07020159 CITY OF CUPERTINO
BUILDING DIVISION PERMIT It I�1EUl[ M�4'TI01�1.
BUILD N(� RESS: PERMIT NO.
� l RAINBOW DR HARTING STEPHEN W AND 07020159
TS NAME: PERMIT ISSUE DATE
_ ARTING STEPHEN W AND GERALDI 05/17/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
REV I S I ON: FIREWALL, S2, BLDG ELECT PLUMB MECH
CJ D O O
p O LICENSED CONTRACTOR'S DECLARATION r fTE11 408
�0�],Description
v F 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ^^ ^�� ^^^���^
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
a in full force and effect.
j ? License Class Lic.#
F Date Contractor
ARCHITECTS DECLARATION
i a< I understand my plans shall be used as public records
)0.0
U.l- Licensed Professional
j OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
z c ca 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 y 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 3q.Ft. Floor Area Valuation
F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
ORE 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 APN Number Occupancy Type
not more than five hundred dollars($500).
❑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.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q P
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.).
❑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.
❑1 am e�xx;T70 u e'F Sec. B&P C for this reason
/< Date 7
WORKER'S OMP SATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insurc 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.
❑1 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 Worker's Compensation Insurance carrier and Policy number are:
Cartier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foranc hundred dollars($100)
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 manncr sosuhiecl to the Workersrts
'Compealion
Laws of California.Date O
Applicant � � l V
NOTICE TO APPLICANT:If,after making Lhif 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
E-r I hereby affirm that there is a construction lending agency for the performance of _
(Y i' the work for which this permit is issued(Sec.3097,Civ.C.)
aQ Lender's Name
z Lender's Address
U Q 1 certify that I have read this application and state that the above information is
r. correct.1 agree to comply with all city and county ordinances and state laws relating to
Jbuilding construction.and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
(/1 liabilities,judgments,costs and expenses which may in any way accrue against said City r
U Z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOTPINT Issued by:
SOURCE R vTo"-.
Re-roofs
Signature of Applicant/ ontractor Date Type of R sof
HAZARDOUS M RIALS DISCLOSURE
Will the applicant or future buil ng occupant store or handle hazardous material
iefrned by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Section 25532(a)? _ / All roofs ;hall be inspected prior to any roofing material being installed.
El Yes
Will the applicant or future building occupant use equipment or devices which If a roof i;;installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes �(No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Codc,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
reywrc s whi must�met prior to issuance of a Certificate of Occu p c 0 Signature of Applicant Date
�� S�� All roof coverings to be Class"B"or better
Owner or authorized agent r Datc
CITY OF CUPERTINO
PERMIT
�^iv.�+ R.
BUILDING DIVISION PERMIT + �N7CRP.C4 }Y `URN� TIfIN
PERMIT NO.
""'L Nf',¢DIJRESS � INBOW DR SAN JO S:� ROOF MAX 07050293
L J J U KFS PERMIT ISSUE DATE
OWNER'S NAME:
MA ANTHONY AND MARIA 1352 CH:CPLAY DR 05/31/2007
SANITARY NO. CONTROL NO.
)NE:
(408) 92 a-7663
BUILDING PERMrr INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
p p LICENSED CONTRACTOR'S DECLARATION Job Description
v[- 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of Ute Business and Professions Code,and my license is TEAR OF.' WOOD SHAKE AND INSTALL NEW ASPHALT
! w in cels and effect gZZ7 to SHINGLE 3
Licensea Class f -3q Lic.
'F La Date -3 j-D"j Contractor SflA oS[ I�IAK
a ARCHITECTS DECLARATION
i a< I understand my plans shall be used as public records
>yU
U.l- Licensed Professional
O a OWNER-BUILDER DECLARATION
aI hereby affirm that I am exempt from the Contractor's License Law for 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
?Z
In prior ht its issuance,also requires the applicant for such permit to file a signed statement Valuation
=G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q.Ft.Floor Area 2 O O O 0
i-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
r that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3665100 AM Number Occupancy Type
not more than five hundred dollars(5500).
0 1,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 forsalc(Sec.7044,Business Required Inspections
and Professions Cade:The Contractofs License Law does not apply a an owner of q p
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.).
0 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 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.
0 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 I 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.
0 1 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 Worker's Compensation Insurance carrier and Policy number are:
Carrier STATe F444 Policy No.: i 8)3953 Z 0C 6
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one 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 Workcrs'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
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
Z, CONSTRUCTION LENDING AGENCY
HFir I hereby affirm that there is a construction lending agency for the performance of
Q.!> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lendces Name
az Lender's Address
U C) 1 certify that I have read this application and state that the above information is
w t" correct.I agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction,and hereby authorize representatives of this city to enter upon the
a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
uj liabilities,judgments,costs and expenses wh'h may in any way accrue against said City
V z in consequence of the granting oC is per Date l /
■'" APPLI NT UNDERSTAN AND ILL COMPLY WITH ALL NON-POINT Issued by
SO ATI
Air_ S- -O7 Re-roofs
rgnat re-ofApplicant/Con4dw DateType of Roof
HAZ OUS MATERIALS DISCLOSURE
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
Cote,Section 25532(a)? All roofs ihall 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 i;installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes p(Ttu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&SafctyCodc, ctions 505,25533 and 25534.I understand thatif Ute building
docs not ratty ave tcnan4 at it is my responsibility to notify the occupant of the
rc a be me rior to issuance of a Certificate of Occupancy. Signature of Applicant Date
All roof coverings to be Class"B"or better
Owner&authorized ag Date
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: bethe
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 36651009.00
DATE ISSUED. . . . . . . : 05/31/2007
RECEIPT # . . . . . . . . . BS000001512
REFERENCE ID # . . . : 07050293
SITE ADDRESS . . : 21330 RAINBOW DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER MA ANTHONY AND MARIA
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4978
RECEIVED FROM . . . . : SAT JOSE ROOF MAX
CONTRACTOR VICTALIANO ARTACHE JR. LIC # 25318
COMPANY SAT JOSE ROOF MAX
ADDRESS 13E2 CHIPLAY DR
CITY/STATE/ZIP . . . : SAT JOSE, CA 95122
TELEPHONE (4C8) 929-7663
FEE ID UNIT QUANTITY TMOUNT' PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
BPERMFEE VALUATION 20, 000 .00 277.56 0 .00 277 .56 0 .00
BSEISMICRE VALUATION 20, 000 .00 2 . 00 0 . 00 2 . 00 0.00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 279.56 0 .00 279 .56 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 279.56 1597
---------------
TOTAL RECEIPT 279 . 56
CITY OF C'UPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Buildin Address:
Owner's Name: Phone#:
Contractor: License#: C�a� ��
c', ROW
Contact{ Cupertino Business License #:
k4a t,�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
ZMII ' ood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cupertino's Tear Off Policy:
Job Description'
� ear o, o ,d -���q1/ -- � ��1
Residential XCommercial ❑
C•/mss. 3s"�'
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: U
Cost o Project: Tre of Cons tr�3lbom Occupancy grou
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE 3ldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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 apprcval.
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 mat trial down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail iu►spection 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.OjHomeowner's Name: r J,-a 14'
Job Site Address: 0 ) ✓ <J C) i I'D n Uo L,� r�
Roofing Company Name: .11!��-Cym paw
I
04
Applicant's Signature: Date: �- d 1-,o 7
Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
"UPEkTINO
Building Department
JOB ADDRESS: PERMIT# (1 I 7 y
a1330 �,-;