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06080067 CITY OF CUPERTINO n a>sa ✓Y.�r.s .e 4 + "a% °'�`P"`�`°gin p �i BUILDING DfVIS10N PERMIT CC1 j1N' `PRMATr Na BUILDING AEPRESS: t SHELTON ROOFING PERMrr"x'06080067 11235 MT CREST EL OWNER'S NAME: PERMIT ISSUE DATE TAKEI TAKETSUGU 1988 LEGHO E: SANITARY NO, CONTROL NO. (650).961-7699 ARCHITECTYENGINEER: BUILDING PERMIT INFO BLDG EO PLUMB )ARCH LICENSED CONTRACTOR'S DECLARATION Job DBSCrIpL100 no I hemby affirm that I am licensed under provisions of Chapter 9(commencing stull(`rm anOdllle)fir0ividon7of deBuinetteM Rofcsd�sCode,and mylicemcr TEAR OFF HEAVY SHAKES AND BURW GRAVE ADD H/SHA Lremc cls L/3 Lie. Dam BURW GRAVEL CLASS A & B ARCH SDECLARATION 1 understand asylums shall he used as public sands Licensed Forfassionsil y� OWNER-BUILDER DECLARATION l ev OO I hereby.(Sero that 1 1. exempt from the Contractor's Co !Any c Lew for site p D fallowing roam¢(Saito 703 construct. Business and Pro(asinm Calc:Any city or minty 5$ which wquiru n permit m etmtrue4 alter.hnprow,h Perm N,fire pair MY ed wumuro .zy prior miu tensed pursuant re 10 the Ute applicant foe oeh Pemitmfhu ntudswomenl D That(commencing nwit pSesuao m the of Division of the a Business i and Prof law(Chapterodd)or Sq.Ft.Floor Area Vfllua al3g 3 (co he is exempt uraitn]000)of Divrim3 the theeeged exe andon.My vilation of .. Nu he r Bumps rany cep m and the bur far be ailogrd exemption.Any violation of Section]to.five airyappBantfw s(a Pewit subjects tee applicant to adullpenalty of APN Number Occupancy Type .at mom then five hundwd dollars(55007. 35626008 . 00 ❑I,u owner of Ne pmpwy fir my employca with wagu u their mleemnpensadon, will do the work•and thestrunwe is not bkadedafanerad fofssio(Sec.Triad,Business Required Inspections and Profeadau Code The Conuackra Lken Law does set apply in am owner of q P property who builds a imports demon,and who does such work himself or through his own employe¢,provided does inch Improvements am sad nemdal fir offered image.If. however,the building or improvement is sold within am year of completion.the owner. builds wN Tuve the burden of proving that M did ms bulb fir Improve far Portae of ale.). ❑1,as owcer of the property,em exclusively contracting with[lamed comrsomm to construct the project(Sec.TWO,Sam=ad Profadam Cade:)The Cuvume3 Li- came Law does tot apply to a owner of prapeny who builds or improves thereon.and. who contracts for such projects with acontmmor(a)licensed p rem nt to the Contractor's License law. ❑1 ane attempt under See .B d P C for this waste Owou Date WORKERS COMPENSATION DECLARATION I hereby&flim under penalty of Padua,can of de following declantiom: - 1 haveand will maintain a Certificate of Consent to emir lf- e far Workees Compen. Made,u provided for by Section 7700 of the labor Code.for dte performance of de work for which this permit is iumd. 1have and will maintain Worker's Compensation Imuran,u required by Section l of the Labor Cade,fur the'dormace of the cork for which Nr Permit r lumcl My Worker's Cornuffsauona ren rtier aart d Policy number : Cartier. S ' T L•—_ policy No,57JO 081- (Q$ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thr senlm need not be completed If Ne permit is form hundred dollen($100) or Ica.) 1 artily that in the performance of the work for which this Permit is Issued.I small not empuoy any person in ay menmrto as In become subject at du Workers'Cooper ado. Laws of California.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Eumption,ym should become subject to that Worker's Compensation provisions of Ne labor Code,you meet ,JZ forthwith comply with such provisions Or this permit Nail be domed newlet. z O CONSTRUCTION LENDING AGENCY [-s [hemby M.that dim r a construction lending agency for the Performance of C(,> site work(or which this permit Is intend(Sec.3097,Civ.C.) Qlarder's Name a z Lender's Addwsa U O I anify that I haw read this application and sate the site above information Is it, f"' torten,l agree to comply with all city and county ordinances and rote laws relating to OU building answnion,and herebyauthmive represenusiws of this city to enter upon the �+0. abort-mentioned Property for inspection purposes. (We)agra to saw.indemnify and kip harmless the City of Cupertino against tirn habilium judgments.coati and as which To N any way sora against said City Uz in conacqu ftht own' t Trois. t•^ APPLIC UNDE 5 D I ALL N N-POINT Issued by: Date SO ORS, y� "/ '�� Re-roofs Signature of AppfiunuConuaetor Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof %B the app[hcutor future building occupatstore or handle haardau material as defired by Ih Cupertino Municipal Code.Chapter 9.11 and thte Health and Safety Code,Section 15533(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes QS.- 41 Will the applicant or future building Occupant use equipment a devices which If a roof is installed without first obtaining an inspection,I agree to remove emit huafdou air ronuminanu u deftmed by the Bay Awa Air Quality Management all new materials for inspection. DishrinT I have road ise Maamxmr 5.2553 immcnts umMl Ghapkt A95 o(thte Wilding doesth&Safety Cede.Sneuou 35505,15571 and 335ld.luMmlythec unp Wilding Jona ms curwntlY h w e enanl then It is Y respominllllY m notil'Y�accupat of me requirements wit tau he n t trance of ru0ca of Occu j9 iSignature of Applicant Date Owner oratht see agent rr� PID�,k All roof coverings to be Class"B"or better CITY OF CUPERTINO •m 2 of 3 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35626008 . 00 DATE ISSUED. . . .. . . : 08/09/2006 RECEIPT # . . . . . . . . . : 35572 REFERENCE ID # . . . : 06080067 SITE ADDRESS . . . . . : 11235 MT CREST PL SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : TAKEI TAKETSUGU ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : BONITA JENKINS CONTRACTOR . . . . . . . : WRAY, RICHARD LIC # 20755 COMPANY . . . . . . . . . . : SHELTON ROOFING ADDRESS . . . . . . . . . . : 1988 LEGHORN ST, STE C CITY/STATE/ZIP . . . : MT VIEW, CA 94043 TELEPHONE . . . . . . . . : (650) 961-7699 *EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 20, 000 . 00 277 . 56 0 . 00 277 . 56 0 . 00 BSEISMICRE VALUATION 20, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00 - ---------- ---------- ---------- ---------- TOTAL PERMIT 279 . 56 0 . 00 279 . 56 0 . 00 • Community Development Department i 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 _ witch the abovestatedpolicy on re-roofing. Homeowner's Name: / L✓!L ,-_1�/1a�.�J Job Site Address: Roofing Company Name: ApplicanfsSignature: Date: 001910 d • Greg Casteel Building Official Revised 11/2/04 Community Development 10300 Torre Avenue aClF Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: 32 L PERMrr # OWNER'S NAME: PHONE # 255 —53 Fr D GENERAL CONTRACT% FAX# I am not using any subcontractors: 6 ature Date Please check applicable subcontractors and complete the following ' ormation: 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 "ZaLer/Contractor Signature Date CITY OF CUPERTINO (AaC6CO(Q� d" REROOF CUPERTINO . PERMIT APPLICATION FORM APN# ,� dC2 Date: 9 0 6 Building Address: //Z 3 S� UU4 PL Owner's Name / �/ p Phone#: Contractor: / a� License#: Z6 /o 4 / Contact: Cupertino Business License #: Type of Roof Covering: Existing: Pro )sed: Built-Up Roof Built-Up roof ❑ Asphalt Shingles Asphalt Shingles Wood Shakes Wood Shakes �❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing covering ❑ 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: Jo Description: Q T O i + N 2W o, P- adcf Residential �J4 Commercial ❑ t Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: j Type of Construction: Occupancy group: 1q, 33 6 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 •