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05010085 FBUILDING tTY OF CUPERTINO BUILDING DIVISION PERMIT = C®NTRAC"TOR£INF®RMATIADDRESS: HERITAGE CONSTRUCTION AND PERMITN005010085 21972 MCCLELLAN RD OWNER'S NAME: - PERMITISUEDATE MASAKA OTSUKA 113622 SARAVIEW DR 01/13/2005 ONE: SANITARY NO. CONTROL NO. (408) 379-2005 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 10, LICENSEDCONTRA SD LARATION igu❑ Wrcb firm mal l em littnxa under sions of Chapter 9(commencing Job Description with Sem )of olv. n of NC Busi olessiumcodia.and myliccmcis in icanr aerrea "' C KIS 5J2 REROOF W/COMP. G�j j�� License Class Lic.N ,Fa Dow Cuntnclor ARCHITECTS DECR f�< ndemand my plana shall he ud m pub m rccn s�{. su Uccn uWq ssonal T\ g 5 OWNER-BUILDER DECLARATIOI'!. v`\ A<f I hereby aRren that I am exempt from the Comrmmfs Lkenu Law for the v -O o following mason.(Section 7031.5.Business and Professions Code:Any city or county <m which myuires a permit ro cenuiter,.Iter,improve,demolish,In repair any structure - $4500 uZ j, prlorlo its ismanec.also requirm the applicant rarsuchromottofleasignedsrstement ss< that W is licemsedi pursuant(a Vic provisions of Vic Contractor's Licensc Law(Chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7")of Division of the Business and Professions Code)or Oak he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 70]1.5 by any applicant for a permit subjects me applicant to a civil penalty of Gr00 Occupancy Type not more Nan five hundred dollars(3500). p Y Yp o I.as owner or the property,or my employees with wages as their sole compensation, will do the work,and due swaum is not intended or offered for sale(Sec.7000,Business and Professions Code:The Contractors License Law duos nut apply to as owner of Required Inspections property who builds or imgo es dumor.and whodoes such work homelier tMugh his own employees,provided that such improvements we not intended or offered for sale.If. however,the building or improvement is sold within one year of completion,Ne Owner, builder will have the burden of proving that he did not Wild or improve for puryose of ink.). ❑1,as owner of the property,am exclusively comma ing with licensed coruacrom to construct the project(See.7W.Busineu and Professions Code)The Contractar's Li came Law door not apply to an owner of property who Wilds or improver theuon,and who contacts for such projects with a Commonly)licensed pursuant to the Convenors License Law. ❑I am exempt under Sec. ,B&P C for this mason wrier Dow WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one or the following declasniom: I have and will maintain a Cer ifimm of Consent to self-imam for Worker's Compen. ration.u provided for by Section 3700 of me Labor Code,for the performance or the work for which this permit is island. ❑1 have and will maintain Worker's Compensation Insurance,az rryvired by Section ]7110 of Vic labor Code,for doo performance of the work far which this Permit is issued. My Workers CnmPemuion Insurance carrier and Policy number art: Carrier: E' �d.J�1�.Policy No.: V C NE OF F-X' PTION FROM KERS' COMPENSATION INSU (This section nod not heewnpincJ If the permit is rmonc hundred dollars($100) or less) I unify mat in me Performance of the work for which oris permit is issued.I shall not employ any pmsen in any manner in as Or hecome wbjcn to the Workers Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should become subject to the Worker'.Compensation provisions of the Labor Cosic.you main �z rorthwi th comply with such provisions or this perm it shall W deemed revoked. - z'vy CONSTRUCTION LENDING AGENCY 1 W mhy offrm mat them is a connmminn lending agency for the Performance of Ys the work for which this permit is issued(sec.3097,Civ.C.) Qlenders Name 7 z Leaders Addma. J 0 1 Certify that 1 have mad mil application end sure mat the above information is y t-' comet,l agree to comply with all city and county ordinances and state laws relating to 0building construction,and hereby authorize mprcuntalives of this City to Inter upon are, [, U ahovc-mentioned properly for impeetion purposes, gy (We)agree mrcm ,indemnify and keep harmless the City or Cupcnino against h ( / liabilities,judgments,costs and expenses which may in any way wens,against mid City ;)z in consequence of rhehegraining of this permit. " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE RE ULATIONS. �O1^ C�r Re-roofs SignatureofA licant/Conuumn Da HAZARDOUS MATERIALS DISCLOSURE Type of Roof WillmeepCu,nwrToroth buildinge.Chaptmomor handle ha Uvad Safety m de,Seo by the Cupertino Municipal Code.Chapter 9.12,end me Health and Safety otic,Section 355J1(a)? ❑Yin 91,,10 All roofs shall be inspected prior to any roofing material being installed. Will the applicant Or metre building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it harardous air contaminants as defined by Vic Bay Area Air Quality Management all new materials for inspection. Wrier? ❑Yes fl Nu 1 have mad the ha aNnm7materials mquiremenm under Chapter 6.95 of the Colton, nixdo HalmurBalmyCve&remand, itI35533 MYMSIP755N.l Mnoury thcim'rol or do dam not Currently have a mnank mat it is my respomihiliry m(roti fy the occupant of thej- mi; mCallwhichmustWmetpnorOrissurre.ofaCcamCon,a ccupermy. I atore of Applicant Date I All roof coverings to be Class "B"or better wrier ur aumoriac agcm p r Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEkTINO �P Building a artment JOB ADDRESS: JTAMIT # OWNER'S NAME: 0 P ONE # GENERAL CONTRACTOR: F I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation: 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 -'7�1 Owner/ ontractor Signature `�Q Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 VPEI,TINO Building Department JOB ADDRESS: /1 // F•RMIT #_ a2to1 C.Qo ,e,(�n _ � t OWNER'S NAME:' ` ' .--•S ( P ONE # GENERAL CONTRA CTOR: - I am not.using any subcontractors: / ' Signatufe'� '> Date Please check applicablesubcontractors 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 t Sheet Rock Tile C n4 ✓� Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U PEI�TINO 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) _ 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, willrequire 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. Homeowners Name: J TS, A— // / Job Site Address: 19 7 Z- IL�.c r 16 2, Roofing Company Name s n r_"! � nnJ CA of Applicant's Signature:✓ " 74l / Date: /O $ f Greg Casteel -` Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO gms, RE ROOF , 0 ICUPEICINO PERMIT APPLICATION FORM APN # 3�_/ b y U 3 Date: C� 13 Building Address: e T e Owner's Name: Phone#: � o Contractor: Phone#: License #: 2-- Contact: Contact: Phone #: Cupertino Business License#: 3 ry,ZS-r> Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles p- Asphalt Shingles ,W 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, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: Residential ® Commercial Fire Zone: Yes ❑ No ❑ Confirmed withPl if there are any stri ions: EJ Cost of Project: Type of ons c Occupancyou ,- Qty. if A l ab e Fee ID Fee Description Fee Grou 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