06040162 CITY OF CUPERTI � '
BUILDING DIVISION PERMIT ;, M„1'RA•GT;CR AI�k`URA'IAT
BUILDING ADDRESS: PERMIT NO.0 6040162
22390 JANICE AV
OWNER'S NAME: PERMIT ISSUE DAIS
BONDS JOHN M AND LEE P 04/26/2006
ONE: SANITARYNO, CONTROL NO.
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLOO ELECT PLUMB MECH
joo LICENSED CONTRACTOR'S DECLARATION JobDMA jt
I FFy 1 he,eby am.that 1 w banded under provisional of Chapter 9(commencing p
�S with Section dda)Of Division 3Oflte Buu•^..and Professions Codd,andmylicenmts TEAR OFF CAL SHAKE TIL m m OMP SHING
SSSS in full forte and a at OI -" t U
'a= `i om 3 `m', CLASS A OR B
Desk —Cantnnar /(.
e ARCHI S DEC R . JUN -
sQQQ�
C� 1 undemanJ my Plans a � II ee s 2006
C� Licensed ProftMOnsl A
y OWNER-BUILDER DECLARATION
rm Nm
<S I hereby from I aexempt from the Contractor's License law far ft �UIL®
O O folkwing moon.(Section 7031.7.Business and Rofwium Cale:Any city or county
3$(V which requires a permit to construct.alter,improve,demolish.lir repair any structure
_t•, pries in is issuance,also q.i.lheappliant forsuch permit to Oka signed awenem
e that loo is licensed pursuant to the provisions oftho Conarmtor's License Law(Chapter 9 Sq.Ft. Floor Area VaIU
pr, 3 (commencing with Section?ODD)of Division 3 ofthe Business and Prefaswns Code)or
that be s exempt therefrom and the bass for the alleged exemption.Any Holuon of
Section 7031.7 by any applicant for a permit subjects the applicant to a civil penalty of 3 API.I Ivl�jQ er 0 0 Occupancy Type
rot mom than Rw hundred dollars(11300). �rjj'']]0O Z S
1,as owner often property,or my employees with wages as one sale compensation,
wilt Prom am Cod the Commutes
raw de fl set apply 70th,Owner
at Required Inspections
roti Profaa11 Cade:The COntracmM1 Liocnse law dao rot apply u an owner of q p
Property who builN or improves the mon.and who docs ouch wok hicasel f m through his
own employees,proided Out such improvements arc not in', martertd for sale U.
however,We building or improvement is mid within ane year ofcompiclon.the manner-
builder
wnerbuilder MR low We bother of proWng Rut he did and MW no,improve for puma¢of
sale.).
I.as owner of the property,am emissivelY canoacti with RameC o nommrs In,
consumer the project(Sm.7044,Busineaa am Professions Cade:)The Conoamols Li-
aom law dao Out apply to an Owner of property who Wilds or Improves thereon,and
whocontrmtsfwsucbpmjeets Mthamnwwtm(q Ikcn dpursuantuthe Cant es
License Law.
❑1 not exernpt under See. .B to P C far this mon
Owner Dow
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penally of perjury ane often:following declarations:
&I haw and will maintain a Cer ifiate of Consent u self-alum fa WOrmes Camper,
satiun,as provided for by Section 3700 of the Labor Cade.for the performance of On;
work for which Wl3 permit Is head.
I haw and will maintain Worker's Compensation lnsunna,u m4aired by Section
700 of the tabor Code,fne the pn:Ramunaaf Ne wok fa which thin permit is lamed.
My Worker's Com,��eematlan hun ce anise and Polley number are:
Carrier: S' ,h A— policy.57/ -OS'IdFrl31
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crisis=am need notecampleted lithe permit Is foam:hundred douan($1011 v
or lest)
1 coal that in the performance of On work for which this pemtit is issued I Mall our
employ any Person in my maxwerm as m become subject to the Wmkcri Compensxder
Laws of California.Data
Applies.,
NOTICE TO APPLICANT.If.after making this Cenifiam of Exemption,you should
become subject m the Worker's Compensation provisions of the labor Code,you mus
.J O forthwidt comply with such provisions or this Permit shut be deemed ranked.
Z wrN. CONSTRUCTION LENDING AGENCY
[+ I MrebY dRrm this tum s a construction lending agency for We settlements of
gL> Rte Mork for which this permit is issued(Sal.3097,Cl,C.)
W�Q Lender's Name
z Lender's Address
UOF i certify that 1 haw demi ad this application ssothat the show intonation is
{L. U carter 1 ager to comply with all city and county mduanas and sere laws olatinj m
C) building convection.and hereby authorize mptalentstives ofthis city to toter upon We
W above-mendoned pmpcny for hapat on purpotea
elr (We)agree to now,indemnify and tap harmless We City of Cupertino gains,
rr
IA Ilebiliim judgments.casts and expcnms which may in my way mean against saidCity /
U Z in conmegocsuc of tau gamin"of IN k Lp O`
"-' APPLICANT EWITA S ILL C PLY 144TH ALL pON-POINT Issued by: Date
SOUR ER LATIO h/�'.
61" 6 Re-roofs
Simuurc a(ApplianRCOntrneur Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
VAR the applicantor future building oaup rumme orlundle haucdoa material
se deRmd by the Cupertino Municipal Code.Chapter 9.11.aM the Health and Safety
Cade,section 15732(a)? All roofs shall be inspected prior to any roofing material being installed.
EJ Vas
WI11 Rte applicant Or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvaNnal air conlmmants as unlined by We Bay Am Air Qadky Management all new materials for inspection.
District? L
❑Yes No
/f
Ihaw mad the he.S.-d mamriasrequimmenlsunder Chapter mtud 7ofthe Califar. e/rE! it
alas rot andeRl rove a;WnZ th37W,2my am137534.1 to renund theoccupant
Wilding G 16
lea not curie hew a tem L th my ropy ibilily m ratify Wayeccupmt of the
reyulrcnn mh e a issuance aCcrWkMofOcp may. Signature of Applicant Date
Owner orauthorized agent Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
C
�UPERTINO :
BuildingDepartment Fax(408)777-3333
JOB ADDRESS:2Z3 9Q _ PERMIT#
60 L 6( l
OWNER'S NAME: PHONE # 7,5 2-gyp jFS b
GENERAL CONTRffCTOEidZWFAX#
I am not using any subcontractors: el --661e G
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
j�� /�-� L.;?La 6
Own ntractor Signature Date
CITY OF CUPERTINO
�m 4 of 4 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35701052 . 00
DATE ISSUED. . . . . . . : 04/26/2006
RECEIPT # . . . . . . . . . : 34149
REFERENCE ID # . . . : 06040162
SITE ADDRESS . . . . . : 22390 JANICE AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . .. CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : BONDS JOHN M AND LEE P
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2747
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
&EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 13, 000 . 00 201 . 96 0 . 00 201 . 96 0 . 00
BSEISMICRE VALUATION 13, 000 . 00 1 . 30 0 . 00 1 . 30 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 203 . 26 0 . 00 203 . 26 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 639 . 30 VISA
TOTAL RECEIPT 639 . 30
Community Development Department
Building Division
tW\p City of Cupertino
i 10300 Torre Avenue
• Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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 " 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: (2,:&
Job Site Address: 21Z3 lrU
Roofing Company Name: /t
Applicant's Signature: Date: y G 06
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
-� CITY OF CUPERTINO v�0�01
REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN # 35� _ O� � Date:
Building Address: ✓ _ L
22390 e-
Owner' ame Phone#:
Contractor• Phone#: License#: /D 9 /
(0,50 9G/ 7699 ZL
Contact: Phone#: Q Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles '4 Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Other(Specify) ❑ Other(Specify)
Number of existing coverings 6 Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Unders!2nd and Will ComplX With Cu ertino's Tear Off Policy:
Job Description: o
6-d C/u�f� x-13
Residential M Commer ial ❑
Fire Zone: Yes ❑ No tf ' Confirmed with Planning Det. if
there are any restrictions: LI
Cost of Project: ,o Type of Construction: Occupancy grogp:
1211 03 /
v 2 -S
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
•