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06030153CITY OF LUPERTINO �Aa BUILDING DIVISION PERMIT V�i\�Q11�1�44J3'A%�,�1\ BUILDING ADDRESS: PERMRNO. 22126 HIBISCUS DR OWNER'S NAME: PERMITLSUEDATE MICHAEL MINN CONTINENTAL DR. 03/27/2006 PHONE: SANITARY NO. CONTROL NO. kk (408)489-7982 CHr1ECDENGINEER: BUILDING PERMIT INFO PLUMB MOECH BO 0 LICENSED CONTRACTOR'S DECLARATION J -tion 1 hereby afillrm that 1 am Hemmed under Provisions of Chapter 9 (commencing withllimmaglU)afOiWdmJoftMLie., albProfetdons in full farm TEAR OFF SHINGLES I 0-YEAR CLASS and �3 vomyliceneu Limm�c C.slas�s `��Lk." , Dam SHINGLES. �/�/� "" y f/f7�ACH17ELTsDECLA 1 understand my Mmu plans all Po used pubic rtt.'a MAY �OOti Licensed Professional OWNER-exempt frDECLARATION r■ 1 herby e1Rrm n I am exempt from the Contractors License Taw for the Code: My tiny or county Following moon. a 7031.5. Business,at and o IL w, dcsiuns whlCll m9Y11Cx a IMmlll 10 CnmWCL eIICf, ImpravC. dCmtdlm. M repair any e1mC1Ym emit t ' prior to its issuan.. alsu requires the applicant for such Permit to rile asigned statement Nat he is licensed pursuant to the provisions of the ComruWr's License Law (Chapter 9 Sq. Ft. Floor Area aluati (commencing with Section 70001 of Division 3 of the Bushman and Professions Code) or that he as exempt therefrom and the basis for the alleged exemption. Any violation of Z]'��tsr� OccUp anCy Typ e Section 70313 by any applicant for a permit subjects the applicant on a civil penalty ofdpy not mom then Ras handrail dollars (5300). L6U Z T 3 O O ❑ 1, u owner of the property, or my employes with wain u Noir sole compenulion, Required Inspections will do the work, and Iheatrunum Is not intended muttered forsale (So., 7094. Business and Professions Cade: The Commcwr's License Law time Imo apply to an owner of property who builds ter improves thereon, and wha does such work himself or through his own employees, provldcd that such Improvements art not Intended "offered for sale. If, however, the building or Imp owment is sold within one year of cumpudon, the owner- builder will have the burden of proving that he did not build or improm for purpose of sale.). ❑ 1, As owner of the property. am exclusively contracting with licensed mntnethrs to construct the project (Sec. 7044. Business and Professions Code:) The Conlnch is U. mme law dote era apply to an owner of property who builds or Improves thereon, and who contracts for ouch pmjeau with •conuactad%) licensed pursuant to, the Contractors License law. ❑ I am exempt under Sec . B A P C for this mann Owner Data WORKER'S COMPENSATION DECLARATION I hereby allirm under penally of perjury mm of the following declarations: I ham and will maintain A CenlBnw of CCNCAI to self-insure far WorkersCMnten- on. As mr ided for by Smdon 3700 of the labor Code, for the prrformnua of the rk for which this permit is Issued. ❑ 1 have and will maintain Workers Compemadon Insurance, as required by Section 3700of Ne Ua Code, far dte performanee of the wart for which Nu permit is itt, ' My Workers Cmmpcunddn ins ice sorer and Policy numbers": tinier. e, Policy Policy No.: "CER'IIPICATE OF E%EMP ION FROM WORKERS' COMPENSATION INSURANCE (Thusntim mode nolbecomplesed lithe permit Is foram hundred dollars ($100) , or less.) I unify, Not in the perfolmanm of the work for which this permit is issued, l ahatl not employ any person i to man subject o Ne Workcn'Compewdo. lawn- GlifoAP f,. .4 NOTICE TO APPLI If, after making this Certificate of Eaempnimn. you mould beeome subject w Workers Compensation previsions of the labor Code, you must forthAr th comply with such provisions or this permit mall de doomed corked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that Nem Is construction lending agency for Ne performance of the work for which Nb permit Is Issued (Sm. 3097. civ. C,) Undoes Name . lender's Address 1 certify that I have most this application and mm that the Above information Is correct. I agree to comply with all city and county o dinanms and state laws elating to building construction, and hereby emhorim reprmentelins of this city to enter upon the ahow-mentioned property for inspection purposes. (We) agree to um, Indemnify and keep harmless the City of Cupertino against Ilsblli ics Judgmenes, costs and expenses which may in say my acme against said City In comegnmc of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 3_ Z SOU L Ng. Re-roofs Type of Roof - rine pplicer'Cunucror Deta HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant more M har dle Murdous material As dented by the Cupertino Municipal Code, Chapter 9.13, and the Health and Safety Code, Section 25532(a)7'- All roofs shall be inspected to any roofing material being installed. ElYes er prior If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant sac equipment M devices which itherardnmaircontaminanusadell oh -Bay Arta Air QWlny MAnegcment all new materials for inspection. vitt? ❑ Yes ❑Ihavemsdthe Pi.,FkalLh&SdctyCoft,Smti=25%5.25533WM34.lw s ml rChapterG93ofthcGlifor-l.demeM Natif Ne building �daes not Currently h A tc,ppppyyp the it u my respmuihillty m ratify do atop., of do _ - rumba n aYbe�M1 ti iorwissumccoraccrdMaemf0cmPancy. natur Applicant Date All roof coverings to be Class "B" or better ff�ar onmd agent Dam CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN ........: 32602027.00 DATE ISSUED.......: 03/27/2006 RECEIPT #.........: 33751 REFERENCE ID # ...: 06030153 SITE ADDRESS .....: 22126 HIBISCUS DR SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: kiersaw COPY # : 3 OWNER ............: MICHAEL MINN ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-0109 METHOD OF PAYMENT ----------------- CASH TOTAL RECEIPT : r AMOUNT NUMBER ____________ __________________ 126.96 126.96 RECEIVED FROM ....: DAVID CAMERON CONTRACTOR .......: DAVID CAMERON LIC # 25538 COMPANY ..........: CERTIFIED ROOFING CO. ADDRESS ..........: CONTINENTAL DR. CITY/STATE/ZIP ...: SAN JOSE, CA 95111 TELEPHONE .......1: (408)489-7982 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL _____ RMFEE _____________ __________ VALUATION 6,000.00 __________ __________ 126.36 0.00 __________ 126.36 __________ 0.00 BSEISMICRE VALUATION 6,000.00 0.60 1 0.00 0.60 0.00 TOTAL PERMIT __________ __________ 126.96 0.00 __________ 126.96 ---------- 0.00 METHOD OF PAYMENT ----------------- CASH TOTAL RECEIPT : r AMOUNT NUMBER ____________ __________________ 126.96 126.96 0 • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 2 6 7L/*5c c,s P4. PERMIT # ©i ce OWNER'S NAME: PHONE # GENERAL CONTRACTOR: Ce r .' ^c FAX # I am not using any subcontracto : - ,7-7r©S Signature Date Please check applicable subcontractors and complete the following information: Owner/ • wner/Contractor Signature Date 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/ • wner/Contractor Signature Date 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. J Homeowner's Name: , / " ` C 4 G {, � L" r/U n J Job Site Address: -L-Z(.26 ff Roofing Company Name: &Y i r D c Applicant's Signature: v�'9�L Date: �o2T �D6 Greg Casteel • Building Official Revised 11/2/04 0 0 CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN# 52,(O——OZ Bldg Permit Fees Date: 3 O6 Building Address- ' / Z�Z%J ibrSCv5 G S C, er�'.yo G L Owner's Name: BSEISMICRE Phone #: BUILDING BSEISMICOM 110,5 8 g-7 2' i Cor t ((� r N tY1i r BPLANCHK License #: 016 G6o 6 Contact:�► p ' CAm BUSLIC Cupertino Business License #: u r N Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof X Asphalt Shingles ❑ Built -Up roof )< Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings ❑ Other (Specify) ❑ Provide I.C.B.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: // 20 i-4 eL& 50 /V r 1,1V Residential' Commercial ❑ G less Fire Zone: Yes ❑ No ❑ Confirmed with Planning DMt. if there are any restrictions: LJ Cost of Project:i ,( 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