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07090145 7777777777777;, si�:i�: CITY OF CUPERTINO BUILDING DIVISION PERMIT �fiIJ � TQIZ I�#a1ATIQ:1�* PERMIT NO. BUILDWA B�G'E�,AFFORD DR DADDARI O ROOFING 07090145 1 G U PERMIT ISSUE DATE OWNER'S NAME: JENKS LAWRENCE H AND GRACE B 1734 WILLA WAY 09/21/2007 SANITARY NO. CONTROL NO. INE: (831) 476-9109 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p Q LICENSED CONTRACTOR'S DECLARATION Job Description VI hereby affirm that I am licensed under provisions of Chapter 9(commencing z UW with Section 7000)of Division 3 of the Business and Professions Code,and my license is TEAR OF S HK, I N S T L O. S.B. & 50 YR COMP. , 35 SQ & t CL. in full force and effect i/�d 7 3 CT Z License Class C Lic.#--t CLASS A . un Dam Contractor ARCHITECTS DECLARATION i d< I understand my plans shall he used as public records )yU Oy Licensed Professional n OWNER-BUILDER DECLARATION I 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 ?z r prior w ill issuance,also requires the applicant Cor such permit to file a signed statement Ft.Floor Area Valuation < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq $14300 K is (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fru a permit subjects the applicant to a civil penalty of 3 6 211018 Number Occupancy Type not more than five hundred dollars($500). ❑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 oroffered for sale(Sec.7044.Business Required Inspections and Professions Code:The Contractors 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.). ❑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 U- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)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 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. ❑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 Workces Compensation Insurancemer and Policy number are: Carrier.�T�ae leu--- Policy No.:259—0"I `Zc CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be cormpictcd if the permit is for one hundred dollars($100) or less.) 1 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 Workers Compensation provisions of the Labor Codc,you must ZO 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(See.3097,Civ.C.) W Q Lender's Name Lender's Address 2 U C) I certify that I have read this application and state that the above information is LL.►- cortcct.1 agree to comply with all city and county ordinances and state laws relating to rte- U building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes. (We)agree to save,indemnity and keep harmless the City of Cupertino against Eliabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. t! � ) d 7 Re-roofs S nnature of Appliemt/Contrictor Date Type of Roof MATERIALS DISCLOSURE 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 Will the applicant or future building occupant use equipment or devices which .s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes Nu_ I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if Urc building does not currently have a tenant.that it is my responsibility to notify the occupant of the requirements which must be in p' to issuance of a Certificate of Occupancy. Signator(.of Applicant Date o - 07 All roof coverings to be Class"B"or better O author'.d age Dam 070 � C) l � CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN# 3 f_ f� I I Date: Building Address: 12 0y r Owner's Name: Phone#: ke v e 950 ontracIL r: License#: adr,'o - `3 ° -73 � Contact: Cupertino Business License r#: W Type of P.00f Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ 4sphalt Shingles phalt Shingles Wood Shakes El Wood Shakes Al"❑ 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: Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project: Type 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 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 buildinE inspector. A final inspection and approval shall be obtained from the bu:lding 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 apprc,val. 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-he job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: i P 1/1 K S Job Site Address: I fQ 2 Roofing Company Name: at U Ol V o [zoo V)0� Applicant's Signature: Date: n!?? / v 7 Greg Casteel Building Official RevisEd 11/2/04 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN . . . . . . . . . 36 :11018 .00 DATE ISSUED. . . . . . . : 09,'21/2007 RECEIPT #. . . . . . . . . . BS000002719 REFERENCE ID # . . . : 07090145 SITE ADDRESS . . . . . : 1202 STAFFORD DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER JENKS LAWRENCE H AND GRACE B ADDRESS . . . . . . . . . . . 1202 STAFFORD DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4952 RECEIVED FROM . . . . : DADDARIO ROOFING CO CONTRACTOR . . . . . . . : STEVE DADDARIO LIC # 26245 COMPANY . . . . . . . . . . : DADDARIO ROOFING ADDRESS 17:34 WILLA WAY CITY/STATE/ZIP . . . : SA14TA CRUZ, CA 95062 TELEPHONE . . . . . . . . : (8:31) 476-9109 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- BPERMFEE VALUATION 14, 300. 00 223 .56 0. 00 223 .56 0. 00 BSEISMICRE VALUATION 14, 300. 00 1:50 0. 00 1 .50 0. 00 BUSLIC FLAT RATE 1. 00 107 .00 0. 00 107 . 00 0. 00 - ------ ---------- ---------- ---------- TOTAL PERMIT 332 . 06 0. 00 332 .06 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 332 . 06 #21931 --------------- TOTAL RECEIPT 332 . 06 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEI�TINO Building Department JOB ADDRESS: PERMIT # l S OWNER'S NAME: a64a wri'v v i►t,7'-54 PHONE # _ e Q GENERAL CONTRACTOR: " v, FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSIPIESS 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 o7 6/Co ctor Signature Date