06070167 CITY OF CUPERTINO '✓QI` `'��'
BUILDING DIVISION PERMIT �01�IT.R GT0 IPFF19ItMATIQN
BUILDING ADDRESS: HAR BRO OF NORTHERN CALIF °'06070167
10332 CRESTON DR
OWNER'S NAME: PERMIT ISSUE DATE
CLARENCE PETERSEN 299 OLD CO TY RD 07/25/2006
NE: SANITARY NO. CONTROL NO.
(650) 593-4500
ARCHITECT/ENGINEER: BUILDINO PERMIT INFO
BLDG ELECT PLUMB MECH
61 1
LICENSEDD CONTRACTOR'S DECLARATION Job Description
sow 1 hemby alRrm that 1 am 1lceexcd under provision Of Chapter 9(oommmeaS P
withSecdon7DgROf DivWon3oft1m OuaiaaaM Grummet Coda.aM mylkenw le
mfull to=andefleja REPAIR RAFTER FROM FIRE DAMAGE LIKE FOR LIKE
L11 Lleerue Clw Lie.
Dam — Contractor TEAR OFF EXISTING ROOF, RE-PLYWOOD & RE-ROOF
ll ARCHIIELISDECLARATION CLASS A SHINGLES
i 1 understood my plan shall be used as public records
'c
Licensed Pmfessimail -
1tm OWNER-BUILDER DECLARATION
f<S I Wmhy antra that I am exempt tram the Conuacmrm License Law for the
p o fallowing moon.(Section 7031.5,Busine»and Professions Cade:Any city of county .
$ which mquirea•permit to corulruc4 also,improv,mmolm,to repair any allruetum
3i Y+ prior in its issuance.also requires the Applicant fimsuch Ismail in file a signed sumowt
C that he is Banned pursuant to the provision of the Contractor"Lkew Law(Chapter 9 Sq.Ft. Floor Area Valuation
8 (commoners with Section 7000)ofDivision3ofthe BOA.and Professional Cuts)of $25000
that he u exempt therefrom and the bank for Ne alleged exemption.Any violation of
Smakm 7031.5 by any applicant fan a permit subjects No applicant to a civil Penalty of APN Number Occupancy Type
rat mom dun 0e.hundred dollars(5500).
❑1,u owner of the pmpemy,a my employm with msec a Ateu wk eompewdon,
will m Newark.and the suueure u not Inmnded w anemd forank(Sw.7044,BudM••
and Profession Cade:The Canuacters Liam Law don rat apply m an ower of _ Required Inspections
Property who buildsn(mprowa Amounts,and who dam each walk himselfa through his
unemployment,provided that such impmwmenu are notlmmsdN oraaeted forsale.If.
however.the building or Improvement 4wld within ane You of completion,ere owner•
builder will have Ne Widen of proving dust M did rat MM or Improve for purpose:of
ole.)• ��
❑1.u comer of the property son exclusively contracting with Ikemed conua7an m ���
U.
ecram,conota Am n not (See.7014.BusOwner
roof ark property
who u Cade:)The Contractor'sl.and corse law don not apply je ts with
A of property ice sed I or Improve Norton,and
who Am Lac4 for such projects wfN a eontrecmrt0 Barad Wrwant m Ne Canmetoh
uceuelaw.
❑lam wmpt under gee ,B&PC far Nis moan - v�
103I.Clial
ear Data 2006
munderWORKER'S COMPENSATION DECLARATION
g HOLDING 1 hereby affirm under penalty of perjury nn of the following tsclan0on: L '
I lam and will cadmum a Certificate of Contralto alf-hnure fa Walkers CamPM-
er,an provided for by Section 3700 of the Labor Cade,for the performance of the
rk fn which this perm)is issued.
1 haw and will mohair Workers COmprandem luurana,u acquired by Section
the Labor Coda.for Ne performance of No walk far which Nis permit ire issued.
Werkee Compensation Irsm oxen,amu and Policy number art:
der. iA !-1e$��v'G Polity No.: r�f�D6 e5
CERfIFlCATE OF E%EMPfION FROM W RKERS'
COMPENSATION INSURANCE
(nds suction need at becompleted lithe,permit is farand hunNW dollen(310)
a teal.)
1 certify Nat In the perfamwce of the work far which this permlt is issued.l shall at
employ anyperwn in any manor w as in became subject ods dm Workers'Commandant
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.If,after making this Cerirmam of Exemption,you should
assume subject to the Workers Campat ation provision of the Iahor Code.you most
0 O forthwith comply with such Provision so Nu permit shall be domed rooked.
„z., CONSTRUCTION LENDING AGENCY
(—, 1 hemby alum that them Is a comuuctinn lending agency for the performance of
G' Am walk for which this permit is tuned(Sec.3OY7.Civ.C.) -
G Q Landers Name
7 2 Laurer,Address
U 0 I certify Nat I have mad this applin ion and Aum that the above InfotmW un is
IU F correct.I as=in comply with all City and county Ordinances and ream Inn muting w
DU building eonwuction,and hereby authorire mpmsemativn or this city to enter upon the
W shove-ra ntianetl pmKrty for inspection purposes
g1 (We)ascot to ave,indemnify and lump harmlw the City of Cupertino Against
v.v res luddlidesjudgmanu,eom andnpsouu which may in any my scene assinuaid City
UZ In consequence or Ne{renting of NU Permit.
^" APPLICANT NDERSTAND ND WILL COMPLY WITH ALL NON-POINT Issued by: Date - 5
SOURCE LATION
/ 7 a§ Re-roofs
SignatGnsallAppl(on nuamor Duca
HAZARDOUS MATERIALS DISCLOSURE Type of Roof .
Will Am applicant or future building occummusrom a handle Illustrious materiel
an deBmd by f Cupemma Municipal Code,Chapter 9.12,and the Health and Safety
Conn. 2ss255324)?Oyu o
All roofs shall be inspected prior to any roofing material being installed.
7i3li ❑Yn
WIII de applicant or future building asupan(as,equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
nts,
it hauAdmS air catsminanb u m0ad by the Bay Area Air Quality Management all new materials for inspection.
istrict?
❑Yes M.
I leve read Ne huaNnw materials requirements unmrCTapmrei.95aftlec Califon&SafetyCode,Sacdon 25505,25533 uu125534.Iunmrstand thNifthe building �n at curmntlY hew a Ienan4 Nu it u my mipoaihility m atify Am occupant of Ne / g ulmme hmust orwluuanaof a Candeem of Ocq �" Signatore ohcant Date
warnr aaNar'uad.enl Data. All roof coverings to be Class"B"or better
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 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 " 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.
CI- e- PFS? Sm�J
.. ., n
Homeowner's Name: �.�---w=--
Job Site Address: ce-r. 5no
Roofing Company Name: —r, 0 ' C�
Applicant's Signature: Date: -2
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32637042 . 00
DATE ISSUED. . . . . . . : 07/25/2006
RECEIPT # . . . . . . . . . : 35373
REFERENCE ID # . . . : 06070167
SITE ADDRESS . . . . . : 10332 CRESTON DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CLARENCE PETERSEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : HAR-BRO INC
CONTRACTOR . . . . . . . : FRANKLIN„ JIM LIC # 20709
COMPANY . . . . . . . . . . : HAR BRO OF NORTHERN CALIFORNIA
ADDRESS . . . . . . . . . . : 299 OLD COUNTY RD
CITY/STATE/ZIP . . . : SAN CARLOS, CA 94077
TELEPHONE . . . . . . . . : (650) 593-4500
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 331 . 56 159 . 15 0 . 00 159 . 15 0 . 00
BPERMFEE VALUATION 25, 000 . 00 331 . 56 0 . 00 331 . 56 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
BSEISMICRE VALUATION 25 , 000 . 00 2 . 50 0 . 00 2 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 598 . 21 0 . 00 598 . 21 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 598 . 21 MASTERCARD
TOTAL RECEIPT 598 . 21
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*CUPEVINO
Building Department
JOB ADDRESS: PERMIT #
0 332- C� ST-I-ti fl2 060 -70 t 6 7
OWNER'S NAME: cA <,.rK+•saJ PHONE # d 50 670-c;?-'7 7.Z
GENERAL CONTRACTOR: FAX# p 3-7- S'3 O
I am not using any subcontractors: T $ ,iJ -7-2
Signature Date
Please check applicable subcontractors and complete the following information:
ba SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
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
Sheet Rock
Tile
Owner/Contractor Signature Date
CG - CITY OF CUPERTINO
CUPEf�F PERMIT APPLICATION FORM
qWPN# 3�•y,1 �t(� Date: o�y—C�
Building Address: -f Mailing Address (if different from building addres"
%c'733.2 sn,^j 063 G . PArAr %-F-
Owner's
-rOwner's Name: Phone
C_J_& "ti e_. P��+c e saws S✓o ) 0
Contractor: License#:
fo
Contact: Phone• 6s�J67o J7 upertino Business License#:
Cs?q-" ]-
Building PennitnInfo: R2 F, f,do cJn�7,e L, KS 0=.-eaL/��
�Iq oF- b 6.
g.X AC7 a.. 9'+ Rt Kmr.
Bld f ` Elect ❑ Plumb ❑ Mech ❑
Job Description:
Residential 4 Commercial ❑
Sq.Ft. Floor Area: Sq.Ft.:
Cost of Project: _ Occupancy Gro�up
c�S DOC) ` 12 -1
Type of Construction: Please check this box if the project is a
second-story addition: ❑
ro'ect Size: Standard Large ❑ Major ❑
Quantity Fee ID Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 500K Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax-Resi/Mobile BUILDING
BELEC1000 Elec 600V<= 1000A ELECTRICAL
BELEC1001 Elec 600V > 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
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CITY OF CUPERTINO
CUPEf�TINO PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Group
BMISCELL Miscellaneous Fee BUILDING
BMITIGATC Comm. Housing Mit. Fee BUILDING
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BOVERTIME Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE � PbIg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Intercepter PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i e Of Fixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinkler/Backflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 din MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFIX'T Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> IOK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BRENEQWP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl Switch & Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter HeatingMECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
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� - CITY OF CUPERTINO
CUPEI�TINO PERMIT APPLICATION FORM
uantity Fee ID Fee Description Fee Group
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs, Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECIAL Special Inspection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Permit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issue PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
PLLONGRNGC Planning LR Comme/Multi-Fam PLANNING
PLLONGRNGR Planning Long Range Residential PLANNING
ZADDCHG Address Change BUILDING
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