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03040093lo; a�Je 3W� 4 O aN 3$� z0 z.. Y Q �z �O �F Yee y W4 V CITY OF CUPERTINO ''>}•__ `��'� -•'' '� BUILDING DIVISION PERMIT CONTRACTOR3INFORMATION..< BWIt')"ATMRBR00K LA JIM KRAUSE ROOFING PERMITNO'03040093 ttItSON WILLIAM J AND ELAIN 2310 DIANA AVE ter` T"ESNA7`17 /2003 'AME: (408)779 -0704 SANITARY NO, CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT 'PLUMB MECH LICENSED CONTRACTOR'S DECLARATION lb Description at I am licensed under provisions of Chapter 9 (commencing 1 hereby affirm that o p with seniun ]((((0��111yyy+++++Iorr D,ivislon 3a1 the BUaincy y�Q Prafces ns Codmylicenseh mmnmred•agplerre YJ" /EROOF License CIJy /OVERLAY Dan Cunt r ARCHITECTS AT IO undcraund my plans shall M used as public he s Licensed Pmfeuionm OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from Ne Contractor's License Law for the following Lesson. (Section 703 1.5, Business and Profession Code: Any city or county which requires a Permit to cnmvuct, slmr. Improve, demnliah, at repair any sWCOm prior o its issuance. also requiem the applicant for such permit to file a signed su emcm that M is Bcenced pursuant to IM provisiom of IM Contractor's License law (Chapter 9 Sq. Ft. Floor Area $ Y2lSE6ion (commencing with Section 7000) of Division 3 of IM Business and Professions Code) or Y Nat be is exempt demfrom and de basis for the alleged exemption. Any violation of 3AM NO Sl [00 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of not mom than fiK hundred dollars ($500). ❑ I, as owner or the property, or my emplo ycca with wagnu NeO seta compensation, — Required Inspections Will do site work and Ne structure is not intended or oRered fonale (Sec. 704W, Business and Profess ions Code: The Contractor's License Law dam not apply to an owner of property who builds or Improves dommon,mri who doessuch work himxelrorthrough his 307 - INSULATION own employees, provided that such improvements are not intended or offered for sale. If, 601 — ROOF TEAR OFF lament. the building or Improvement is sold within and year of completion, the owner - Milder will ban tM burden of moving that M did not build or improve for purpose of 602 - ROOF PLYWOOD NAIL u1. 603 - ROOF BATTENS ❑ 1, as owner of project property, , Business exclusively conuaiing with licensed convectors 1. Code;) 604 — ROOF IN- PROGRESS oThoverdemon. and Came Lat emnot asec.n an ofprodrty who Wi law does not apply owner or property who builds of improves thereon, and, who who projects with Licensed pursuant oNIL Conuscmh c m Lactsforsoh "`"m 1 tin emmpt under S.C. . B & P C for this mason exempt FINALED at Dam SEP 132003 WORKER'S COMPENSATION DECLARATION I hereby offrm under Penalty of m0ury am of the following declarations: . ❑1 have and will of Consent oCode,fure for Workers COmpen• for by eCcni37M rforma provided for by Section 7700 of the labor Code, rm Live performance of the �I`�Ir� Workf r work for which this permit is isseed. ❑ I haw and will maintain W WYeri Compensation Imursmc. as requimd by section 7700 of wlabor Code, for the mrrormance or the wok for which this permit is iaad. My War led Compensatio Inaunae carrier ad Polic numMr arc: r Policy NO.: CERTI ICATE OF EXEMPTIONFRO ORK�RS• ' COMPENSATION INSURANCE (This section need not becompleud if IM permil is for one hundred dollars (SIM) or idea) 1 certify Nat in Live performance or the work for which this permit is issued. l shall not employ any person in my mannerx u o become subject to tM WOrkeri Campemetion Laws of California. Dam Applicant NOTICE TO APPLICANT: Ir, after making this Ccnlficate of Exemption, you should become Subject o the Worker's Compensation provisions of the labor Code, you mum forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that Bert is a Construction lending agency for the prfurmance of ' the work for which Nis permit is issued (Sec. 5097, Civ. C.) Lender's Name lender's Address 1 certify that I have read this application and sum that the above inf.amed. is Contact. 1 agree to comply with all city and county ordinances and sum laws relating to building convection, and hereby surround represenmins of this city to enter upon the shove - mentioned properly for impection purposes. (We) agree to UK. indemnify and Phamless the City of Cupertino against limilitim,judgments.ccum an w' hmay in anywayaccnmegainm said City APPLICAN"UNh`gr WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE R C/ 7 r%? Re -roofs Type of Roof a0froffi of Arhpli rfl a.M setw Dale HAZARDOUS MATERIALS DISCL SURE Will the applicant or future building occupant sore or handle hayudum mammal as darned by the Cupertino Muntc' .Code. Chapter 9.17. and the Health and Safety Codd. Seenen 75537(4)? All roofs shall be inspected prior to any roofing material being installed. MY. No If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future bas Idling mcupant use equipment or devices which emit ha¢mdn is air mnumimnu u fined by the Be, Area Air Quality Management at l ew materials for 1 e ion. District? ❑Yes Nu I have mad the huvaNnyympetinls iremcnu under CMpmr6.95 of rrc Glifor• _ aiaHalN &Sarcty Cade 5 33 and 25534.1 untie and thWifde Wilding y dos not c ndy h n my rcapoasihillly o non' Nc amPant of Ne Wremd nor o inuanccort CcrdOCam or u cy wnvnd .Sig re of Applicant Dat All roof coverings to be Class "B" or better Owmr er agent am A 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36920005.00 DATE ISSUED.......: 04/17/2003 RECEIPT #.........: 21636 REFERENCE ID # ...: 03040093 SITE ADDRESS .....: 875 ALDERBROOK LA SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: suem COPY # : 1 OWNER ............: MASTERSON WILLIAM J AND ELAINE ADDRESS ..........: CITY /STATE /ZIP ...: CUPERTINO CA, CA 95014 -4613 E RECEIVED FROM ....: JIM KRAUSE ROOFING CONTRACTOR .......: KRAUSE, JIM LIC # 21415 COMPANY ..........: JIM KRAUSE ROOFING ADDRESS ..........: 2310 DIANA AVE CITY /STATE /ZIP ...: MORGAN HILL, CA 95037 TELEPHONE ..... ... : (408)779 -0704 • FEE.ID ---------- UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ------------- ---------- BPERMFEE VALUATION 5,000.00 ---------- ---------- ---------- ---------- 107.00 0.00 107.00 0.00 BSEISMICRE VALUATION 4,250.00 0.50 0.00 0.50 0.00 TOTAL PERMIT ---------- --------7- ---------- ---------- 107.50 0.00 107.50 .0.00 METHOD OF PAYMENT AMOUNT __ NUMBER ______ CHECK _____ ____ ____________ 107.50 ------------------ 19618 TOTAL RECEIPT 107.50 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 E Community Development Department Building Division City of Cupertino a 10300 Torre Avenue Telephone: (408) 777 -3228 CITY OF Fax: (408) 777 -3333 CUPEkTINO • 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 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. IMPORTANT: 1. Flat roofs must have a minimum of Y4 " 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: Job Site Address: Roofing Compan A plicanYs Signl &� Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper • C� � J CUPEfTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM � 3ayWf5 APN # BPERMFEE — Date: BENERGY Energy BUILDING `7 BSEISMICRE Bu' 'ndre LL BSEISMICOM Seismic Commercial BUILDING BPLANCHK Owner's e: BUILDING Phone #: . Business License BUILDING J� �b - - (o2-. Con actor: Phone #: License #: C_ d SS Contact: Phone #: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: 0 uilt -Up Roof ❑ Built -Up roof Asphalt Shingles b"Ksphalt 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 T� ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ob Description: Residenti Commercial Fire Zone: Yes ❑ No B� Confirmed with P nning Dept. if there are an tri 'ons: LJfI� Cost of Project: ep Type o Construction: �\ Occupancy g up: Qty. if A lica 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