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09010124 CITY OF CUPERTINO BUILDING DIVISION PERMITS I ��I�N� PERMIT NO. BUILDING ADDRESS: 906 LIBERTY CT ROOF ROOFING PERMIT ISSUE DATE OWNER'S NAME. BR A CONTROL NO. -.O (408) 265-9270 BUILDING PERMIT INFO ARCHITEC IENGINEER: BLDG ELECT PLUMB METH 00 LICENSED CONTRACTOR'S DECLARATION Job Description iu) I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force and ems^„- �s(� RE-RF RMV EXT CMP SHGNL& INSTL 40 YR CMP SHNGL Lic1? License Class S!J—� Contractor �r C L S Date Contractor ARCHITECTS DECLARATION A 26 SQ i < I understand my plans shall be used as public records SC >dU OH Licensed Professional y 3 OWNER-BUILDER DECLARATION ' I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county m�u which requires a permit to construct,alter,improve,demolish,or repair any structure o"r^ prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation -Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq•Ft.Floor Area I=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 7000 i 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). 35611071 . 00 0 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(See.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.). 0 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 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. 0 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: I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- .don,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 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 Work�s,CompensaG s insurance carrier and Policy number are: Carrier-JC+{ �� "4 Policy No. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Chis 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. ""' CONSTRUCTION LENDING AGENCY Hrte. 1 hereby affirm that there is a construction lending agency for the performance of (Y,> the work for which this permit is issued(Sec.3097,Civ.Q W Q Lenders Name Z Lender's Address U O I certify that I have read this application and state that the above information is LL 0-4 correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building concoction,and hereby authorize 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 Hliabilities,judgments,costs and expenses 'w may in any way accrue against said City V`Z in consequence of the granting of This it. ��WDate APPLICANT UND DS WILL WITH ALL NON-POINT Issued by: SOURCE R 2 Re-roofs Si u or pplicant/Cod6actor Date Type of Roof HAZARDOUS 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. 0 Yes No 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 tit hazardous air contaminantsas defined y the Bay Area Air Quality Management all new materials for inspection. .strict? 0 Yes o 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25P3 and 25534.1 understand that if the building does not currently have a tcna t' ' my responsibility to notify the occupant of the mquiremcni �rto��utceofaCcrtifrcatc��c��. Signature of Applicant Date `' All roof coverings to be Class''`'or better r authorized agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35611071 . 00 DATE ISSUED. . . . . . . : 01/29/2009 RECEIPT #. . . . . . . . . : BS000007066 REFERENCE ID # . . . : 09010124 SITE ADDRESS . . . . . : 906 LIBERTY CT SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : RACE KENNETH W AND KUWA ADDRESS . . . . . . . . . . : 906 LIBERTY CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4018 RECEIVED FROM . . . . : ROOF ROOFING, INC CONTRACTOR . . . . . . . : HANK OLOCKI LIC # 26739 COMPANY . . . . . . . . . . : ROOF ROOFING ADDRESS . . . . . . . . . . : 5577 VASSAR DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95118 TELEPHONE . . . . . . . . : (408) 265-9270 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 7, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 7, 000 .00 0 . 70 0 .00 0 . 70 0 . 00 1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 339 . 70 0 . 00 339 . 70 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 339 .70 #1557 --------------- TOTAL RECEIPT 339. 70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTIN09 0 1 C) O ,. REROOF CUPEkTINO PERMIT APPLICATION APN # Date: Building Address: Owner's Name: Phone #: Contractor: Phone #: qvg ?,LS-- t,- - 0-', 1 Fax#: � �---c- Cupertino Business License#: 3 Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles >f- Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes Wood Shingles ❑ Wood Shingles eilwv❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: sU_,�... -�-,f�,_ik C�, 1+_0,1 a Co Residential Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: applicable, include in Ian set & the sheet index. Valuation: � - 7?0:115> I Have Rea U tand and Will Comply with Cupertino's Tear-Off Policy: c . o9 Signature Revised 01/07/09 M.In oor Air uality and Finishes 1.Use Low/No-VOC Paint 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use Low/No VOC Adhesives 3 IAQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes D 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes 0 7.Seal all Exposed Particleboard or KIDF 4 IAQ/Health pts y=yes 0 B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 111do N.Flooring 1.Select FSC Certified Wood Flooring B Resource pts y=yes 0 2.Use Rapidly Renewable Flooring Materials 4 Resource pts y=yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 B.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 t Total Points Available: 1 140 130 57 Total Points Projec 1 01 01 0 zo `Se�2�e G q G:datalprogs/greenbuildngguidelines/remodelers/greenpointsfinal2.12.04protected.xls Community Development a 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `;UPEkTINO Building Department JOB ADD ESS: PERMIT # OWNER'S NAME: PHONE #1X;'t 2A; GENERAL CONTRACTOR: FAX # �a--.�-- 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