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07090011 CITY OF CUPERTINO BUILDING DIVISION PERMIT TkACC?R I0MT��1'. PERMIT NO. BUILDING ADDRESS: 19111 PRUNERIDGE AVE WESTERN ROOFING SERVICE 07090011 PERMIT ISSUE DATE OWNER'S NAME: HEWLETT PACKARD CAFE 2594 OAKDALE AY ng/n9/2007 SANITARY NO. CONTROL NO. NE: (415) 6,18-6472 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p zO LICENSED CONTRACTOR'S DECLARATION Job Description UI hereby affirm that I am licensed under provisions of Chapter 9(Commencing ;yUW with Section 7000)of Division 3 of the Business and Professions Code,and my license is SINGLE ::LY ROOF—OVER OF MANZANITA CAFE BLDG @HP =y in full force and efleet ��U 3 �? Lice n Cl ss Lic•g CAMPUS. t- pare Contractor VQ immo ARCHITECTS DECLARATI j a< I understand my plans shall be used as public records >qV ' U.y Licensed Professional : a OWNER-BUILDER DECLARATION j< 1 hereby.)'firm that 1 am exempt from the Contractors License law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county e which requires a permit to construct,alter,improve,demolish,or repair any structure "y prior to its issuance,also requires the applicant for such permit to file a signed statement t' ,Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 tCl hs (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $190440 that he is exempt therefrom and the basis for the alleged exemption Any violation of �p Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 316 0 7 0 4 : 0 Number not more than five hundred dollars(S-SM). 0 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 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.). 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractorls)licensed pursuant to the contractors License Law, 0 1 am exempt under Sec. B Ik P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Workers Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number arc: Carrier: 5 g �v'1 Policy No.:W -� 2-61 t � � 1 CERTIFICATE OF EXEMPTION FROM WO CERS' .— -e1 Fk0S/ COMPENSATION INSURANCE (This section need not be completed if the permit is formic 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 2 forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY Htom. 1 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 Lenders Name az Lenders Address J 0 1 certify that 1 have read this application and state that the above information is corccL I agree to with all city and county ordinances and state laws relating to O U building conswc on,an creby authorize representatives of this city to enter upon the a above-mentioned property r inspection purposes. e re to save,i cmnilo and keep harmless the City of Cupertino against liabi 'es,judg ts,costs an expenses which may in any way accrue against said City /� �✓� ()Z in asequence oUE of this permit. Date �—J t-+ A LICANT UDS AND WILL COMPLY WITH ALL[OJNOINT Issued by SO RCE REGUS Re-roofs Signatu t/Contractor Dare T Of Roof AZARDOUS M ALS DISCLOSURE Type Will the applicant or future ing occupant store or handle hazardous material as defined by the Cupertino Muni at Cade.Chapter 9.12,and the Health and Safety Code.Section 25532(a)? A roofs sh 11 a inspecte prior to any roofing material being installed. ❑Yes I a roof is in t lied withou first obtaining an inspection, agree to remove Will the a lican or future ing occupant use equipment or devices which emit hazardou r c inants fi d by the Bay Arca Air Quality Management 1 new rr aten for inspe tion. District? ❑ s No I It ve read the hoz ous materials quirements under Chapter 6.95 of the Califor- v nial-Icalth SafctyCodc, tions 25505. 533 and 25534.1understand that ifthe building t% does not cu ntly have a. ant,that' is m responsibility to notify the occupant of the requiremen which must t r to i ante of a Certificate of Occupancy. Signature o Appl c nt Date All roof coverings to be Class"B"or better Owner or authorize age t Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMI`I RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN 31E07042 . 01 DATE ISSUED. . . . . . . : 09/ 05/2007 RECEIPT #. . . . . . . . . . BSC00002552 REFERENCE ID # . . . : 07C90011 SITE ADDRESS . . . . . : 191.11 PRUNERIDGE AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : HEWLETT PACKARD CAFE ADDRESS . . . . . . . . . . : 19=.11 PRUNERIDGE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : WESTERN ROOFING SVC CONTRACTOR . . . . . . . : MARK BLEDSOE LIC # 29322 COMPANY . . . . . . . . . . : WESTERN ROOFING SERVICE ADDRESS . . . . . . . . . . : 2594 OAKDALE AVE CITY/STATE/ZIP . . . : SAN FRANCISCO, CA 94124 TELEPHONE (4:-5) 648-6472 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ------ BPERMFEE VALUATION 190, 440. 00 1244.16 0. 00 1244 .16 0. 00 BSEISMICRE VALUATION 190, 440. 00 19 .10 0. 00 19 .10 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 1263 .26 0. 00 1263 .26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 1, 263 .26 #096709 --------------- TOTAL RECEIPT 1,263 .26 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- --------------- 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS 01� 09 CITY OF CUPERTINO RE-ROOF CU EkTINO PERMIT APPLICATION FORM APN# 3 / / 6--7il- � /"' D Date: $ t S o B�;L,t-kr ding Address: 7 - t - 1't % n+vo Oner's Name: Phone Et- N 1-k..6 ZSZ • I`i6 b CQ tractor: License#: E cN (16 05 Contact: Cupertino Business License #: Cgile-- Type of Roof Covering: ExiProposed: wBuilt-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles L3 /Wood Shingles ❑ Other(Specify) N Other(Specify) ��►(��A ryy 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: Jw"'V�Vj ?_*o -cwt?'' 0� -[+ c a&-c t3vt G oN `(eft k'VJL htt CA+AV-V L, Residential ❑ Commercial Fire Zone: Yes ❑ No Confirmed with Planning De t. if there are any restrictions: Cost of Project: Type of Constru,-tion: 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 BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Buildi:n De artment JOB ADDRESS: PERMIT # d`? O Oct OWNER'S NAME: PHONE # 411-S ' Z GENERAL CONTRACTOR: , FAX # . S41,4 I am not using any subcontractors: • ,nature bate 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