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07110101 CITY OF CUPERTINO �� ,�,�j��;. ;: BUIJ 91NG D� Y1SlON PERMIT � . _ , ; .:. ,...... . pERM1T NO. BUILDINGADDRESS: ECONOMY �� OOFING 07110101 . 7536 DE LA FARGE DR pERivf1T ISSUE DATE .�+NER'S NAME: • 11 � 1 6� 2 � Q TJON HENK R 8 2 5 CAMDI�N AVE SAMTARY NO. CONIROL NO. P"o"E: (408) 866 -1800 BUILDING PERMIT INFO ARCHITECT/ENGINEER: H� EO PLU�MB ME�CH � p � LICENSED CONTRACTOR'S DECLARATION IOb DeSCI'1pLlOi1 � V I hcrcby sffirm that I am liccnsed undcr provisions of Chaptcr 9(commcncinS z � wiihSccuon7000)of '� � o«B�°� � C� am REROOF R �MOVE USING LMTL ULTIMATE 1/ 2" OSB 3 LB �� y in tu l l force an d e[ f F ELT 3 � � Q S. � v� z Licensc C lasa CO �� 3 � u Da�c 1TEC1'S DECLAR �rl/ � �� I undcrstanJ my plans shall be uxd as public recards Fll m � � w� y Liccnscd Pcufcuional pWNER-BUILDER DECI.ARATION �< � � hcrcyy af(irm that 1 am excmp� Crom �hc Convactor's License Law far the i p O following rcason. (SceGon 7031.5, Busincss and Pmfcssioas Calc: Any city ar coun�y K$ P�i which tcquires a pcimit to conswcL altcr. improvc. d�m��Lsh, nr re�wir any swaure Valuation y� y prior w��s issuancc a lsu icqu�ccs t h c a P P �� a n< < o r s u ch p crmit to filc a si gncd statcmenl F t. F l o o r A r e a $12 6 91 — z< �hat he is liccnscd pursuant io thc p�ovisions o( thc Conuactor's Liccnsc law (CAaptcr 9 S q• Y �� (commcncing wi�h Scction 7000) of Division 3 of Wc Busincss and Profcuions Codc) or y�� lhst ►ie ia eaempt the�efrom �nd Ihe bas'tt [or ihe s1�e8cd eumptioa Any violauon o[ OCCIl SI1C T e Section 7031.5 by airy applicant for a pemut subjecu �he aPP��can� a a Gvi] penalty of 3 5 9 2 6 0 3 C�(� Number p y yp �rot more �han five hundred dollars (5500)• � I. u owncr oC tAe proPertY, a my employces witti wages u �he'v solc compensadon. willdothework,and�hesttucW�eisnotintendedoroffe[edforsale(Sa.7044 Required Inspections and Pro[essions Code: The Convactors License Law does noi appiy m an owner of pmperty who buiids or improves �hereon. and wha does such work himsel[ ar Ihmugh his own anployces. Providcd tl�a� such improvemen�s ue not in�ended or ot[ered for sale. l[. 6owever. the building or impmveme�� is sold within one yesr of rnmpletion. the ownu- buildu will have tlie b�ude� o[ proving �hat he did not build or imp[ove tor purpose of sak.). ❑[. as owner of the property. am aeclusively conuuting wi�h Gcenaed rnnuactors w consnuct Uie pmjea (See. 7044. Business and Professions Code:) 71ie Conuacwr's Li- cense Law dacs oot apply w an owner of propeny who builds or improves �hneon, md , wta conuacts for such pmjects wiw a comractar(s) licensed pursuant to the C.onvacwr's ' icense Law. , B& P C for ihis reatan 1 am exempt under Sec. .�wner Dam WORKER'S COMPENSA'I10N DECLARATION I hercby atTim� under penalty of perjury one u[ the following declaradons: ❑ I hs.�e and will mainuin a CcniGcam of Coatent to ulf-insure for Workers Compen- sarion, u provided for by Secrion 3700 af the Laboc Code, foc the P�da�e� °� � woric for which Nis pertnit is issued• 0 I have and will muntain Workcr's Compensation Insurana, u mquired by Scction , 3700 of �he Labor Code. Cw the pedormane� of the wort for which this pecmit is issued. My Worker C m na uon lnsurance ca �cr and Policy number arc: Gmer. Poliey No.: � (.7Cp P'!'ION FROM S' . COMPENSATION INSURANCfi (Ihis secdoa necd not bc compieted if the petmit is for onc hundred dollus (5100) . or Icss) I certify �hut in t6e performancc of thc work fw which �his permit is istued• I sha�� not employ any pccson in any mannc� w az w becomc wbject w ihe Workccs' Compensation Laws of Califomia Da�e Applicant NOTICE 7'O APPLiCAM: If, aflcr making ihis CcrtiGca�c of F�ccmption, you shoulJ become subject w lha Worlcer's Compensation provisions of the Lsl+or Code, you muu � z forthwitd comply with such provisions or this permil shall bc dccmed mvoked. � � CONSTRUCTION LENDING AGENCY _ E.r ►-. I heroby aflirm diat there is a conswction Icnding agency (or thc perfortnancc of • . p�., � ihe worlc for which �his pemi9t is issued (Sec. 3097, Civ. CJ W Q Lendcr's Name � z Lcnder's Addmss V 0 1 cenily thu I have rcad tfus applicuion and statc that �hc abovc informatiun is w � cortcct. I agece w comply with all rity �nd county ordinances and suie laws reladng w 0 U building consuuction, and hereby auU�orin ceprcsenuGvcs of this city w cn�cr upon ihc � w abovo-mcntioned ptoperty for inspeclion purposes a (Wc) agme to save, indcmnify and kecp harmless the Ci�y of Cupenino against �„H,� � IiabiliGu, judgmcnls, co and expenscs which may in any way acc[uc agtinsl said City V z in consequence ot th ng of �his permi� Date � APPUCANT UN ANDS AND WIL COMPLY W1TH ALL NO -POINT Issued by: SOURCE REGU A1T0 . � � Re-roofs . � ' ,�Z ' / Signuurc of ApQii � a� �•� 'r pf F'.00f OUS MATERiALS DISCLOSURE YPe Will thc appl' t w futwc building occupa�t storc or handlc ha•rardous ma�crial efncd by the C rtino Municipal Code. Chaptcr 9.12, and the HcalU� and Safety .,,� Scction 25532 )? All roofs shall be inspected prior to any roofing material being installed. Dy� No Will the applicant or utuce building occupant use equipment or Jcvices a'hich If a roof s installed without first obtaining an inspection, I agree to remove emit harardous air conuminanis as Jcfincd by the Bay Area Air Quslily Managcmcn� all new n iaterials for ' pection. as�;�� y� Nu 1 havc cexd the hva�dous mamrials requiremcnu undcr Chap�cr 6.95 of thc Califor- / � 7 nia Heallh & Safc odc, 5ections 75505. 25533 and 25534. l undcrsiand thaz i[ ilx building � docs not curtcn y ve a tcnan4 ihat' is my responsibility to norify ��P.�� r u� Date rcyu'vemcnLSw ' et 'o W issuancc oCa Ccnificaic o Signature: of Appli t All roof coverings to be Class "B" or better Owner or autha ' d a cnt �� ' CITY OF CUPERTINO 2 ITEMS OF 2 PERMI7' RECEIPT OPERATOR: suew COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN ........: 35��26030.00 DATE ISSUED.......: 11i�16/2007 RECEIPT #••-••-•••: BS(i00003267 REFERENCE ID # •••: 07�.10101 SITE ADDRESS .....: 75: DE LA FARGE DR SUBDIVISION ....... CITY .............: CUI'ERTINO IMPACT AREA ....... OWNER ............: TJC)N HENK R ADDRESS ..........: 75:�6 DE LA FARGE DR CITY/STATE/ZIP ...: CUI�ERTINO CA, CA 95014-4361 RECEIVED FROM ....: JAPIA HORSAGER CONTRACTOR .......: HOF;SAGER, PAUL B LIC # 19307 COMPANY ..........: EC()NOMY ROOFING ADDRESS ..........: 82�� CAMDEN AVE CITY/STATE/ZIP ...: CAPIPBELL, CA 95008 TELEPHONE ........: (4()8)866-1800 FEE ID UNIT QUANTITY 1�MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 12,691.00 201.96 0.00 201.96 0.00 BSEISMICRE VALUATION 12,691.00 1.30 0.00 1.30 0.00 -�--------- ---------- ---------- ---------- TOTAL PERMIT : 203.26 0.00 203.26 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 203.26 MC --------------- TOTAL RECEIPT : 203.26 CITY OF CUPERTINO :z �2E ROOF cu��Tr�vo PERMIT APP)LICATION FORM v�/��/�� APN # �� L �� Date: Building Address• J Owner's Name: _ Phone #: - O '�� Contractor: License #:, / � �L. Contact: � _ Cupertino Business License #: � Type of �:oof Covering: E�sting: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles � Asphalt Shingles � Wood 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 Com ly With Cu�ertino's Tear Off Policy: ❑ Job Description: , F � SI�G l-� YUl l� . �� i b ( Residential � Commercial ❑ ` 3 � �J Fire Zone: Yes ❑ No �-- Confirmed with Planning D�t. if there are any restrictions: Cost of Project: Type of Construc,t' n: Occupancy roup� Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE �tldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE 3eismic Fee Res BUILDING BSEISMICOM �eismic Commercial BUILDING BPLANCHK ?lan Check Fee BUILDING BUSLIC Business License BUILDING St �. �� (,�-!�C . ��t�� 7 �I�rK �,� i� �b� -��. P _ _ , 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 (:ity of Cupertino 1. Prior to permit issuance, you must agrE�e to comply with 1997 UBC Standards and manufacturers specifications on re -roofing. 2. New roof coverings shall not be applie �. without first obtaining all inspection and written approval from the buildin�; 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 an�� roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre-inspection and/or tear off apprc�val. 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 i irst obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be perf��rmed. 7. NOTE: If you call for a plywood nail vlspection 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 he job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: (�f-e� � ��,�' �� Job Site Address: � � � �Q � . L_-(.f � �� / Roofing Company Name: " l_' ��1 Y� V � �F � \��7 Applicant's Signature: Date: Greg Casteel Building Official Revised 11/2/04 Community Development -_ " :, 10300 Torre Avenue ;�: � Cupertino CA 95014 � .�: ,.. Telephone (408) 777-3228 Fax(408)777-3333 CITY OF CUPEi�TiNO Buildi��1 De artment JOB ADDRESS: PERMIT # � �- - � �� ( v 1 � ( OWNER'S NAME: - � `" PHONE # � - � � � L GENERAL CONTRACTOR: .— FAX # - `� 1 d �r� � � - ?�7 I am not using any subcontractors: • �,��. Date Please check a licable subcontractors and om �lete the followin information SUBCONTRACTOR BUSIrfESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing IIectrical 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 �heet Rock Tile Owner/Contractor Signature Date