07050284 CITE'OF CUPERTINO
BUILDING DIVISION- PERMIT GIT I1El�RM�TI(�N*
PERMIT NO.
BUILDJNQ9D�jtESN DE ANZA BLVD CALIFORNIA ROOFING INC 07050284
l(J l PERMrr ISSUE DATE
OWNER'S NAME:
FRED BARNHARDT 1595 S 10TH ST 05/31/2007
SANITARY NO. CONTROL NO.
NE:
(408) 293-7977
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p LICENSED CONTRACTOR'S DECLARATION Job Description
VP I hereby affirm that I am licensed under provisions of Chapter 9(commencing
;z� with Section7000)ofDlvlsion3oftheBusinessandProfessionsCode.andmylicenseis REROOF—FEMOVE TILE, INSTALL ASTM 30LB FELT,NEW
w in full force and effect t
t=Z License I Lic.# (�'`s TILE
ITECrStD BATTENS,NEW EAGLE TILE SERIES #3689 CAPISTRANO,
Con
ARCH
i aa
I understand my plans shall be used as public records
;a.< 100 SQUP.RES.
U.H Licensed Professional
y 2 OWNER-BUILDER DECLARATION
>. I hereby alTurm that I am exempt from the Contractor's License Law for the
jn Oy� following reason.(Section 7031.5,Business and Professions Code:Any city or county
{i which requires a permit to construct,alter.improve,demolish•or repair any structure
z r prior to its issuance,also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
$7 3 O O O
aF$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
.. that he is exempt therefrom and the basis for the alleged exemption.Any violation of pj�j
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type
not more than five hundred dollars(5500). 32610054 .
Q1�U'
❑I,as owner of the property.or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.70U.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 thmugh his
own employees,provided that such improvements arc 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.
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors 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 Contractors
License Law.
❑1 am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑I have and will maintain a Certificate of Consent to self-insure for workeescompew
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 Workers Compensation Insurance carrier and Policy number are: _
Carrier - CA Policy No.;W L��
CERTIFICATE F EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars(5100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any mann cr 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
p!> the work for which this permit is issued(Sec.3097,Civ.C.)
W QLender's Name
az Lender's Address
U C I certify that I have read this application and state that the above information is
L>.► correct.1 agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
to 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 i / ('✓�
APPLICANT UNDER ND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGUL TIdNS.
Re-roofs
Signature of Applicant/Contract r Dare T Of Roof
HAZARDOUS M PALS DISCLOSURE Type
Will the applicant or future 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)7 All roofs E hall be inspected prior to any roofing material being installed.
❑Yes IZO
I If a roof iE installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Iu
1 have read the hazardous materials requirements undcrChapter 6.95 of tic Califor-
niaHealth&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building
does not c3( /0-7
urrently h that it is my responsibility m notify the occupant of the
requircmcn whi must be me prior to issuance ora Certificate of Occupancy. Signature �f Applicant Date
• All roof coverings to be Class"B"or better
Owner or authorized agent Dare
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk Lot :
APN . . . . . . . . : 326:_0054 . 00
DATE ISSUED. . . . . . . : 05/:31/2007
RECEIPT #. . . . . . . . . BS000001504
REFERENCE ID If . . . 07050284
SITE ADDRESS . . . . . : 10591 N DE ANZA BLVD
SUBDIVISION . . . . . .
CITY CUPERT INO
IMPACT AREA . . . . . .
OWNER FREI) BARNHARDT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : LOS GATOS CA, 95032
RECEIVED FROM . . . . : CALIFORNIA ROOFING
CONTRACTOR HAPPER P CAMPBELL LIC If 28096
COMPANY CALIFORNIA ROOFING INC
ADDRESS . . . . . . . . . . : 1593 S 10TH ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (403) 293-7977
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- - ---------- -- -------- ---------- ---------- ----------
BPERMFEE VALUATION 73, 000 .00 689. 04 0 .00 689. 04 0. 00
BSEISMICOM VALUATION 73, 000.00 15.33 0 .00 15 . 33 0. 00
BUSLIC FLAT RATE 1 . 00 107 .00 0 .00 107 . 00 0.00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 811 .37 0 .00 811.37 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 811.37 8337
---------------
TOTAL RECEIPT 811.37
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
T CITY OF ("'UPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
Owner's Name: Phone#:
V7QLF_7 —7 G D --
Contractor: License#:
Contact: Cupertino Business License#:
aIG_
Type of R)of Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
0- Other(Specify) T\La Z. Other(Specify)
Number of existing coverings ( 0- Provide I.C.B.O.Report# *k-t-l!o o - 42_S02_I
2�- To be Removed %- Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ►ertino's Tear Off Policy: Er
Job Description: �6�`'\Ovt -e- S-t-t'� "fit , t"`S. `�4"aT ` 3a l 1
Ka-3 4AU-
Residential ❑ Commercial
Fire Zone: Yes M No ❑ Confirmed with Planning Dept. if
Gi,A�S 1A -4�9,c ?-- -Tc-Q> there are any restrictions:
Cost of Project: Type of Construction: Occupancy group:
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
a BUSLIC Business License BUILDING