05080145 CITY OF CUPERTINO x -_ cw < `" ' '✓ ^�"� •r
BUILDING DIVISION PERMIT CONTRACTnRANFORMATION ,„
BUILDING ADDRESS: VIOLA LEE PERMIT No.05080145
623 OPAMM? RT.QRRQM DR
OWNER'S NAME: PERMITISSUEDATE
VIOLA LEE 08/17/2005
NE: SANITARY NO. CONTROL NO.
ARCHITEC rENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
uoo LICENSED CONTRACTOR'S DECLARATION
I hereby of ton mal I.m licensed under provisions of chapter 9(commencing Job Description
with Section 7003)of Division 3 of the Business and Professions Cade..M my Beam Is
��= m ten fame and effect REROOF-REMOVE WOOD SHAKE./INSTALL COM.
License Class Lic.0
Date Contractor SHINGLES Ica A
ARCHITECTS DECLARATION \('t
a U 1 undcrYanJ my plans shall the used as public rtenrds `;'? IF'�t,.ad�n
B G t< Licensed Pm(cummit ti A"
N...1 OWNER-BUILDER DECLARATION
Z I hereby M.that I am exempt from the,Cma acmSip
es License Law for the 1 /S__1005
00 following reason.(Secuon 7031.5.Business and Professions Cock:Any city or county
<m 11` which rtyuiree a Permit to construct eller,improve,dcmnlish,or repair any structure A p C
prior to its issuance.also requires the applicant for such Permit to Ole a signed statement
Ezp that Wislicensed pursuant tothe provisions ofthContractor's UeenscLaw(Chapter 9 Sq.Ft. Floor Area
el- (commencing with Section 7")of Division 3 of the Business and Professions `15300
Code)or fy� , 1• �j' til?
y d$ that W is comps th oxfmm and tbo basis for the alleged exemption.Any violation of �T:3' ,�Vit_"Z,
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Oeeu ane Type
not mom man five hundred dollars($50n. 36611079 . 00
P Y YP
p I,m owns of tW property,or my employees wish wagee u theta wie compenauon,
will da the work,and the swan¢is not intended m offered f...le(Sec.7044,Business
and Profeedimo Code:The Contemn',License Law does not appy m an owner of Required Inspections
property who builds orimproves memon,and who docs such work himself or through his
awn employees.provided that such improvements an,oat inteoded aoRered forale.If.
however,the building or improvement is sold within one year of completion,the owner.
builder will have the Wrden of proving mat M did not Wild or impmw for purpou of
alc.j.
p h as owner of the property,am exclusively contracting with licensed emmiseters m
consort the pmject(Sec.7044.Business and Professions Cod,:)The Conu¢wr's Li.
eerie law docs not apply to an owner of property who Wilds or improves hereon.and
contracts for sus projects with a conuK
acmA m me licensed pursuant Contruh
te
L'coca law.
I vmeaemptu c. ,D.Bk PCf rdo
on -
.... Owner e
WORK
COMPENSATION DECLARATION
T hereby affirm under peeelty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to selbiuom for Worker's ConcKn.
cation,as provided for by Section 3700 of the LeW1 Code,for the performance of the -
work for which this permit is issued.
C1 I have and will maintain Worker's Compensation Insurance,an myuired by Section
37W ofthe labor Code,for the performance of the work for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number are
Cartier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sen ism needrent vcompiced if the permit is fnrone hundredd R.IS Hall
or less.)
I certify thus in me perfn a of me work forhich oris permit is issued.I shall not
employ an)'Person in any mann n W w bjen to the Workers'Compemauon
Laws of Calihoori.,Date
Applicant
NOTICE TO APPLICA er making this Cenificate of Exemption,you should
Wceme subject in the Worker'Compensation provisiau of the tabor Code.you most
.J O foMwich comply with such Provisions or this Permit shell bo deemed revoked,
Z� CONSTRUCTION LENDING AGENCY
[—� I hereby arm that there iso consuvclon lending.geney for tW perfurmince of
fY Ne work for which this permit is issued(Sec.3097,Civ.C.)
C. Q Iandces Name
0 z Lender's Address ,
U 0 1 ccnify that 1 have reed this application and start,that the knout infom edun in
lyr PcovocL I agme to comply with all city and county ordinances and slate laws relating to
OU building construction,and hereby aumorire representatives of this city to enter upon me
above-mentioned property for inspection purpowhich ms.
F 1 (Wt,)agrne m ave,#cmnify and keep harmless the City of Cupertino against
h incoisietjudgments,costsandofpenscs which they in any way carne again said City
U z in consequence of me Barring of this Permit.
'—t APPLICANT UNDER$$T5iNN D ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIO'tQS.�I
Re-roofs
Signature of Applicant/Contraeor f1bute
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle brcanious notional
as defined by the Cupenino Municipal Code.Chapter 9.12.and the Heabh and Safety
Ini.Health&S"'
de,Section 35532(a)7 All roofs shall be inspected prior to an roofing material being pct,, No P P Y g g installed.
-If a roof is installed without first obtaining an inspection,I agree to remove
Will the apPlicam or future Wilding acupam tau equipment or devices which g Pe
it haiardous at conuminanu/�s defined by the Bay Area Air Quality Management all new materials for inspection.
❑Yes �Nu
I have the herandoue matunals requirements under Chapter 6.95 of the Califon,
yCode,Secu=u %5,25533and25534.1umkrsundNuifdcWilding
es not currently a e ant m it u my responsibility m notary ds,occupant of the
uirements which' t met r to issuance of.Certificate of P. Signature of Applicant Date
t b rj
owner oraomonr dkgcnt ,te All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
{ '�` Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
*UPEkTINO ,
Building De artment
JOB ADDRESS:
(.')3 L b 6 . dlA e j-at a 64PERMIT
OWNER'S N VL-61L k-r--Z: PHONE #
GENERAL CONTRACTOR: bLzmt4 tL6upFAX #
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
I o.l
Owner/Contractor Signature Date
Community Development Department
Building Division
j ` City of Cupertino
tt � 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
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: l h LN U--
Job Site Address: 3 10a x o S _
Roofing Company Nam : L"--,=nom, f���aE� Y
Applicant's Signature: ! e Date: Pl 7/
Greg Casteel
Building Official
Revised 11/2/04
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
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.
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 (r verse side).
Property Owner's Signature: Date: 7
Job Address: 7�� BS�ki ��� (b l�tltfuT Permit#
Any changes to the information provided on this form shall b submitted to the City of Cupertino Build
Department.
1 4
City of Cupertino Building Department
CITY Of 10300 Torre Avenue
CU PEf�TINO Phone: (408)777-3
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 vourself 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 compensation•
contributions.
There may be financial risks for you if you do not cavy 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. CUPERTINO
tCd REROOF
OF
IRCUPERTINO PERMIT APPLICATION FORM
APN # Date:
11 b-S
Building Address: Eh �
�¢k�hp QA IS T
Owner's Name: Phone#:
�g X53 - 838
Contractor: Q - . License#:
1,In 1 Q�
Contact: oz Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑I Wood Shingles ❑ Wood Shingles
❑ Other(Specify) p 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 Polic ❑
Job Description:
Q uqo (A)n4a C�t� t J 1
come—
Residential Qj Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Projec : Type of Construction: Occupancy group:
536� •�
Qty. if
A licable Fee ID Fee Description Fee Group
i 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