07030282 CITY OF CUPERTINO
BUILDING DIVISION PERIVIIT' Q�N�' Q�I }RMTION
BUILDING ADDRESS: PERMIT NO.
1145 YORKSHIRE DR DADDARIO ROOFING 07030282
OWNER'S NAME: PERMIT ISSUE DATE
JESSE AU 1734 WILLA WAY 03/27/2007
)NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
TEAR OFF EXISTING AND BLDG ELECT PLUMB MECH
C� D D C7
o p 40
LICENSED CONTRACTOR'S DECLARATION L o Description
U
P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
:Z w with Section 70(1(1)of Division 3 of the Business and Professions Code,and my license is
y in full force and ef9cL
[[ 4 LK N H'3d 7 3
? License Class 7
F m Date 23, -:21?—e7 Contractor
ARCHITECTS DECLARATION
i a I understand my plans shall be used as public records
>yU
LL y Licensed Professional
y;
OWNER-BUILDER DECLARATION
> 1 hereby affirm that I am exempt from the Contractor's License Law for the
j p 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
zy prior to its issuance,also requires the applicant for such permit to rile a signed statement
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Q h (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
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 APN Number Occupancy Type
not more than five hundred dollars(5500).
❑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,BusinessRe uired Inspections
and Professions Code:The Contractor's License Law does not 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.).
❑1,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 contractors)licensed pursuant to the Contractoes
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 fine of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for Workces 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 Worker's Compensation Insurancecarriercarrier and Policy number are:
Carrier.s/ /-<- 97t4_ t 1 Policy No.:C9C940'L9Zg-IOeI
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
,J. O forthwith comply with such provisions or this permit shall be deemed revoked.
z V) CONSTRUCTION LENDING AGENCY
[~-h I hereby affirm that there is a construction lending agency for the performance of
a. the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
z Lender's Address
U C) I 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
0 H 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
liabilities,judgments,toss and expenses which may in any way accrue against said City -e,
U Z in consequence of the granting of this permit. Date ( U�
APPLICANT UNDERSTAND D WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIO
Re-roofs j
um o!A61icanUC96tractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of R)of
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:.hall be inspected prior to any roofing material being installed.
❑Ycs ❑No
Will the applicant or([tort building occupant use equipment or devices which If a roof is 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 m iterials for inspection.
District?
❑Yes ❑No
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 the building
does not currently haveAlcnanit is my responsibility to notify the occupant of therequirements which muto issuartce of a Certificate of Occupancy. �gna:ture Sf p cant Date
All roof coverings to be Class"B"or better
r
Date
or aur z
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI" RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: B1}:. Lot:
APN 36207021. 00
DATE ISSUED. . . . . . . : 03/27/2007
RECEIPT #. . . . . . . . . : BS000000796
REFERENCE ID # 07030282
SITE ADDRESS 1145 YORKSHIRE DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER JESSE AU
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUFERTINO CA, 95014-4953
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR STEVE DADDARIO LIC # 26245
COMPANY DAEDARIO ROOFING
ADDRESS 1734 WILLA WAY
CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062
TELEPHONE (831)476-9109
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 13, 950 .00 212 . 76 0 . 00 212 .76 0. 00
BSEISMICRE VALUATION 13, 950. 00 1.40 0 . 00 1.40 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 214 .16 0. 00 214 . 16 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 214 .16 21758
---------------
TOTAL RECEIPT 214 .16