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06020007CITY OF CUPERTINO * i ._$, r "•''2 °"�" *,' sub afi" BUILDING DIVISION PERMIT T1YOMA�I fC0NTRAOR BUILDING ADDRESS: KEVIN SULLIVAN ROOFING PE MRNO06020007 7576 KIRWIN LA 0.'S NAME: FBRMIT ISSUE DATE PACIFIC AUTISM CENTER 1696 VALLEY OAKS D 02/01/2006 PHONE: SANITARY NO. CONTROL NO. (408)842-1057 ARCHnrRcvENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 LICENSED CONTRACTOR'S DECLARATION o Job Description I hereby affirm Nal I am licensed under provisions of Chapter 9 (commencing p with Section 70110) of Division 3m' the Bminessand Pretreat ... Code, and my lica uc is I. fail faroaand affect. REROOF-REMOVE SHAKES, INSTALL 7/1611 OSB. License a Lk.N /JIS� :'44' can,wT�A7s� 30 LB FELT/LIFETIME WARRANTY ((((ASPHALT ARCHnECse DECLARATION f� tl��'ra_ 1 undenunJ my phos NJI h teed u public ncnrds E I �1 tlf�Ujj (L^J (�'y` Licensed Professional OWNER-BUIMER DECLARATION I hrohy Arbon n that I am exempt from the Contranotn Lnmso Law for theQ ,t 2OU6 fallowing mason. (Sa mon MILL Business and Pmfeulons Cod": Any city w coomy an\ which raquires a pscrant, m construct. slue improve, demolish. or repair any structure prior to its issuance. also acquire; he applicant forsuch permit to file A signed sutemenl that he is licensed pursuant to the provisions of the Comaxctota Liasse law (Chapter 9 Sq. Ft. Floor Area p {A '�S ti (Jy{ Ts{ w Velli i81i 0 0 0 (commencing with Seaton 7M) of Division 3 of the Business and Potassium Cade)or �y t 'I '� �1 that he ls exempt threfrool and the bash for Ih alleged eaempbon. Any vuoldun of ,i-: f—,III tttfffiii t� I �`/f APN Number Occqpancy Type Section 7031.5 by arty applicant for a permit subjects the Applicant to a civil penalty of not mare than five hundred dollars (SsoD). 35922025.00 0 1, as owner of the property, or my employees with wages an their role compensation. Required Inspections ees will do the work and the structure is not intended offered for ask (See. 7044. Business and Pmfesdans Cade: Th Cmarn nts License Law donot apply to in owner of q p property who buildster improves dteaon, andwhodoessuch work himse fmthrough his awn employees, provided that such improxemenu art but intended araRered for We. If. how... the building err improvement is mid within oro year of compleum, the owncr- builder will Na the burden of proving that Its did not build or improve for purpose of sale.). 0 1. u owner of the property. me exclusively tanuaaing with Banned conaacbra no combust the project (Sec. 7044, Busirlw and Pro(esdam Code) The Consonants Li- ane law does nm apply in an owner of plapery wha builds or improves Iheum. and, who commas for such projects wit A consoactw(s) licensed pummum to tis ContrxctM. Liconce Lan 0 1 am exempt under Seo. . B Q P C far this won r Dau WORKERS COMPENSATION DECLARATION 1 hereby sfiLm under penally of perjury oro of the following dahn0uns: 0 I luveand will mountain sCettiftcateoloonsam to self-insure for Womme.Cumpmt- nation• m provided for by Section 3700 of the labor Code, for the performance of he w�aork /for which this prot is Waco. ®Thava and will maintain Workers Compemuion Insurance, an acquired by Section , 3700 of the Labor Coda, for the performance of the wart for which this parmit Is issued. My Worker, Compensation Inuuntee wrier and Policy number 1m: Cartier: .s04.65- 4-Z Policy No.:Z2910—O CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need ant becempleu l Ede permit In forone hundred dallan (SIOD) or less.) I ceNfy that In the performance of the work for which thin permit is issucd. I shall nal employ any person in my meaner an as to become subject to the Warkan Compenss0on Lsw, of CaRfomis. Dau Applicant NOTICE TO APPLICANT: If, after making this CcniOate of Exemption. you should become subject to the Workers Compema0un provisions of the tab"r Code, you meat forthwith comply what such peovisiom or this permit mall h clamed mwked. CONSTRUCTION LENDING AGENCY 1 hemby Affirm that Nem its construction lending agency for the performance of the wad for which this pemmil is Wood (Sec. 3097• Civ. C.) ' landcte Namc , fender, Anew I carry that I have mad W, application and nuts thou die above Information il ' cocoa 1 gree an comply with all city and county on irso ern and suss laws missing to ' Wilding construction. and hcmby authorise representatives of Nis city an enter upon the aha .mentioned property for Inspection purposes. (Wa) sgrea to save, indemnify and keep homeless the City of Cupertino against liabllida.judgmen s. emu and expense, which may in my way amu: against said City in consequence of the graming of this PCMIL APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEREG L IONS Re-roofs Type of Roof 4 6 Signan a�UConuacnr E Dale, HAZARDOUS MATERIALS DISCLOSURE Wit the applicant or future building uccupmt store or hmdlc handaus materiel Mrated by the Cupertino Municipal Cade. Chapter 9.12. and the Health and Safety Section 25532(a)7 O ❑Yes 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 Will the applicant or future building occupenl use equipment or devices which emit herardous air conuminm—tsasby the Bay Amer Air Quality Management all new materials for inspection. /defined Dissoict7 - Yes l I hove red the Ismoms materials requirements underMpur Il of the Glifw- nh Health Safely Code, Savor 25505,25533 and 73534,1 undersand dor ifthe Wilding does not currently how a u nmq that i1 as my responsibility an andfy de oaupmt of the myalmmcn i m"°a e�°"pE° n;-'7 ",.-) Signature of Applicant Date All roof coverings to be Class "B" or better Owner or, IhhwimdA cot Dow •11 OCIF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: °1s?� c J [I✓• PERMIT # '7 OWNER'S NAME: PHONE # GENERAL CONTRACTOR lv 34elG v FAX I am not using any subcontractors: ! (O Signature Date Please check applicable subcontractors and complete the following information Owner/ ntract 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/ ntract Signature Date A CITY OF CUPERTINO item 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN ........1 35922025.00 DATE ISSUED.......: 02/01/2006 RECEIPT #.........: 33041 REFERENCE ID # ...: 06020007 SITE ADDRESS .....: 7576 KIRWIN LA' SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: PACIFIC AUTISM CENTER ADDRESS ..........: CITY/STATE/ZIP .... , OPERATOR: suem COPY # : 2 METHOD OF PAYMENT ----------------- OTHER TOTAL RECEIPT : • AMOUNT NUMBER ------------ ------------------ 181.46 MASTERCARD 181.46 RECEIVED FROM ....: KEVIN SULLIVAN CONTRACTOR .......: KEVIN E. SULLIVAN LIC # 23810 COMPANY ..........: KEVIN SULLIVAN ROOFING ADDRESS ..........: 1696 VALLEY OAKS DR. CITY/STATE/ZIP ...: GILROY, CA 95020 • TELEPHONE ........: (408)842-1057 FEE ID ---------- UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BPERMFEE ------------- ---------- VALUATION 11,000.00 ---------- ---------- 180.36 0.00 ---------- 180.36 ---------- 0.00 BSEISMICRE VALUATION 11,000.00 1.10 0.00 1.10 0.00 TOTAL PERMIT ---------- ---------- 181.46 0.00 ---------- 181.46 ---------- 0.00' METHOD OF PAYMENT ----------------- OTHER TOTAL RECEIPT : • AMOUNT NUMBER ------------ ------------------ 181.46 MASTERCARD 181.46 • it it i CITY OF CUPEkTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Subject: Re -roofing policy for the City of Cupertino Telephone: (408) 777-3228 Fax: (408) 777-3333 1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards 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: g� Job Site Address: /, 7,6 KILCWIAJ W, Roofing Cor Applicant's • Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper J 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: g� Job Site Address: /, 7,6 KILCWIAJ W, Roofing Cor Applicant's • Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper J �d OUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM D�Ga4�W7 APN # as oa S Date: Building Address: Energy S76 BSEISMICRE Owner's Name: BUILDING Phone #: 6AW cyan / 2-' sa'-r Contractor: Ph o a #: c.i��.J 6a a579cSti License #: o37( Contact: Pone #: Cupertino Business License #: G5/ial ¢2� vS%623 S/d Type of Roof Covering: . Existing: Proposed: ❑ Built -Up Roof ❑ uilt-Up roof ❑ halt 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. Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: lob Description: k6VjZ 59046f, , P j.✓,Yl*z-- 7/a 'OSS -f- 306. r7k,7-f- 4 M7ft6 ,�-, Residential Commercial ❑ s Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: U Cost of Project: 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 u