLSe 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