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04050071CITY OF CUPERTINO WWI' BUILDING DIVISION PERMIT kCONTRACT,OR, INFO] O,N.- BDII.DING ADDRESS: DARLENE THORNE PERMIT"b4050071 OWNER'S NAME: PERMIT LSSUE DATE DARL ONE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description mcming al 1 am licensed under mvisions of Chapter 9 (cmm I Wreby affirm Np Ne Busircssaw Rofessiov Code.aw myliccvcu withllto=a �g� /1 deffe(DlviYonJaf and effect. Lerase �z.�® REROOF la License Clea Contractor Dau: Cumracwr ARCHITECT'S DECLARATION MAY 2(o 2004 1 uwcrsund my plans shall W used as public mw,ds L a I>�jt lf�Il ®�p�Rp a Liccnmd Pmilcuu nal OWNER -BUILDER DECLARATION I hereby affirm Nal I am commit fount the Contractors License law for me Lel 1� a fallowing moon. (Section 7031.5, Business and Pmfevdov Cade: Any city or county which requires a permit to cnnstruch alter, improve, demolish, or mpoir any swcturc 1 ono prior w its iuvancc, also myuims tW applicant for such permit to file a signed automem Sq. Ft. Floor Area Valuation Nat he is licensed pursuant the pmvisinv of the Convector's Liconse Law (Chun., 9 (commencing with Session 7") of Division 3 of The Business and Professions Code) or Nat he is exempt Nemfwm and the hats for the alleged exemption. Any violation of 3 64Y313N;.ffi%ei0 0 Occupancy Type Section 7031.5 by arty applicant for a permit subjects the appTzad in a civil Penalty of not mom Nan five hundmd dollars ($500). I,uowrter ofdm pmpeny,mmy employees with wagesu Nov tele eornpevetion, Required Inspections will do Ne work.end Ne,mnu a isnminteMed mothered forsam(Sa. 7014. Business and Polfica o u Code: The Contractors Liarue Law does nut apply to an owner of property, who builds or improves Nercon, and who doeuuch work himself or through his own employ., provided that such improvements arc not intended oroRemd forsala If. however, Ne building or improvement is sold within one year of completion, the owner - builder will have the burden of proving Nn be did not Wild or improve for purpose of salt.). ❑ I, a owner of and Impart, am exclusively contracting with licerued commicum to F cpvtmcl the pmjecs (gee. 7014, Business and Rofesome, Code:) The Conuadem's Li cove law dao not apply to in owner of property who Wilds or improves themon, and, who contacts for such projects with a eontrictorW licensed pursuant in the Contractors Li arses law. 1 sm exempt unit,, Sec. B & P�C2for Ois�m��an 0 �u. -- WOR O FNSAT ON DEC ATION a 1 hereby affirm nit ty of perjury arc of She following declaratiorts: I have and will maintain a Catificate017CUnmla to self -imam for Wortcr's Compcn- salio., a provided for by Section 3700 of the labor Cade. for the perf0rmawe of She work for which this permit is issued. Fl haw Md will maintain Worker's Compensation Insurance, as required by Section 37W of the LaWr Code, for the performance of ft work forwhich Nu permit is issued. My Workers Compensation Ivummx artier and Policy number Me: Carver. Policy No.: CERTIFICATE OF EXEMMON FROM WORKERS' COMPENSATION INSURANCE (This Section need nm W completed If the permit is foranc hundmddullaa ($101) or lea.) is s issued, all not I Modify N kF,t in the perfmmenc fyb wo r which Nu I N man e s e� Wor cmn ver' employ any�y In any g6 Laws of- cons. Date ApPlia t NOT16E,'dJ IT: If. Slier making this Cenifi a of zcmplion, you should baom bjcn 'ohcr's Compensation provisions of the Labor Code, you muss formwi :, comply with such provisions of this Permit shall W deemed invoked. - CONSTRUCTION LENDING AGENCY 1 hemby aRrm Nu Nem is a consimcOnn lending agency for Ne performance of Nc work fur which Nis permit u issued (Sec. 309'1. Civ. C.) Lenders Name Lender's AM. I certify that I have mad this apitimam. and sou that She a Ww information is correct I agree to comply with all city and county ordinmocs and sum laws relating to building construction, and hereby authpdm repmmnutives of this city in enter upon the above-mentioned property for Inspection purposes. (We) agree to ave. Indemnify add keep hairiness the filly of Cupertino against j Iiabiliues.judgmcnu. costs and expenses which may in any way same against said City in comes,mme of the gaming of this Permit. APPLICANT U RSTANDS WITH ALL WILL COMPLY WIALL NON -POINT Issued by: Date 5 U 4 RGE RE LA .r _ O Se-roofs Type of Roof Sigvwreo J Intent, Dem ZARGOLIS MATERIALS DISCLOSURE Will cans tar future Wilding occupant more orhandlc hatommus material a a dcRncO Cupertino Municipal Cade. Chapter 9.12. and She Hcalth and Safety we. Section 255320)? All roofs shall be inspected prior to any roofing material being installed. ❑ Yes If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. Disuics7 ❑secs Aim I have mW the hmardoos numn.1s rcquircmcnu under Chapter 6.95 of the Colifor- Nail Nc Wilding nine HwlN&Safety Cook. Savonshtit C isi55J3awmmilil1 somur, t docs our cu,mnd m tenant that it is my mzpovibility w nwfY Um amupans of Ne mymmmen a tact Prior w issuance of a Ccnlficatoof 0 14pancy. Signature t 5ate ' y All roof coverings to be Class "B" or better Owns agent am BUILDING DIVISION PERMIT LICENSED affirm Net I u win SaMn 70(10) of Division Sof the Butinesr AM P oleasum s Lanae. Ana my necrsm AS In full forte and effect License Class Lk. p DO-¢ Connector ARCHITECTS DECLARATION 1 undereund my plans smil the used As public records Licensed Professional OWNER -BUILDER DECLARATION 1 homes, affirm not 1 am csempt form ne Comtrmlmrl License law for no, following mason. (Section 7031.5, Business and Professimm Code: Any city or county which requires a Permit m comwcl. alar. Improve, demolish, or repair any swnure prior m its issuAnce, also mquims the applicant forsuch Permit to file a signed summer that he is licensed pursuant to tk provisions of the Contractor's Licence law (Chapter 9 (commencing win Section?IX)0) of Division 3 of the Business and Professions Code) or that he u exempt skrefrom And the haze for the alleged exemption. Any violation of Section 7031.5 by a" appliesnt for a permit sobjecu the aPPIMAm to A civil penalty of not mom than five hundred do1Wa (SSWL ❑ I. AS ow a r of the property, or my cmployca with wages AS their sole compensation, will do the work and the suunme is not intended of offered for salt (Sec. 704,s. Business and professions Cede: The Contractor's Liccme Law dors not apply m An owner of property who builds or impmva hereon, and who does such work himself or through his awn employers, provided nonsuch improvements arc not intended or offered for ASIA. If. however, hA building or improvement is sold within one year of cnmpinion. the owner builder will have the burden of proving that he did not build or improve four purpose of 1. AS owner of the poison, am exclusively connecting with licensed conuauurs to street the Mica (See. 70M. Business and Professions Code:) The Contractor's U. se law docs not apply to an owner of property who builds or improver neuron, and o concocts for such projects with a cormactoKs) liamcd pursuant he the Contranors oto law. t.m aemmunder See. __ .B&P C for this mason 1 kmby affirm under penalty of perjury ono Of he I have and will mainuln A CerdOc re of Conserv to self -insure for Worker'sCompen- AStion, as provided for by Seniors 37M of the labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will mainume Workers Compensation Insmaa. As "hired by Section 37M of the labor Code, her the performmea of the work for which this pemlil is issued. My Workers Compensation Insurance carrier AM Policy number sae: Camey. Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This aeelimn naval nor k complcu:d !film permit is fmrmnc hundreddnllars ($]M) or Mss.) I certify nal in the rformanee of the work for which this Permit u issued, I dull not cmpmymEi mymmner. as m become subject to the Workers,&'nommar Laws of Dam NfJ TO APPLICANT: If. other making this Ccnificalc of Exemption, you Should k 2me subject to he Workers CUrn,eution provisions or nn LaMrc Code. you mum Z forthwith comply with such provisions or this permit shall k deemed mvokcd. Z� CONSTRUCTION LENDING AGENCY [-. 1 hereby AM. then there is A commotion Mmling apmtc,, for the pedo... or a > tk work for which sou permit u issued (Sec. 3097. Civ, C.) W Q Undoes Name z Lamleri Address U (::) 1 certify that 1 have read this application AM sum het he above information is W F cancel. 1 agree m comply with all city ad county odmances and sure laws relating to OU building convection, and hereby auhodre represemetivet of this city to enter upon the N W shove-mcntimteal property for inspection purposes. 6. (We) egme to rove, indemnify And keep harmless he City of Cupertino against rfA liabilitles.judgments.costs and expenses which may In my way acrncagWut aid City U z in eo mgMnce of the grating of this Permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOURCE CATIONS. , awre of ApplicaVCmntralor Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building confront mom or handle ha emmus material As defined by ted Cupertino Municipal Cede. Chapter 9.12. and the Hcalth and Safety CWe, Section 255320? 0Yes No Will the applicant or future building arupant use equipment or devices which mit haaardous air contaminants M defined by he Bay Area Air Quality Management Disnica ❑ YaA I have mad he Wardoess materials requirements under Chapter 6.95 of the Califor- niaHcalth&Se@ty Co ,S .25505.25533ad25531.1 undcrsuM ual building does Ms eunemil bac A ¢nor. oat is u my..,maibilo, to notify ort oampat or n2 muuirvoMWA,1 bskh must An met prior to iss9pce of a CerdOcam of Occupancy. SIMON SAYS ROOFING 1"Bn"""04050071 PERMlf 155UB DATE Job Description REROOF Required Inspections Re -roofs Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ignature of Applicant All roof coverings to be Cla(s ;'B"# better ❑C Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESSrW apaq Tb/», A� PERmnW U OWNER'S NANO. 6a PHONE y af-:5 BUSINESS LICENSE # GENERAL CONTRACTOR: FAX # lei I am not using any subcontralt ,S: r� Signature Date Please check applicable subcontractors and complete the following informs ' n Owner/1 for Signature _Szv/V7/ >/ 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/1 for Signature _Szv/V7/ >/ Date 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 4a 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. is Person/Firm Address/City Phone Number Type of work to be erformed 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 Owner's Sigr;Sture: ate: S v Job Addr ss 7DOq t%piin % Permit # �YU 50-b Any changes to the information provided on this form shall be submitted to the Citv of Cupertino Build Department. a fflo CITY OF CUPEkTINO Dear Property Owner: City of Cupertino Building Department 10300 Torre Avenu Phone: (408) 777 - 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 compensatiors 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� UPEI�TINO 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. 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: ��Gtr�ehe�ri Job Site Addr-4: -719 n D/' Roofing Company NahvK: 2� ? A plicant's Sign % Q IQ Date:' � / eel \�t/�CiwDUV Greg t Building Official Revised 1/30/03 Printed on Recycled Paper 4qCITY OF UPEI1TINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Subject: Re -roofing policy for the City of Cupertino Telephone: (40$) 777-3228 Fax: (408) 777-3333 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. is 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: �ati \ � e\ P T�0 -�\r n Job Site Address: o C)5� 1�r/ � V!��c- Roofing Company Name: C) L, i ) <J e ( A plicant's Signature: fi Date: .5--/3 -01-/ G Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper • a CITY of CUPERTINO CITY OF CUPERTINO REROOF o 7 o -�—° o7 1 PERMIT APPLICATION FORM APN # � / 33 6 BUILDING Date: Building Address: BUILDING SEISMICRE Seismic Fee Res BUILDING BSEISMICOM Owner's Name: 0G� r /r norm BUILDING Phone #s Yoh—a2 Contractor: Phone #: BUSLIC License #: s•' .oto.. S f n-. {• vt �d F - S�"jl -3d3 / 7 � K sr' S�� Contact: a Phone #: Cupertino Business License #: � Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Asphalt Shingles ❑ Built -Up roof b�_Asphalt Shingles r.0' Wood Shakes ❑ Wood Shakes ,Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings 'z— ❑ Provide I.C.B.O. Report # ve�'To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Undersled and Will Comply ith Cu ertino's Tear Off Policy: ❑ Job Description: &�� (i Residential Comme cial Fire Zone: Yes ❑ No ❑ Confirmed with I r D t. if there are anre ctions: Cost of Project: Type of Cf ns c io Occupancy W. if \\ A nlienh p. FaS.fta] Fee Descrintion Fee Groun BPERMFEE Bldg Permit Fees BUILDING ENERGY Energy BUILDING SEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING i�-4 zs -r� ala, /° 7I , 0 CITY OF CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN # 3 O �— BENERGY Date: I BUILDING BSEISMICRE Seismic Fee Res BUILDING —, 1, I 0 Building Address: BUILDING BPLANCHK Plan Check Fee U BUSLIC o BUILDING Owner's Name: Phone #: _ C / Contractor: Phone #: License #: Jae '1 e— Contact: Phone #: Cupertino Business License #: `'S o3/ Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Asphalt Shingles ❑ Built -Up roof Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report # MTo be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: 1zzyyN0j 6 00A CO Residential Commercial ❑ oS3 ID/ Wovd Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are anrestrictions: LJ Cost of Project: Type of Construction: Occupancy group: 00 v Qty. if Annl i cable Fee M Fee Descrintion Fee Grotto BPERMFEE zSs 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 Z% .