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07010094 777777777 77 77 CITY OF CUPERTINO BUILDING DIVISION +� �� " :'� �� * PERMIT BUILDING ADDRESS: PERMIT NO. 11571 SEVEN SPRINGS DR CAST ILL ' PER ISSUE DATE OWNER'S NAME: MOCK BING T AND SYLVIA S 1703 CPTHAY DR. 01/17/2007 .ONE: SANITARY NO. CONTROL NO. (408) 2E1-3565 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH j O p LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing .z�, wilhSection70(IO)orDivision3ofdie Businessand Professions Code.and mylicense is REROOF- TEAR OFF EXISTING COMP SHINGLES AND in mu rotaartderrect D 57p INSTALL NEW COMP. CLASS A ��z Licence C1 � Lie.a 3 F in Date Cont �� ARCHITECTS D 'AT10N m U I understand my plans shall be used pts c records a y Licensed Professional n n< OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the r Q O following reason.(Section 7031.5,Business and Professions Code:Any city or county e m which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement s Ft.Floor Area $6800 Valuation EEC that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q 6 8 0 0 F-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y 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 3665204 4 . Number Occupancy Type not more than five hundred dollars($500). ❑I,as owner of the property,or my employees with wages az their sole compensation, will do the work-and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's License Law does 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 or completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑I•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 does 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. C]1 am exempt under Sec. B&P C for this reason OwnerDare WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty or perjury one of the following declarations: ❑f have and will maintain a Certificate of Consent to self-insure for Workees Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑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 Wmrke�s�f mpertsatiaa carrier and Policy number are: Carrie ST/1��Fi Gre� Polley Na: 3 V ono 9� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars($100) mr 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. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of ai the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name az Lender's Address U I certify that 1 have read this application and state that the above information is w" correct.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction.and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. lei W (We)agree to save,indcmmify and keep harmless the City of Cupertino against C,p) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date r-- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALZ/7& ON-POINT Issued by: SOURCE REGONS. Re-roof; Signature t/Contractor Date Will"IHAZARDOUS MATERIALS DISCLOSURE Type of Roof icant or futuce building occupant store or handle hazardous material as defined by the Cupertino Munici 1 Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roof s shall be inspected prior to any roofing material being installed. ❑Yes Will the 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 District? hazardous air contaminants az fined by the Bay Area Air Quality Management all new materials for inspection. District? [3 Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor. nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant,that its my responsibility a notify the occupant of the requirements ' must be'"r to issuance of a Certificate o(rOc �. Date - / D Signatw a of Applicant owner e a n zed agent Date All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 `'UPEkTINO Building Department JOB ADDRESS: //Y-?/ / —?1 4vvro-y :�� /s PERMIT # OWNER'S NAME: / PHONE # GENERAL CONTRACTOR: FAX # I'Lle 7 I am not using any subcontr rs: Signature Date Please check applicable subcontractors d corn plete the following information: SUBCONTRACTOR BUSI]vESS 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 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 agi ee to comply with 1997 UBC Standards and manufacturers specifications on r, 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 bi tilding 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 Citi, the following steps are required: 1) Pre-inspection and/or tear off apps oval. 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 me terial down to the sheathing, so a proper City inspection can be per:'ormed. 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: I V�c� 0 C-k.- Job Site Address: 1171 C Y:e r) �5P 6 n l S Q- Roofing Company Name: Cprs4; I b 1S 120a Applicant's Signature: '1 _ Date:2 4C J U 7 Greg Casteel Building Official Revised 11/2/04 iY!(X CITY OFCUPERTINOOq%04 R1,.ROOF CUPRINO PERMIT APPLICATION FORM APN# 04+ Date: I1 -` IU -1 3�U_ 52- Building Address: 7 ► r i 17 V_- _ Owner's Name: Phone#: ,�),o� 0 11 C,�.. - 6_P� Contractor: ILicense#: 11�504 ,--- (a ("\Is 12 Contact: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑/ Built-Up Roof `❑ Built-Up roof H Asphalt Shingles V Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Nu her of existing coverings Ll Provide I.C.B.O.Report# VTo be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With C u ertino's Tear Off Policy. Job Descri 'on: 1 tAl-slhn � 00 57h ima le Residential Coratnercial Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: LI Cost of Project: Type of Constr uction: Occupancy group: e eto .� 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