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07110099 CITY d�' CUPERTINO BUILDING DIVISION PERMIT �� « ' > ;:• ,. BUILDING A DRESS: PERMIT NO. 116�33 FOREST SPRING CT M& S ROOFING CO. 07110099 vvJNER'S NAME: P �� Dp '� PREM MODAK 208 COFCO LN ' 11/16/2007 PHONE: SAMTARY NO. CONTROL NO. (408)314-0870 ARCHI'IECT/ENGINEER: BUILDING PERMITINFO BLOC ELECI' PLUMH MECH � 0 � � u O p UCENSED CONTRACI'OR'S DECLARATION JOb D0SCi1pIlOi1 i� V I hcrcby affirm ihat I sm licenscd undcr provisions o[ Chaptcr 9(commcncin; z� � wiih Sccuon 70(M)) at Division 3 of ihc Busincss and Profcssions Codc, snd my licensc is RE – R00 F � RIKU EX S T S HAKE RF & I N S T L 5 � YR ° a in full fo�ce and effect. �� z Licensc Clasa _j'� Lic. M �� C OMP � 2 7. 5 � y �, p Da�c Contracmr ARCHITECI'S DECLA ATIO S Q C LA � S A ,� �� t undcrstand my plans shall be uscd as public records a ; �. y Liccnsed Pcufcssional n y � OWNER-BUILDER DECLARATION I hercby a�rm Uut 1 am cxcmpt from �hc Convxtor's Liccnsc Law Car the � p O following icuon. (Scction 7031.5, Busincss and Profcssions Calc: Any cily or county K,°, Pi which requima a pertnit to conswct, altct. improvc. dcmalish. or mpnir any swcwic '� Z y prior w i�s isuancc, aLw rcquires ihc applicant far such permit to filc a signcd s�atcmcnt £ s � that he is liccnsed pursuant to thc pmvisiona oC Uic ConUactor's Licensc I�w (Chaptcr 9 Sq. Ft. Floor Area �, 6 O 0 Valuation y F- �(commcncing wi�h Scction 7000) of Division 3 of ihc Busincss and Profcssions Codc) or y �.. �ha� he ia exempt theccfrom and the basis for the allcgcd exempdon. Any violaUon o[ Section 7031.3 by siry applicant for a pem�it subjecu ihe applicant to a civil penal[y of � Number Oeeupaney Type �o� m� m� r� n��aRa aou� cssom. 3 6 6 510 .. 7�� ❑ I. u ow�rcr oC tlie p�nperty. a my employca with wages u the'v sole compensatlon, wi11 do We work and the a�cuctme is not intended or oEfaed for sale (Sec. 7044, Busineas Re uired Ins ections and Peofessions Code: The Conuactw's Lianse Law does not spply to an ownec of Q P property wYw builds or improves thereon, and who does such woric himulf or through hia awn employces, provided that such improvemrnts are not intended or offued for sala If. however, the building or impiovement ia sold within om yesr of compleuon, ihe owna- builder will have �he burden oC proving �Aal he did no� build or improve for purpose of sakJ. ❑ I, u awnu o( che propeny, am exclusively conuuting wi�h Gcenxd rnnuactors w consuuct the projett (Sec. 7044. Business and Professions Cade:)'The Con�raewr's Li- ccnse Iaw docs aot apply w an owner of property who builds or improves Ihmeon, and , who conuscts for such pmjecu with a conuutor(s) licensed purswnt w �he Convactofs "•ense Law. am exempt under Sec . B& P C for ihis reuan Owner Dam WORKER'S COMPENSATION DECLARA710N 16ercby aflimi under pendty of perjury one af the follawing deciantions: ❑ I hsae and will mainuin a Cutificam o! Consent to x1f-insure for Workcrs Compen- sarion, az provided For 6y Sec[ion 3700 af the Iabor Code, far the pedormance o( �hc work tor which Ihis permit is issued. ❑ I have and will munlain Workers Compensation Insurance, u mquired 6y Scction 3700 oC the Labar Cade, (or the performance ot the work for w6ich this permit is issued. My Worker's Compenudon Luurana cartier snd Poliry num r a�e: , Camer ��y - �, , '� lj 7 Poliry No.: '" cF�"�� oF sx�rrcox �oM woRxExs COMPENSATION INSURANCE • (7Lis sectian necd not bc canpictcd if Ihe pecmit is Cor anc hundred dotlara (S I00) or Icss.) ' [ cenify �hat in ihc performu�cc of thc work for which �his permi� is issucd. I shail not employ any person in any manncr so u to bccomc wbject to the Workers' Compensatian Laws of Glifomia Da�c Applicant N077CE 7'O APPLICANT: !f, alYcr making this CertiGca�c of Excmption, you should bccome subjcct to thc Worker's Compcnsation ptovisions of ihc Lalwr Codc, you muu � O forthwiih comply with such provisions or �his pecmit shall bc dccmcd n.wokcd. z ""' CONSTRUCt10N LENDING AGENCY [– � I hcroby �rm ihst thcre is a consuuction Icnding agcncy Cor ihc perCortnancc uf �Y, � ihc wurk for which �his pertnit is issued (Scc. 3097, Civ. C.) � A Lendcr's Namc • � Z Lcndec's Address V 0 I certify Iha� I havc read �his applieation and sutc Uut �hc abovc infortnatiun is w� coricc� 1 a6ree to comply with all city and county oNinanixs and state laws celating to 0 U buildins consuuction, and he�eby �uUiari�e reprcxnutivcs of ihis city w cntcr �pon Ihc aAove-mcnGorad propcny for inspecUan purposes � " W (Wc) agrce to save, indcmnify and kecp humless ihe Ciiy of Cupenino agsinst �'' �„� � liabiliues, judgmcnts, costs and expenacs which may in any way acccuc agains� said City ,r V z in consequence oC thc granting oC U�is permi� `� �" APPLICANT NDER�7'ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date � � 1 �-, SOURCE R ULATlOI�6. � � Re-roofs ignaturo f Applicanl/C nvact � Da�c H DOUS MA'IFRIALS D[SCLOSURE Type of F.00f Will Ihc appli w futurc building occupant storc or handlc ha•rardous ma�crial Jefincd by lhe Cu 'no Municipal Codc. Chaptcr 9.12, and the Health and Safcty �«� .Scction25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes �'�Vo �� If a roof is installed without first obtaining an inspection, I agree to remove Will ihc a�licant or fuwrc buiiding accupant usc cquipmcnt or Jeviccs which � cmi� har�rdous air coniaminan�t az cicGncd by the Bay Area Air Quslity Managcmcn� all new rr aterials for inspection. Disuict? QYcs n� u 1 havc rcad �he hvardc�t maicrials requiremcnu undcr Chap�cr 6.95 of �hc Califor- nia FIcaIN & Safcty Code, Scx�iau 25505.25533 anJ 25534.1 undcrstand thu if Uu huilding dacs noi curtcn�y havc a mnan4 �at it is my responsibiliiy ta nouCy ihe accupant nf thc rcq�ucmcnts ichmust �m«�;o�a;u��orac�r��oro��P�. SignatureofApplicant Date ' � '� `' All roof coverings to be Class "B" or better Owner or au�harized a n� �� i�a�� CITY OF I�UPERTINO �"�' RE:�OOF CUpE[�TJiyQ PERMIT APPI,ICATION FORM APN # � � � � � � � � � ! , � Date: � i � _ Cs1 u � Building Address: • , � �� .� � �f J �� . � ��. Owner's Name: Phone #: ' �Ze � ��' -3I _ ,�� -� Contractor: � � �,� � License �� 1 � K�"JiJ Contact: . .. Cupertino Business License # ` I � � -� Type of P.00f Covering: E�usting: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles � Asphalt Shingles �' Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Nuinber of existing coverings ❑ Provide I.C.B.O. Report # � To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: Job Description: ` f A�- /� � � � c ��. � � �, / �' L'"� Residential � Commercial ❑ / ��, �-y f� J �.< V Fire Zone: Yes ❑ No . Confirmed with Planning D�t. if there are any restrictions: LJ Cost of Project: ' �� Type of Constructio�� Occupancy group� � �� L'L� Qty. if Applicab 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 BLTILDING . Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building I�epartment Subject: Re-roofing policy for the C'ity 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 appliecl without first obtaining all inspection and written approval from the building 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 sheathi.ng, so a proper City inspection can be perf<�rmed. 7. NOTE: If you call for a plywood nail vlspection and the job is not ready, you will be charged a re-inspection fee of $176.18. The re-inspection fee must bepaid 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: '�' �� N� � f.'�,(r�-� Job Site Address: �� .� � � ��(�' �t�� 1�1� hl �"� �� Roofing Company Name: Ir ' �' ' � � � �j '�-�� ' � ` Date: t� 16 `U� Applicant's Signature: �-� Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMI'I RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN ........: 36E51057.00 DATE ISSUED.......: 11/16/2007 RECEIPT #.......... BSC00003265 REFERENCE ID # ...: 07]10099 SITE ADDRESS .....: 11E�33 FOREST SPRING CT SUBDIVISION ....... CITY .............. CU�'ERTINO IMPACT AREA ....... OVJNER . . . . . . . . . . . . . PRf:M MODAK ADDRESS ..........: 11f�33 FORREST SPRING CT CITY/STATE/ZIP ...: CUI'ERTINO, CA 95014 RECEIVED FROM ....: M E: S ROOFING CO. CONTR.ACTOR .......: MIF:SAD KRAJWIC LIC # 28360 COMPANY ........... M f: S ROOFING CO. ADDRESS ..........: 20f3 COPCO LN CITY/STATE/ZIP ...: SATd JOSE, CA 95123 TELEPHONE ........: (4()8)314 FEE ID UNIT QUANTITY ��MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 7,600.00 147.96 0.00 147.96 0.00 BSEISMICRE VALUATION 7,600.00 0.80 0.00 0.80 0.00 ----------- ---------- ---------- ---------- TOTAL PERMIT : 148.76 0.00 148.76 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 148.76 #2010 --------------- TOTAL RECEIPT : 148.76 Community Development �` � �. � 10300 Torre Avenue ;� : � � Cupertino CA 95014 Telephone (408) 777-3228 , CITY OF Fax (408) 777-3333 CUPEf�TINO Buildi:n De artment JOB ADDRESS: PERMIT # � .�� t �� . C� 7lCG�� OWNER'S N . � ,� . ,� PHONE # � — �' � � GENERAL CONTRACTOR: 2 � FAX # � I am not using any subcontractors: � �� -�-- �� ' �—�� Si� ature Date Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrfESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing IIectrical 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 �,.�- _ ��-j ( �� er/Contractor Signature Date