05080199 r CITY OF CUPERTINO
BUILDING DIVISION PERMIT -CONTRACTOR INFO.,RMATION 11
BUILDING ADDRESS:. IRMA PHELPS PERMITNO05080199
20889 DUNBAR DR
W NER'S NAME: PERMIT ISSUE DATE
IRMA PHELPS 20889 DUNBAR DR 08/22/2005
ONE: SANITARY NO. CONTROL N0,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT .PLUMB MELD
L O o LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 hereby affirm An[I am licensed under provisions of Chapter 9(mmmop
e"eing
b with Section]0M)'fDivision]of the Business and Professions Code.and my liccvc is
in fun fora and effem. REROOF-T/O SHAKES, SHEET W/1/2"OSB
License Class `k'' 30 YR. COMP.
o Dat Can,.,
--i"!5 ARCHITECTS DECLARATION
z 1 understand my plans shall be used is public meordt
�aU
o Licensed Pndcssional
$ 3 OW NEm exempt
m Ce Contr GN
d Y 1herebymrso affirm that 1 1. exempt from the Contras Co License Law for the
pO f�ngnmem.(Sc permit
W3Lmer,aimssmprve and defom Code;Any city or county
X m which its isms a permit po construct,alma improve,demolish,or a pair any summere
that he its cense pursec.purpolsuant
the the
ovisio antsof dic for such Contrarmiuoiamse Law(ned Chapter
F.1-nthathcencinmwJpunuanuothcpmviaionsoofibcBrmmrandProclaw(Cbapur9 Sq.Ft. Floor Area Valuat
y�FG (commencingwithftmim]AddeDasis sal of theeged e.smmd Professions Cwk)or
� Net be u exempt tltemfrom and the buffs for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3ApNNumher00 Occupancy Type
not man than five hundred dollars($500). 22 66 33 0161
❑Las owner of the property or my employees with"raw Heir wk compensation,
will do the work and the structure is notinumded or naertd banal.(Sec.704d,Business
and Prornshions sae:The ws traaars and who
law doer not apply lf an owner is Requires u -tipec onsL E
Ownproperty who Wudsmimprat sthcrconandwho dent in wart oroffe or offered
k nu !I Il
Own employees,providedinori Oat such rat is sold within one
intendedmORead for wanes,
however.
the Wildinguimprovementis soldwithinone year of completion,thepose or
builder will have the buNen of proving that Inc did not build or improve for purpose of 'O
sale.). / 7
O h as Owner of the property,am exclusively contracting with licensed contractors to 2005
consumer the project(Sec.704,1,Business and Professions Cao:)The Conmcror's Li.
carom law duet not apply to an of property who Wilds or improves thereon,and
swho contracts for such projeots cwithith a re
contraztor(s)licensed pursuant to the Contndoh yvil
11 R;'7�
License law, tU fYl
❑Ism ex ptunde,See. _ ,B&PC fw,MyNis rcawn
NG
Owns - - Date �Z
WORKER'S COMPENSAT3 NDECLARATION
1 hereby affirm under penalty of perjury one of the fallowing deelurtions:
I him and will maintain a Cerufink of Contin to self-insua for Workcls Compcn-
137M
ion,as Provided for by Section 3]00 of the Labor Code.for the performance of the
rk for which this permit nomad.
1 have and will maintain Worker's CompmuNan Insurance,u required by Section
of the Labor Codc,for die performance of the work for which this permit is issued.
y Workers Compensation Inwrana carrier and Policy number amartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is foranc hundred dollars($1IX)
or less.)
1 certify that in the performmcc of On,work for which this permit is is tied,I shall not
employ any person in any manner so as to become subject to the,Workeri Compensation
Laws of Cattails..Da¢
Applicant
NOTICE TO APPLICANT:If,after making Nu Certificate of Exemption,you should
became subject to the Worker m Compensation provisions of the Lather Coe.you must
,JD faMwith comply with such provisions or this Permit mall W deemed revoked.
Z'-' CONSTRUCTION LENDING AGENCY
Iherehy affirm that there is a construction lending agency for the performance of
C' the work For which this Permit is issued(Sce.3097.Civ.C.)
W� A Under's Name
.7 Z Lenders Address
U Q 1 canify that I have sad this application and Auto the the above information is
W. F torten.1 agree to comply with all city and county oNinmco and muse laws telaung to
0 U building construction,and hereby authoma reprommutuus of this city to anter open the
above mentioned property for inspection purposes.
(We)agree to save,iademmfy and keep humless dre City.r Cupertino against
rV] liabilities,judgmenss,costs and expenses which may in my way accrue againstsed City
U Z in eorsequcnce of the granting of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGULATI0 D �/ n G
�rnam• [tiV -� {�`r_ a Re-roofs
Si tum of ApplicmUContnc or Date
HAZARDOUS M RIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as dented by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
,jdjjWmIr.Sc y es a 25532(a)] 1641 All roofs shall be inspected prior to any roofing material being installed.
❑Y
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haardous air conuminanu as dconod by the Bay Ana Air Quality Management all new materials for inspection.
ixuim7 �
❑Yrs RNu
1havenad the hoar wsmaterialsrcyuimmenuunder Chapter6.95ofd¢Califon
nu Hwl"Safety Code,Sec mxZ55o5.25533md2553a.l understand thaziftW Wilding
Ones not currtnd,have a tenon.Nat it u an,responsibility m noury the aaapant of the
mqm muwnknmaappmet i.umanr.ceraneateofamp_ry. Signature of Applicant Date
Owner or amhorircd age I Date All roof coverings to be Class "B"or better
.� Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
S Uri' Ph V� c>s-2� 9 7
OWNER'S NAME: PHONE # -2
GENERAL CONTRACTOR: AX #
I am not using any subcontractors: 9(ZA10 12
Signature D to
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
Owner/Co tractor Signature Dat
CITY OF CUPERTINO
azgru REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # 3 26 30 Date:
O
Building Address: M
Owner's Name: Phone#:
Contractor: Few hofe#f: License#:
p�f
Contact: Phone #: Cupertino Business License#:
70
Type of Roof Coverin :
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )< Asphalt Shingles
gi[ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O. Report#
'15c To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Descriptiop
Residential XCommercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: 15
Cost of Project: ��D Type of Construction: Occupancy group:
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