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07020044 77777-777777777777777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT 4.0 IRMATION�' BUILDING A DRESS: • PERIv11T-ID_ ^O OP%EROS NAME: PERMIT ISSUE ID'A�TE(,J\ �Onctld t .l hPa'" Irv) Ward)Meri o -1 )NE: SANITARY O. CONTROL NO. 263-Q`70� .1t►Se . CSA . 5123 BUILDING PER INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH [ p C LICENSED CONTRACTOR'S DECLARATION Job Description shakes ac6l .m)= 1 hereby 0)of that I am licensed under provisions of Chapter 9(commencing v 1/�1� Z vOi with Section 7000)of Division 3 of the Business and Professions Code,and my licen is ^ ^_ . `�)/)Hyy1 o=w in full force and cffes(, ` �,/i��[)j /�,.�`,�`� t r Z License Class CC —LC-: 1 R E Datc Contractor ARCHITECTS DECLARA N j a a I understand my plans shall be used as public rds //100Sa Licensed Professional 44 CA :O a OWNER-BUILDER DECLARATION ,,N..t I hereby affirm that 1 am exempt from the Contractor's License Law or the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure u"y prior to its issuance,also requires the applicant for such permit to file a signed statement r' Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 rq / 61180and Professions Code)or K F (commencing with Section 7000)of Division 3 of the Business i that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN N mbeT not more than five hundred dollars(5500). .r ❑1,as owner of the property,or my employees with wages as their sole compensation, will do thework.and the structure is notintended oroffered forsale(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 of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ❑1,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 docs 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. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑1 have and will maintain a Certificate of Consent to self-insure for worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. vc and will maintain Worker's Compensation Insurance,as required by Section 00 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compens4uon Insurance carrier and Policy number are: Cartier. CER Policy No.: J��i I C E OF CEMPTION FROM WORKERS'7T COMPENSATION INSURANCE (This section need not be completed if the permit is for anc hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner so as to become subject to the Workeri 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 (�►fir I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.) (la Q Lender's Name [Lender's Address U J 1 certify that I have read this application and state that the above information is Il." corecL 1 agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against �F- liabilities' gmcnLswapplicant costs and expen s which may in any way accrue against said City V z in co q of ' permit. Date 2 (� ►" A ICDS ND WILL COMPLY WITH ALL NON-POINT Issued by: U . _.. 'a Re-roofs rg oreractor Dare Type Of F.00f RDOUS MATERIALS DISCLOSURE yP ( Wfuture building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code.Section 25532(a)? _ All roofs 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 s installed without first obtaining an inspection, agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspecti District? /� j,/ ❑ Yes [� I have the hazardous materials uircmcnLs under Chapter 6.95 of the Califor- nia Health& ety Code,Sections 505 533 and 25534.1 understand that if the building docs not ntly have a tenon at my responsibility to notify the occupant of the requ' `cn Zhic t be c of a Certificate of Occupancy. Sign urc Of pp t ate � t6 All roof coverings to be Class"B"or better Owner r authorized agent Dat CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN . . . . . . . . . 31634025 .00 DATE ISSUED. . . . . . . : 02,'08/2007 RECEIPT #. . . . . . . . . . BS000000420 REFERENCE ID # . . . : 07020044 SITE ADDRESS . . . . . : 10.152 CEDAR TREE CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WELLER DONALD ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2003 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : MARTINEZ, JAVIER LIC # 21207 COMPANY . . . . . . . . . . : WINTER ROOFING INC ADDRESS . . . . . . . . . . : 15:_ WYANDOTTE DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : 4083638052 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 10, 180. 00 180.36 0. 00 180.36 0. 00 BSEISMICRE VALUATION 10, 180. 00 1 .10 0. 00 1.10 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 181.46 0. 00 181 .46 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 181 .46 MASTERCARD --------------- TOTAL RECEIPT 181.46 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 applie,I 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 abovef stated policy on re-roofing. Homeowner's Name: Job Site Address: /!�S S �c�r Roofing Company Name: 141)t4 1 C,`c- Applicant's Signature- Date: � - Greg Casteel Building Official Revised 11/2/04 CITY OF ..UPERTINO olouc)44 RKROOF CUPEi�TiNO PERMIT APPLICATION FORM APN# ..� t t �� Date: 31� 5 Building Address: e G^ Ow er's Name: Phone#: U Contractor: _ License#: L41 i P1 h), &,r2 w, Conta t: Cupertino Business License #: Q 144,e Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ _Asphalt Shingles A" Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings / ❑ Provide I.C.B.O. Report# Pl*'—To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: ,- r. Residential commercidl ❑ Fire Zone: Yes ❑ No Confirmed with Planning Det. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy roup: Qty. if Applic ble 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