08030016CITY OF CUPERTINO
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WILDING -DIVISION PERMT
^L154
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BUILDI�7Qf�ogp? MILLER AVE
OSCAR T TAYO
PERM . No.
08030016
NERR''SUNAAME: -
PERMIT t§trE DATE
SANITARY NO. CONTROL NO.
ARC HITECf/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
j LICENSED CONTRACTOR'S DECLARATION
Job Description
1 Icreby aRinn Net 1 am Iksrand under pmvidons ofChapter 9 (mmmmming
with section 70M) of Division 3 of Ne Businessad Professions Code.and my license is
RE-RF CLS A 45SQ ASPHLT SHNGLS ON 1/2"CDX PLYWD
In full fuse and afros.
t License Lima Lk. It
gDate Contractor
7 ARCHnECTS DECLARATION
< I understand my plans shall he used at public tames
J
Licensed Pmfcmional
fr DECLARATION
1 am exempt from Na Canuactafs License law for the
F I .(Eras hot I am exempt
following mnsnn. (Saito 7031.5. Badness and Cole: My city or =my
nodus on
�O•
nes docan
LL which ire my
re Cres
itsisu{aPermit
ftalter.Ir,Iporsuh permit a sig edtoccom
y prior In is issuance. also requires Ja applkmt for sahpmmitm file aaigaJ wtemem
< Comea,me, Lice= Law (Chnine, 9
Sq.Ft.FloorArea
Valuation
O that lu: is licensed pursuant to ft Inevishms of the
ionlardteBusi..dP fessioasCade)or
$8000
(commencingwiNSadon70 )dMD
_
Nat he u axmpn Nemfmm and the basis fm the alleged esemptimv Any Hoiatim of
Number
AF�
Occupancy Type
Schon 7031.5 by arty applicant for. prmit subjects Ne app0unt Ina dull penally of
not more than five hundred dollen (5300]
3 7 5 0 4 018
1..., of the property or my amPloyea with wages as their ule compensation,
Required Inspections
will do the work.and be .0. hoot inandedoroffered for India (See. Ida, Busircia
and Professions Cade The Convacmr's License Law does sat apply m nm so awof
q p
propenywho builds a improm themon,and whodoessahmrk himsciforthmugh his
awn employees, provided thntuch improvemms are nminunded aroRerad (orale. If.
however, he building or improvement is sold within am year of completion, the Owner-
.
builder will have his burden of proem, Wt he did not build or inepmvs for pure. of
sale.).
tC}'1, u owner a( Na pmpenY• am exeluaivelY cmbacting with IianW conwcmrs to
concoct Ne project (Sec. Ida, Business and Profession Cade:) The Contractor's U.
ce. Law, don not apply to an owner of property, am build, or impmm Neeson, shed,
who conuacs for such projects wits acomonsm(s) licensed pursuant in rte Conuaotoet
Lkcslae La
❑tom tie pt undera .B&PC for thh moron
se Data
WORKERA COMPENSATION DECLARATION
I hembY alaon under penalty of pedury oren of Ne following declaration:
Q In, andwill of o-
he performance
Section 1'!00 of do Labor Coda, for the pertomlana a( site
as (us3700 ft Lab Code,
thi fPe
we&fmproh
wart far which this permit is iasucd.
mi
❑ 1 have and will mainsin Worker's Compotsxtian Ina .. as required by Sermon
Ne sabm Code fm Ne reeRomlaae cork fnu whir pmmit h iasueJ.
are:
My Worker's Compensation hansrm artier shod Policy number am:
My Wo r and
Cartier. Policy No,;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlbh section need not M cmnpleted if ds permit is forme, hundred dollar (SIM)
or leas.)
1 coldly that in the performaneo of Ne work for which this permit h issued. I shall nal
employ any'Itn In any mmrursyras m become subject m the Workers' Compcnation
Laws of Cll'Ism• n•• a
AIt licant
NOTICE TOPPLICANT: If. Mr making this Certificate of Eaemption, you should
become subject m the worker's Compensation provision of the labor Code you mus
OfoMwiN comply win such provision or this permit shall la: dttmed revoked.
CONSTRUCTION LENDING AGENCY
I hereby aft m than them h a comuatinn lending agency for de, perfaemarate of
the work for which this Permit h iastted (Sec. 3097, Civ, C,)
QLcnde's Name
z Lender's Address
Q 1 certify 6.1 I haus mad this applicNim and sate dou the above Woman. is
E^ correct. 1 ata In comply with all city and county Ordinances and sae laws relating to
Ubuilding construction, and hereby authorim represcnstim of this City to enter upon do
W a1mve-mentioned property for inspection purpevas.
(We) agree to nue, indemnify and kap harmlam da City of Cupertino againt
req liabilities judgments.costs and espertva which may in any wayaameagaimtsmd City
Z ineonequenaoIdea gnnongof this Permit. I
APP ICANT UNDERSTA)IDS AND WILL COMPLY WITH ALL NON-POINT
q
�vµ
Issued by: Date C
sou�icE REGuyAnON�
.
Re-roofs
Type of Roof
--CI,I.,n„a 314 16
il-
Signmrmof AppliandC nsactor DD he
HAZARDOUS MATERIALS MATERIALS DISCLOSURE
Will the applicant or future building acupantsam orhandlc hvardom material
u dented by the Cupertino Municipal Code. Chapter 9.13, and the Hcalth soul Safety
Sudan 355334)7
All roofs shall be inspected to any roofing material being installed.
❑Yes ®No
prior
If a roof IS installed without first obtaining an inspection, I agree t0 remove
Will the applicant or future building occupant use equipment or deAces which
emit In.dnn it cmuminers as deRncd by the Bay Area Air Quality Management
all new materials for inspection.
District? -
❑Yes [0(t
1 have mad be, bvudnn mamruh mquimmens under Chaptes6.95a(the Califon.
ria Heslth& SafmyCode.Sarims35S05,25513 lool a. l unJrnmnd Jul ifthe holding
B
does nqt curteMy hme a ascot.# It h my responsibility m roufy the acupmt M the
requi he")mtswhk� h lenxreaVormesataaaonCest,;cm,of r
SignatureofApplcant - Dat
3 a
- All roof coverings to be Class "B" or better
TT-dtSgN
' Owner or authorized agent Date'
2 ITEMS OF 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37504018.00
DATE ISSUED.......: 03/04/2008
RECEIPT #.........: BS000004080
REFERENCE ID # ...: 08030016
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
585.80
---------------
585.80
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN -PROGRESS
605 FINAL REROOF
•
SITE ADDRESS .....:
10366 MILLER AVE
SUBDIVISION .....
CITY .............:
CUPERTINO
IMPACT AREA .......
O SQ- &4_ j ' R y Q
OWNER ............:
AKOPNYT"OKSAIVA'
ADDRESS ..........:
10366 MILLER AVE
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-3426
RECEIVED FROM ....:
MAGDALENA CORP
CONTRACTOR .......:
LIC # *OWNER*
COMPANY ..........:
OKOPNYI OKSANA
ADDRESS ..........:
10366 MILLER AVE
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-3426
TELEPHONE ........:
FEE ID
UNIT QUANTITY
AMOUNT PD -TO -DT.
THIS REC
NEW BAL
----------
1BSEISMICR
-----------------------
VALUATION 8,000.00
---------- ----------
0.80 0.00
----------
0.80
----------
0.00
1REROOFRES
SQ FEET 45.00
585.00 0.00
585.00
0.00
TOTAL PERMIT
---------- ----------
585.80 0.00
----------
585.80
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
585.80
---------------
585.80
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN -PROGRESS
605 FINAL REROOF
•
OUPEPTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
otos, ool �-
APN #/� -75� �O
J
Date:
3-4-08
Building Address:
i 0366 LA tLl-r [Z "F- -%
C -L4 P r=PT \v L0 i Cq 9 5014
Owner's Name:
Phone #:
0SCr.g2
L4 -o8 50-7-9815
Contractor:
Phone #:
Fax #:
Cupertino Business License #:
Contractor License #:
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
a Asphalt Shingles
-. Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ .Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
X To be Removed
❑ Provide Mfgr. Installation Specs.
Job Description: (=-)c�S' 141 ROOFING LUL1..1_ BEtRGKOVEp,ec�tP N�
ROOFING wll_L_ %r-_ \ti1sjP.Ll_�D . poo�lhyG �J�LL tt�C1.t 1D� -LGY� �AL`3
guct{ A5 ifsPliA�T stllriGl ts,Ait�z "C(Pis"A ex -s MA i+L Or.l Yy C:�x
PL�{IJP. �iJl{F�ZE S1 k�.TuJG \s �aNGL� tJ/ (Od 'NhtLS @i (o"LD6� tl 124.
Residential
Commercial
Fire Zone: Yes ❑ No L
Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: Do 0 _
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
• _.IC,A,A _..j
Signature
OCUPE'RJINO
CITY OF CUPERTINO
REROOF
FEESCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1RER00FC0M
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
44-• Cel Ly
1REROOFRES
Re -roof Residential
B
1SFDWLR00F
1BSEISMICRE
Seismic Residential
B
1RER00FMRES
Re -roof Multi -Family
B
1MFDWLROOF
IBSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
0
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.
Homeowner's Name: 055 iN.M -T. TALC b
job Site Address: 1036 M11_i
Roofing Company Name:,
Applicant's Signature:
Greg Casteel
Building Official
Revised 11/2/04
Date: 7 W
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
The 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.
I declare under penalty of perjury that the above is true and correct.
Owner -Builder Information (reve se side).
Property Owner's Signature:
Job Address: /03 tote ly lle,ue, t �/I/�Niro 9�Oiq
Type of work to be
I have read and understand the
Date: -JAFA?
Permit #
Any changes to the information Qrovided on this form shall be submitted to the City of Cupertino Build
Department.
741TYP
City of Cupertino Building Departmeo 10300 Torre Avenue
C U P E IST I N O Phone: (408) 777-3228
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 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 compensatione
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, O
City of Cupertino
Printed on Recycled Paper
I
U
Commllei%Devele�lx�aE
l:.Y[sCPtliiO CA YSU l4
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
t036(o M)L.4bp, C uPe� 0
PERMIT #
0&-0300/&
OWNER'S NAME: 05GA R TA o
PHONE #(_Y09)-720 -to Za
GENERAL CONTRACTOR: 0W M u t (,V!?
FAX # og - !o
•
I am not using any subcontractors:$ 3 a 8
Signature Date
Please rherk annlicable subcontractors and complete the following information:
Owner Contractor Signature
3 oe
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 Contractor Signature
3 oe
Date