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06070167 (2) CITY OF CUPERTINO '✓QI` `'��' BUILDING DIVISION PERMIT �01�IT.R GT0 IPFF19ItMATIQN BUILDING ADDRESS: HAR BRO OF NORTHERN CALIF °'06070167 10332 CRESTON DR OWNER'S NAME: PERMIT ISSUE DATE CLARENCE PETERSEN 299 OLD CO TY RD 07/25/2006 NE: SANITARY NO. CONTROL NO. (650) 593-4500 ARCHITECT/ENGINEER: BUILDINO PERMIT INFO BLDG ELECT PLUMB MECH 61 1­ LICENSEDD CONTRACTOR'S DECLARATION Job Description sow 1 hemby alRrm that 1 am 1lceexcd under provision Of Chapter 9(oommmeaS P withSecdon7DgROf DivWon3oft1m OuaiaaaM Grummet Coda.aM mylkenw le mfull to=andefleja REPAIR RAFTER FROM FIRE DAMAGE LIKE FOR LIKE L11 Lleerue Clw Lie. Dam — Contractor TEAR OFF EXISTING ROOF, RE-PLYWOOD & RE-ROOF ll ARCHIIELISDECLARATION CLASS A SHINGLES i 1 understood my plan shall be used as public records 'c Licensed Pmfessimail - 1tm OWNER-BUILDER DECLARATION f<S I Wmhy antra that I am exempt tram the Conuacmrm License Law for the p o fallowing moon.(Section 7031.5,Busine»and Professions Cade:Any city of county . $ which mquirea•permit to corulruc4 also,improv,mmolm,to repair any allruetum 3i Y+ prior in its issuance.also requires the Applicant fimsuch Ismail in file a signed sumowt C that he is Banned pursuant to the provision of the Contractor"Lkew Law(Chapter 9 Sq.Ft. Floor Area Valuation 8 (commoners with Section 7000)ofDivision3ofthe BOA.and Professional Cuts)of $25000 that he u exempt therefrom and the bank for Ne alleged exemption.Any violation of Smakm 7031.5 by any applicant fan a permit subjects No applicant to a civil Penalty of APN Number Occupancy Type rat mom dun 0e.hundred dollars(5500). ❑1,u owner of the pmpemy,a my employm with msec a Ateu wk eompewdon, will m Newark.and the suueure u not Inmnded w anemd forank(Sw.7044,BudM•• and Profession Cade:The Canuacters Liam Law don rat apply m an ower of _ Required Inspections Property who buildsn(mprowa Amounts,and who dam each walk himselfa through his unemployment,provided that such impmwmenu are notlmmsdN oraaeted forsale.If. however.the building or Improvement 4wld within ane You of completion,ere owner• builder will have Ne Widen of proving dust M did rat MM or Improve for purpose:of ole.)• �� ❑1.u comer of the property son exclusively contracting with Ikemed conua7an m ��� U. ecram,conota Am n not (See.7014.BusOwner roof ark property who u Cade:)The Contractor'sl.and corse law don not apply je ts with A of property ice sed I or Improve Norton,and who Am Lac4 for such projects wfN a eontrecmrt0 Barad Wrwant m Ne Canmetoh uceuelaw. ❑lam wmpt under gee ,B&PC far Nis moan - v� 103I.Clial ear Data 2006 munderWORKER'S COMPENSATION DECLARATION g HOLDING 1 hereby affirm under penalty of perjury nn of the following tsclan0on: L ' I lam and will cadmum a Certificate of Contralto alf-hnure fa Walkers CamPM- er,an provided for by Section 3700 of the Labor Cade,for the performance of the rk fn which this perm)is issued. 1 haw and will mohair Workers COmprandem luurana,u acquired by Section the Labor Coda.for Ne performance of No walk far which Nis permit ire issued. Werkee Compensation Irsm oxen,amu and Policy number art: der. iA !-1e$��v'G Polity No.: r�f�D6 e5 CERfIFlCATE OF E%EMPfION FROM W RKERS' COMPENSATION INSURANCE (nds suction need at becompleted lithe,permit is farand hunNW dollen(310) a teal.) 1 certify Nat In the perfamwce of the work far which this permlt is issued.l shall at employ anyperwn in any manor w as in became subject ods dm Workers'Commandant Laws of California.Dam Applicant NOTICE TO APPLICANT.If,after making this Cerirmam of Exemption,you should assume subject to the Workers Campat ation provision of the Iahor Code.you most 0 O forthwith comply with such Provision so Nu permit shall be domed rooked. „z., CONSTRUCTION LENDING AGENCY (—, 1 hemby alum that them Is a comuuctinn lending agency for the performance of G' Am walk for which this permit is tuned(Sec.3OY7.Civ.C.) - G Q Landers Name 7 2 Laurer,Address U 0 I certify Nat I have mad this applin ion and Aum that the above InfotmW un is IU F correct.I as=in comply with all City and county Ordinances and ream Inn muting w DU building eonwuction,and hereby authorire mpmsemativn or this city to enter upon the W shove-ra ntianetl pmKrty for inspection purposes g1 (We)ascot to ave,indemnify and lump harmlw the City of Cupertino Against v.v res luddlidesjudgmanu,eom andnpsouu which may in any my scene assinuaid City UZ In consequence or Ne{renting of NU Permit. ^" APPLICANT NDERSTAND ND WILL COMPLY WITH ALL NON-POINT Issued by: Date - 5 SOURCE LATION / 7 a§ Re-roofs SignatGnsallAppl(on nuamor Duca HAZARDOUS MATERIALS DISCLOSURE Type of Roof . Will Am applicant or future building occummusrom a handle Illustrious materiel an deBmd by f Cupemma Municipal Code,Chapter 9.12,and the Health and Safety Conn. 2ss255324)?Oyu o All roofs shall be inspected prior to any roofing material being installed. 7i3li ❑Yn WIII de applicant or future building asupan(as,equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove nts, it hauAdmS air catsminanb u m0ad by the Bay Area Air Quality Management all new materials for inspection. istrict? ❑Yes M. I leve read Ne huaNnw materials requirements unmrCTapmrei.95aftlec Califon&SafetyCode,Sacdon 25505,25533 uu125534.Iunmrstand thNifthe building �n at curmntlY hew a Ienan4 Nu it u my mipoaihility m atify Am occupant of Ne / g ulmme hmust orwluuanaof a Candeem of Ocq �" Signatore ohcant Date warnr aaNar'uad.enl Data. All roof coverings to be Class"B"or better 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 " 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. CI- e- PFS? Sm�J .. ., n Homeowner's Name: �.�---w=-- Job Site Address: ce-r. 5no Roofing Company Name: —r, 0 ' C� Applicant's Signature: Date: -2 • Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO !m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 32637042 . 00 DATE ISSUED. . . . . . . : 07/25/2006 RECEIPT # . . . . . . . . . : 35373 REFERENCE ID # . . . : 06070167 SITE ADDRESS . . . . . : 10332 CRESTON DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CLARENCE PETERSEN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : HAR-BRO INC CONTRACTOR . . . . . . . : FRANKLIN„ JIM LIC # 20709 COMPANY . . . . . . . . . . : HAR BRO OF NORTHERN CALIFORNIA ADDRESS . . . . . . . . . . : 299 OLD COUNTY RD CITY/STATE/ZIP . . . : SAN CARLOS, CA 94077 TELEPHONE . . . . . . . . : (650) 593-4500 �EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 331 . 56 159 . 15 0 . 00 159 . 15 0 . 00 BPERMFEE VALUATION 25, 000 . 00 331 . 56 0 . 00 331 . 56 0 . 00 BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00 BSEISMICRE VALUATION 25 , 000 . 00 2 . 50 0 . 00 2 . 50 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 598 . 21 0 . 00 598 . 21 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 598 . 21 MASTERCARD TOTAL RECEIPT 598 . 21 • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 *CUPEVINO Building Department JOB ADDRESS: PERMIT # 0 332- C� ST-I-ti fl2 060 -70 t 6 7 OWNER'S NAME: cA <,.rK+•saJ PHONE # d 50 670-c;?-'7 7.Z GENERAL CONTRACTOR: FAX# p 3-7- S'3 O I am not using any subcontractors: T $ ,iJ -7-2 Signature Date Please check applicable subcontractors and complete the following information: ba 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 CG - CITY OF CUPERTINO CUPEf�F PERMIT APPLICATION FORM qWPN# 3�•y,1 �t(� Date: o�y—C� Building Address: -f Mailing Address (if different from building addres" %c'733.2 sn,^j 063 G . PArAr %-F- Owner's -rOwner's Name: Phone C_J_& "ti e_. P��+c e saws S✓o ) 0 Contractor: License#: fo Contact: Phone• 6s�J67o J7 upertino Business License#: Cs?q-" ]- Building PennitnInfo: R2 F, f,do cJn�7,e L, KS 0=.-eaL/�� �Iq oF- b 6. g.X AC7 a.. 9'+ Rt Kmr. Bld f ` Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential 4 Commercial ❑ Sq.Ft. Floor Area: Sq.Ft.: Cost of Project: _ Occupancy Gro�up c�S DOC) ` 12 -1 Type of Construction: Please check this box if the project is a second-story addition: ❑ ro'ect Size: Standard Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax-Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V > 1000A ELECTRICAL BELEC200 Elec Svcs 600V <=200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of 3 CITY OF CUPERTINO CUPEf�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE � PbIg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Intercepter PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 din MECHANICAL BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIX'T Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace> IOK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BRENEQWP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter HeatingMECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 � - CITY OF CUPERTINO CUPEI�TINO PERMIT APPLICATION FORM uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inspection BUILDING BSWIM Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING PLLONGRNGR Planning Long Range Residential PLANNING ZADDCHG Address Change BUILDING 3 of 3 I