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08020086 CITY OF CUPERTIN0 4 pa, 74;i T5 o-d' nu L' «�ftATIO BUILDING DIVIaION PERMIT tCUNTRACTORINP`URMN eu1LI)ff445�CUPERTINO RD TBD - TO BE DETERMINED PERMIT08020086 E0.'S NAME: PERMIT ISSUE DATE SUNNY VIEW LUTHERAN HOME 02/13/2008 PHONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG EIEC( PLUMB MECH 300 LICENSED CONTRACTOR'S DECLARATION O O O O i bereby affirm that 1 am llccmed under provisions of Chapter 9(commencing Job Description with Secdon7")ofDiviion3afthe Busi, ad ProfessionsCode,nWmylicrose is RE-ROOF RMV 'EXSTNNG ASPHLT SHNGL & RPLC W/NEW 3 23- mm)mineande TAB SHNGLS, CLASS A 30SQ. A QUINTERO ROOFING PD z Licnnsc on a in.P G Ott S Dz¢ ARCHITECTS DECLARATION BSL I Maintained my plans Nall W used pe public 2/11/8 kind' Licensed Pmfcsdonal 5y OWNER-BUILDER DECLARATION I am hereby .(frm oro 1exempt from Me Contractors License Law for the following memo. 7031.A.BMArA and all Code:Any city or county which permit t maroot altms mprow.conm smy aum prior to its isooc.dwre Me be permit torile a,gCtsinment oral¢ullcensedpuwmoktohcpovisiomofMeConuscmr'siournslaw(Cbapmr9 Sq.Ft. Floor Area Valuation �$ en that An is g with incentives, th bassisan 3 the al egid Auand Ascription..Any vi Ca.an o, �5�0� — dol io ts eamp Zany Appli and oe aper+for the cts ed vtto Any vipen lty of net.. Man five any red dolt rte a permit subjects the applmm w a civil penalty of Number Occupancy e net mart Nan Tisa hundred dolWa(5500). 32615124:°'�� P YZYP ❑1,As awnef of Me property,or my empiayeo with wages as them win compensation, will do the work,and the mmcwM Is at intended smeared for sale(See.7044,Busima and Professions Cade:The Conuacmfs License Law doer at apply to an Owner of Required Inspections progeny wW builds mimpavo thereon,antl who daosuchworkhimvlfarduoegh his mwemployers,imevided that such improvements are int intended aroQamd for We If, le mever,the building or Improvement 4 sold within one year of eempledon.the owner. builder will bave the aurhn of paving oar K did net Wild m Improve far prgAow of ole.). ❑1.pe..of six property,am exclusively comonamg.1%Hemmed ontrwtms m consumer the project(Sec.7044.Business and Professions Cade:)The Contractors U. neve Law dam not apply At an owner of property who Wilda ter improws theman,And who cmnmeb for such projects with aeMMwlar(3)licenced pursuant to the Guarantee. Lmense law. ❑I am vmpt..it.See ,B k PC far this maven er Dam WORKER'S COMPENSATION DECLARATION I hereby aOUm under penalty of perjury ane of the fallowing dneterations ❑Thaw and will forbynetion Seam of Me Labor wlFWUM(v Warkeanceof e sa0an,r Provided for by Section 3700 of the IaWr Cade,far the Performance a(the wants far which this permit is iuuetl. ❑1 have sad will maintain Workers Compensation Inswana,As rtquired by Section 3700 ofthc latter Code,far the performance ofthe work for which this permit is intend. ' My Worker's Crom�penu`tim Insurance orrim And Policy number m: Carrier. u Policy No.:7(�O0I13'f7ri CERTFlCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE fib s sx ion need wthe completed times permit is foranc humbed delian($100) car leas) 1 certify that in the pvfomanca of the work for which this Permit is issuctl,I shall not employ,any human in my manner an in in become subject to the Workers'Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:IL after making this Certificate of Eaempdam.you should Assume Aubjm in the Workers Compensation provisions of the labor Code,you mus O EfaMwith comply with such Provisions m permit this peit Nall domed in voked. zCONSTRUCTION LENDING AGENCY 5 Ibemby AM.that themiAacovuuctnt lending agency far the parfur ..[ ti the work for which this Permit is issued(See.31197,Civ.C.) GQ Lender's Name , ,=z Lcndeh Add. V O 1 certify that I Mw read this application and mm that the above information ts U.! tomo I agrte m comply with all city and county oNivnm ws and state laMinding to -0 SV' Wildingconstruction.and hereby Authentic repreaetwives ofthis city in anter upon the show-mendoned Pmpeny for inspection purposes (Wer)agree to save,indemnify sad soup hamlets the City of Cupertino against ti cA Itabiliom judgments.costs and e.parsns which may In say say Ac rue,against said City O 7 in consequence of the granting of this Permit. rt7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date / Z�3 4-- SOURCE REGULATIONS. Stgm app,oeBC6n�� g=hVV—G Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the Applicant or future Wilding accounted son At handle baallou maw" ' defrcd by the Cupertino Municipal Code.chapter 9.12.and the HW o and Safety .Section 25532()7 All roofs shall be'inspected prior to any roofing material being installed. ❑Ype Fa,9a Will the applicant or future building=open,use Aqulpmont or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit I MYmlons air contaminants as defined by the Bay AMA Air Quality Management all new materials for inspection. Dimict7 0Ype Pace I have mad the haallountamrialsMquimments under Chapter 6.95ofthe Califor. nu Hnslth h Safety Cade,Snew.25505.25533uW25534.1 undersand onirde building Z J dfi (fig drca rot currtndy new A vacuum.oat It u my inspansiMlity m notify do ocupand of ft J_ roquiinmttgnor which mus Wreel ptia ofa Cadfwam of oucupnmy. � ,Z 13I� Signature of Applicant Date Owns,or as ad..ed Fna �D3e All roof coverings to be Crass"B"or better o � o � ooh CITY OF CUPERTINO REROOF IOCUPEkTwO PERMIT APPLICATION APN # � r) � / � ' O � Date: Building Address: 2IgA 19 li-O 44 Owner's Name: Phone #: Contractor: Phone #: -log 9 Z-s -7a¢Z Fax #: Cupertino Business License #: Contractor License #: S9 a6 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof .We Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ 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. Job Description: Sf.- -7 4..s r� CC-1u,5 4 Residential L Commercial Fire Zone: Yes No ❑ Confirmed with Planning Dept. if there are any restrictions: ❑ Valuation: I Have Read, Understand andel Will Comply with Cupertino's Tear-Off Policy: Signature CITY OF CUPERTINO D' REROOF 18CUPi TINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group v 1RER00FC0M Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B 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 building inspector. A final inspection and approval shall be obtained from the building 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 approval. 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 the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: Job Site Address: 2Z4�6 ti' L. RA Roofing Company Name: Applicant's Signature: �� Date: 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: Blk: Lot: APN . . . . . . . . : 32615124 . 01 DATE ISSUED. . . . . . . : 02/13/2008 RECEIPT # . . . . . . . . . : BS000003933 REFERENCE ID # . . . : 08020086 SITE ADDRESS . . . . . : 224.45 CUPERTINO RD SUBDIVISION . . . . . . . CITYCUPERTINO . . . . . . . . . . . . . . IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SUNNY VIEW LUTHERAN HOME ADDRESS . . . . . . . . . . : 22445 CUPERTINO RD CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1043 RECEIVED FROM . . . . : ALEX QUINTERO CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . ® TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICO VALUATION 5, 000. 00 , 1 . 05 0 . 00 1 . 05 0. 00 1BUSLIC FLAT RATE 1 . 00 110.00 0. 00 110. 00 0. 00 1REROOFCOM SQUARES 30. 00 337 .00 0. 00 337 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 448 . 05 0. 00 448.05 0. 00 METHOD OF PAYMENT _ AMOUNT REFERENCE NUMBER ----------------- --------------- -'------------------- CREDIT CARD 448 . 05. , MC --------------- TOTAL RECEIPT 448 . 05 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS 605 FINAL REROOF • 1 Community Development 10300 Torre Avenue ! i Cupertino CA 95014 Telephone(408)777-3228 �UPCITY OF E(�TINO Fax(408)777-3333 Building De artment JOB ADDRESS: PERMIT # y- c OWNER'S NAME: g PHONE # -fog GENERAL CONTRACTOR: rk . FAX # 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 Tiles Owner/Contractor Signature �^Dat—e —