06080027 CITY QF CUPERTINO , ,W-
BUILDING DIVISION PERMIT O'CbN ACT(TR�INF'URMATj®N '=
BUILDING ADDRESS: , EV E MASTON 006080027
81
10732 CULBERTSON DR
OWNER'S NAME: PERMIT On DATE
EVELYNNE MASTON 08/04/2006
lipNE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG 0 PLUOMB MEOCH
I0G LICENSED CONTRACTOR'S DECLARATION JobDescrition
I hereby amren that l am licensed under provkions of Chapter 9(commencing P
U
with Section 70"of Division 3 of to Business and Professions Code,and my licen¢is
j� mmllfarmandonea REPLACE GRAVEL INSTALL 1/ " OSB FELT PAPER ADD
;'LIZ License Cuss Lic.g COMP SHINGLES S d4-dD-$5z'
F,ow Dam Contoular
f7ARCHITECTS DECLARATION
I undersand my plms shall be used as public.,ands
°t Licensed Professional
OWNER-BUILDER DECLARATION
<E I hereby affirm that I am exempt frore aha Coruscate,License Law for Ism
0o rolualog,mason.(Seaton 70d I.S.Business and Prolamines Code:My city or county
3$ which mndma,a permit w eansuun,alms,improve,demolW,or repair my structure
z'y^
prior at its issuance.also requires;she appikamforsuch permit to file a signed statement
22 G that he is licensed pursuant an the Ammons of the Conuxtor'sLicerue law(Chapter 9 Sq.Ft. Floor Area Valuat 0 0
2� (commencing with Seaton 7000)of Division 3 of the Business and Professions Code)or
that he is exempt Ihco from and the basis for the allgas exemption.Any vloudon of
Sector,7031.5 by any applicant nor a permit subjects the applicant m a civil penalty of ��µp7,w�t*}TyQ1.lyer Occupancy Type
nut mom Nen Bn hundred dollars(1501)), 3 VL1 - OO
❑I,as amcc of the propenY,ar my employees wish wages as,Wee hak eampewdon,
will do We work,and the structure lm not Intended or offered to,aak(Sec.7044,Budrcss Required Inspections
and Pmfesdans Cade The Coordinate,License law does not apply m an moues of q P
propertywho build,or i¢prosesdor an,and whodoessuch wrk hintaelrarIhtaugh his
ow employees,Wildin or dedImprovement
prom suehimpronmenuam rnt ear deal efcnroffered auctim,does aver-
however,the Wilding urimpronruentlahathwithin oto yet or completion,pu owoer-
builder will have We Wrden of proving that he did tet Wild m impow for purpose or
xek.).
❑1,as an=of We property,w eaGustecly convecting with Bxmad rnnuacmn at
consumer the project(Sec.7061.Business and Profeadons Codc)The Canuxmr's U.
emus law dors tet apply in m owner of property who builds or improves Werenn,and
who cormunts format project with a cootracta*)Bummed potatoes w se Crommaoes
License Law.
❑lam mem Bea ,B&PC nor ts `�
Owner Dema Ld U
WOR 0 EN A NDECLARATION
1 hereby a0irm under penslty of perjury arc of the following dedmadons:
I haw and will maintain a CWOate of Consent to self-insum far WarkeraCampen-
sellon,a proNded for by Scion 3700 of the Labor Codc,fur the performer¢of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,a required by Section
3700 or the Labor Code,for the performance of the work for which We permit is luted.
My Workers Compensadon Insurance carrier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu season need rat bccomplemd If the permit is Forane hundred subsea($I00)
or less.)
1 certify Nat in the rfammme.of W ark for which this rands is issued,l shall hurt
employ any perm y we gpL.imthe Wurkers'Compenaadae
Laws of Gl' - •, -
APPIIcanI
NOTICE M XPPLXAW.K.RE,making this CcndRtote of Exempten,you should
accome subject at tlrc Wmaers Compcmadon provisions of Woe Isles Coda you must
O fonhwidt comply with such provisions m this permit Nall M deemed mwaed.
Z CONSTRUCTION LENDING AGENCY
(-a I hereby arum that them is a construction lending agency for the performance of
ai We work for which this permit is issued(Sec.3097,CN.C.)
W�Q Lenders Name
z Leadees Addmss
U O 1 asdfy that I ham read this application W tote Wu the above ulomudon u
ly F' COMM T agree te comply with all city and county ordinances and fain laws relating In
0Ubuilding construction,and hereby authanne repmanmtises or Wie city to cover Oran the
W ahovo-mentioned
acuts.property
at far Inspection purposes.
LL (WO)agree to sen,indemnify and keep harmless the City of Cupertino against
y Iiabilities.Jasgmenu.tosu andeape'a"O which may In any wyaceme egalnsuald City
U Z in consequence of the granting thin permit. (� LJ_iSZ�
.. APPLIC UNDERSEA AN ILL COMPLY WITH A11.NON-POINT Issued by: 67Q"
rdafln1by
LAn N ��s�
Re-roofs
ph HAZARDOUS MATERIALS DISCLOSURE all Dam Type of Roof
applicant m future Wilding Occupantstore m handle Ismardum material
e Cupamlm Municipal Cade.Chapatr 9.12,and she Hedth and Safety
3532(.)7 All roofs shall be inspected prior to any roofing material being installed.
Nu.ppu ant ar¢tam b win as am an If a roof is installed without first obtaining an inspection,I agree to remove
g p equipmrnl w dcvias whichair contaminant u dcNmd by the Bay Ams Air Quality Management all new materials for inspection.
District?
EYes No
I have mad the haeardtms mamdau requirements under Chapter 6.95 or the Califor.
nla Health&Safety Code.Sections 25505,25533 and 25534.1 understand this true building V lJ
dans not c nenty how a tenmL t' .a h responsibility at Iwtry the Weapon of the
myulp� w mmabc mi3 sae tr.certinaamo�arnpan�ty. ,./' ignature OfA pli4ant Dale
116°' ( ,r ?f o'I- US
o auum ,<a, ent Dam All roof coverings to be Class "B"or better
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform
• A. `YN All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked, complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City. Phone # State License # Type of work to
i+c performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
• portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse side).
Property Ownei s Signature: ` Date: "Off- 0b
jobAddress: 7��—�UL/ %�olt� 1�iQ Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
•
City of Cupertino Building Deparhnent
10300 Torre Avenue•
CU PSLTINO Phone: (408)777-3228
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensatioro
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers' compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino •
Printed on Recycled Paper
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 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.
Homeowner's Name: BEVEL j dJ k* /YHhM- AD
Job Site Address: 1073 2 G U I-QE7l A) -
Roofing Company Name: effLF
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
•em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37534021 . 00
DATE ISSUED. . . . . . . : 08/04/2006
RECEIPT # . . . . . . . . . : 35514,
REFERENCE ID # • : 06080027
SITE ADDRESS . . . . . : 10732 CULBERTSON DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : EVELYNNE MASTON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : EVELYNNE MASTON
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : EVELYNNE MASTON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- - ---------
BPERMFEE VALUATION 3, 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BSEISMICRE VALUATION 3 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 83 . 66 0 . 00 83 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ---------- --------
CHECK 83 . 66 161
TOTAL RECEIPT 83 . 66
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aClOF Fax(408)777-3333
40UPERTINO
Building De artment
JOB ADDRESSPERMIT#
/a-? S2. C- ��c+sov) 1�� . 60E--G62I
OWNER'S NAME: '^v r� a s`ro n PHONE # ' 2,57= 6�o Sr'
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: (D g e ,�To4,
Signature Date
Please check applicable subcontractors and complete the following information
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
er/Contractor Signature Date
CITY OF CUPERTINO
Ww I
REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 315-Address: 311 M 1 Date: 6 D�
Building Address:
�1 'VLt
Owner's Name: Phone#:
TEL Y IU kyz S s—rza &J (yo&) SS— X06
Contractor: 0 (n License#:
Contact: � Cupertino Business License #:
OL._-J�
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X 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 Comely With Cu ertino's Tear Off Policy:
Job Description: SF D Gra
1 //
Residential 14 4Dn cvw* cial
Fire Zone: Yes ❑ No X Confirmed with Planning Dept. if
there are any restrictions: IJ
Cost of Project: Type of C�ttuction: Occupancy group:
��_
3, qe- r
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
BUSLIC Business License BUILDING