03070223 It CITY or CUPERTINo �� •��� �.� � � �� �,d
BUILDING DIVISION PERMITCONTRAC-TOR,INFORMATION ;;;
Bu1LDINC ADDRESS: DANIEL D KENNEDY PERMIT N003070223
OR09 W ESTATES DR
a OW NER'S NAME: PERMIT ISSUE DATE
DANIEL D KENNEDY Q7/30/2003
ONE: SANITARY NO, CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
+Oo LICENSED CONTRACTOR
nsedan&, DECLARATION
fto Cd m.)`mmallamuan.�danmrnroviaion=n(Chapter v(e.mmenemg Job Description
6� wiNSection](g1B)of Division 3 of the Business and Professions code.and my license is
mfell force anderraa'. REPLACE ROOF
License Class Lk.M
'FO Dalc Contractor FINALEbaa{/p
sflJ' ARCHITECTS DECLARATION ,v
f n U 1 underamnd my plans shall W..it as public rcCards '
oLicensedProfeesimol SEP '0 '.9'2003
jS OWNER-BUILDER DECLARATION
a y I hereby affirm that I am exempt from the Contractor's License law for the
C
00 following reason.(Section 703 1.5,Business and Professions Code:Any City or county �'�'�
m which remi
quires a pert to consuuct,altar.improve,demolim sh. riled,aO,sm
tncre 6 O O
prions asissuance,also rcyuirra the applicant for such Permit to file a signed statement
oto that he is licensed pursuant To the provisions of the ContnetoriLianseLaw(Chapter 9 Sq. Ft. Floor Area Valuation
2t- (commencing with Section 7(M)of Division 3ofthe Business and Professions Colic)or 36923034 . 00
Nu therefrom add he exempt therefroand Ne basis for the alleged exemption.Any violation of
notSecon Onfor031.5 by any undoodicanafor rs(SS smitsubjects NcapplicanuoaCivil pcmlryof APN Number Occupancy Type
bol mart On Bw hundrtd dollars(SSW).per
❑ I.as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(See.7W.Business gB
anProfessions Codc:The Contractor's License Law does net apply a an owner of 307 - INSULA'1' d Inspections
property wo builds orimproves Neeson,and who does such work himselror through his -
owncmployecs,providedthxt such improvements are not intended oroffered for sale.If, 601 — ROOF TEAR OFF
hawewa the building or improvement is said within one year of completion,Ne owner-
builder will have the burden of proving Nat the did not Wild or improve far puspou of 602 - ROOF PLYWOOD NAIL
sic)' 603 - ROOF BATTENS
1,as owner of the progeny,am cxclmively contracting wish licensed Convectors to 6 04 - ROOF IN-PROGRESS
camlrvd the project Ike.70m.Business and Professions Cade:)The Contractors Li
Cebu law does not apply to an owner of propcny who Wilds or improves thereon,and
who contracts fO h projects with a convectorp)licensed pursuant in Or Conuactofs
Lill Law.
x pt un r ,B&PC In,
2this
, azon
tuner Datc ^+ '
WORKER'S CO TION DC ATIDN
1 hereby afore under Penalty or perjury ane of the following declarations:
I have and will maintain a Cenificm.of Consent to self-insua for Workers Compare
urian,u Provided for by Section 37W of Or IaWr Cade,for the pandarm rad of tW
work for which
this
permit is issued.
❑1 hats and will maintain Worker's Compensation Insurance,as required by Section
371.11C labor Code,for be performance of the work fol which this permit is issad.
My Worker's Compensation Insurance carrier and Policy number are
Cartier. Policy No.: _
CERTIFICATE OF EKEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This section need nes W emallemd if I W Icrmit is for one hundrtd dollars(g IUD)
or Ro=d
1 Modify Nat in IW performance of the work for which this Permit is issued,I shall not
employ any Person in any manner so as to become subject o the Workeri Compensation -
Laws of califomia.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate Of Exam prion,you should
become subject to the Worker's Compcaution provisions of the Labor Cade.you mea
�Z forthwith comply with such provisions or this Permit shall be deemed mwked.
.Z.,O CONSTRUCTION LENDING AGENCY
1 herby off da Nat there is s e d(Sec.nn lending agency,Ito tW Performance of
Y Le work for which Nis permit is issued(Sec.JB9'!.Co,C.)
Z, Q fender's Name
�Z Lender's Address
J C) 1 certify that 1 have read this applieati.n and sur¢Out she aWvC information is
L P corm.1 agree to comply with all city and county ordinances and state laws relating to
�U building convection,and hereby aothoriu upsesentatives of this city to enter upon the
4 shove-mentioned progeny far inspersion Purposes.
(we)agree to save,indemnify and kap harmless the City of Cupertino against
en ince
liabilities, enra.estsand g axpemesmit. may in any way accme against said City
Uz inconseyeencc or the wanting of this permit. r
^" APPLI T UNDERSTANDS AND WILL C WITH ALL NO -PO Issued by: Dale
SO CE GUL
of ApPlican"Contr am Re-roofs
HAZARDOUS ATERIALS DISCLOSURE Type of Roof
Will No appiicam ar future Wilding occupant store or handle W7,o n x matesial
az defined by the Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
We.Section 35533(a)?
❑Yea _l?INo All roofs shall be inspected prior to any roofing material being installed.
will thea applicant or future building Occupant quip If a roof is installed without first obtaining an inspection,I agree to remove
rap s gam am equipment or ticvica which B P
it hazardous air contaminants az defined by the Bay Area Air Quality Management all new materials for inspection.
uin? b
❑ccs III No 1
Ihave&Sdrt I the .S.N see malanalsnyuimmcnuundcr Cha.dffi5or be Califor- �
-SO
nix Health ASafctyhe ba aadats 25Wals requirements
rats and rChapandthte if the Wilding
docs oat currently have a Itiolm Out It Is my rexpensiblllly In huffy the 0.Ya,.,Of the
myuim ms ichor mdpnunoissuanceofa ofOccupan gnat PApplica
Date
cr_W'uihosncd agent Da1C All roof coverings to be Class 'B"or better
,
awnt,Kezrl
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
Fax: (408) 777-3333
U P E IST I N O
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 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: a(-6 e-1 0•
Job Site Address: U U GJ fi ES e-
Roofing Company Name: o G 0+
—
A plicant's Signa e: Date: j 3 6/
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform:
A. 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
be 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 Informat' n� e side). /
Property Owner's Sigrtat� `-"Date: 3U
Job Ad es . A2iL 7 (k)• C-26Tef S D �CiP Permit#
Any changes to the information provided on this form shall be submitted to the Citv of Cu ertino Build
Department.
City of Cupertino Building Departmen
CITY OF 10300 Torre Avenu
C U P E R T I N O Phone: (408)777-322
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 vourself 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 goverment 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 compensation
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
CITY OF CUPERTINO
- , REROOF
OF
CUPEKTINO PERMIT APPLICATION FORM d30;N.23
APN# _ Date:
Building Address:
10 c� q
Owner's N e: Phone
cti of �, T(, -o q C) l
Contractor: Phone#: License :
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: 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, Underst d and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: ��
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with nin De . if
there are any r st icf ons:
Cos ct: Type of Cons Occupancy g up:
QIY .
A is le Fee ID Fee Description Fee Group
BPERMFEE Bld Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
(1 . 40