05070093 CITY OF CUPERTINO ?a ,a ,BUILDING DIVISION PERMIT �CONT' Q—TOR INFORMATIlb
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BUILDINGnDDRESS: WATER HEATERS ONLY 1ER1ITNOO5070093
OWNER'S NAME: PERMIT ISSUE DATE
ALEX STIN 97n F. MATIST
g; SANITARY NO. CONTROL NO,
OO
ARCH=7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
30 j LICENSED CONTRACTOR'S DECLARATION Job Descri
y11 rte eby affirm that I am licensed under previsions of Chapter 9(communing
with Sndan 7010)of Division 3af u$1 Pref rectum. myliceucks
^ in full face rotb 1.
omem�,s WATER HEATER /f
all _T ARCHI727SDECLAR TION 'J 2005
Q I understood nd my plan shall used u public mcnrd
Is xx..
iI x Lkeuederchyoff. BUILDING
033 OWNER-BUILDER DECLARATION
0 2 I heresy.(ince on I am exempt from the Contactors Licence Law for the
;02 whichfollowingrx mason.Permit
i H)313,Business and a Profession Code:My city or county
$�i which its ism a pemu re wutro a .lux,improve•h pcmith.or repair any awmum
met leprior,uientedpdmn in ft lrovisi applicant Contractor's
o flicUccr c,Lawdsukmcnl
< (comma liceucdpurnimmthepmvivouaftheConusiness ceufLaonsCooter9 Sq.Ft.Floor Area Valuation
that he
ingwith grnion)Dnd the
bs3 oft he Business arMon.My vi Catlel of
Inst he ue exempt themfran and dte bub for the alleged exemption.My violation of
section 7031.5 by any.pplieant for.Permit shAjeete the.pplicant We CIV)penalty of 3 O&)c ItutTbefO 0 Occupancy Type
not mom Nan Ow hundred dollars($5W).
I,a owner of Ute proptrtY.m mY tmployen with wgea u Uro sok eompenadou,
will do the work.and the structure 1.nalnumded orofferad for uk(Sec.1061.Business Required Inspections
and Profession.Code:The Contractors Llceun e Law donot apply toe ns an Owner of q P
propeny w ho builds er imprews deeaom,and who don such work himself or through his
own employees,provided that such Imp nmemenu sm not intended orartered formic.if,
however,0e building or Improwment is sold within one yev ofmmpletion.the owner-
builder will new the border of proving dust he did not build or improv for purpose of
sal.j.
❑1,as wmee of at property,am esclu8wly conurcring with littmed conu ears to
construct the project(Sec.7W,Business and Profnuons Code:)The Courtesies Li.
cense Law does not apply in an owner of property who builds or improm thereon,and
who comnms for such pmjecu with.conuacmr(s)licensed pursuant to the Contractors
License Law.
0 I am exempt On&,See .B&P C for this anon
Owner Date
WORKERS COMPENSATION DECLARATION
1 thereby affirm under penalty of perjury one of de following dalaradau:
Nw.nd will.,deal.a Certificate of Consent to self-imam fa WoetwesCOmpe.-
mtion,u provided for by Section 3100 of the Labor Code,for the performance of the
work for which this permit is lssned.
1 haw and will maintain Worker'Compensation Insurance,is required by Section
3100 of the Libor Code.for de,performance of the work for which Nb poem,b Tamed.
My Work C. p said Insurance esnicr antl Poliry number am:
Grtier. POIkYNa.:O-S 1-4503-0 1-S
RTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Dussocllw need not M completed if Ute permit Is feconchundred dollaa(Skil)
or lese)
I certify Net in the performance of the work for which this permit is issued.I shall not
employ any person In my manner so as in become subject to the Workers'Compensation
Laws of Calif.r.m.Dar
ApPliesnt
NOTICE TO APPLICANT;If,after making this Cerium of Exemption.you should
become subject m the Worker's Compensation pmvbions of Ur Labor Cale,you most
.,O forthwith comply with such provisions or this permit shall he dnmcd n mkcd.
z CONSTRUCTION LENDING AGENCY
f'v ti IMreby affirm the them b•concoction lending agcmy for the Performance of
pi? dee woM1 for which this permit Is Issued(Sou.3091,Civ.C.)
W Landers Name
z Land e.Addrem
U O 1 certify Nu 1 haw read true application and sur that the.bow information b
IX. comem I agree in comply with all city and county ordinances and sate Isco mating m
0 building construction,and hereby anthorice mpresenullm of this city to enter upon tic
W above-mentioned prepeny fa inspection p opoms.
P. (We)agree to mw,indemnify and keep harmless the City of Cupertino against
res Iiabilidn,judgmenu. osuandexpenresw 'h may in any way ancrue against said City
In consequence of, ranting o n
APPLICA RSTA D L ON-POINT Issued by: Date
SOURCE
/( Re-roofs
Signeu c ofApplicenUConuacmr Dae
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will use applicant a future building occupant sac or handle harerdous material
u de0ncd by the Cupertino Municipal Code.Chepmr 9.12.and the Health and Safety
Code,Scctian 2553747 All roofs shall be inspected prior to an roofing material beim Installed.
❑Yes Q� P P Y g g
Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining anlinspection,I agree to remove
haardoa air contaminants u defined by the Bay Am.Air Quality Management all new materials for inspection.
uice7
❑Yes aflw�
I haw read the haardmu materials requiromene under Chapter 6.95 of the Califor-
nia Health&SaretyCak.Seeliau 25505.25533 and!25534.1 understand the ifthe building
does not cunen0y a tenant, t I rospomi ty m notify Ur aeupant of the
requimmenuw mute vanccat rdOcauofOccup Signature of Applicant Date
owner ar.athanred.gem Dom"�S All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
OCOF Fax(408)777-3333
`UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #050-) 009 ,3 SO70U93
OWNER'S NAME: PHONE # D
GENERAL CONTRACTOR: yFA�X#
I am not using any subcontractors:l.(. l'�u�ea�we
Signature 11 Date
Please check applicable subcontractors 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
Sheet Rock
Tile
• � n � /5 Q S
Owner/Contractor Si ature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
? CITY OF Telephone: (408)777-3228
UPEkTINO 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 " 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 abovestatedpolicy on re-roofing.
Homeowner's Name: Sit -n- n/Gv12 /O a_n G r&
Job Site Address: IO G 7.<'
1
Roofing Company Name•Ji t' . .
Applicant's Signature: Date: 7 /9—/OS
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
I• 2 of 2 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36611031.00
DATE ISSUED. . . . . . . : 07/15/2005
RECEIPT #. . . . . . . . . : 30392
REFERENCE ID # . . . : 05070093
SITE ADDRESS . . . . . : 7666 RAINBOW DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ALEX SUN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR. . . . . . . . : MCGEE, PAT LIC # 18986
COMPANY . . . . . . . . . . : WATER HEATERS ONLY
ADDRESS . . . . . . . . . . : 970 E. MAIN ST, SUITE 200
CITY/STATE/ZIP . . . : GRASS VALLEY, CA 95945
TELEPHONE . . . . . . . . : (800) 835-5946
ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
_____ _____________ __________ __________ __________ __________ __________
BENERGY PERMIT FEE 1.00 34.86 0.00 34.86 0.00
BPWHEATER PER HEATER 1.00 10.79 0.00 10.79 0.00
PPERMITFEE FLAT RATE 1.00 38.37 0.00 38.37 0.00
__________ __________ __________ ----------
TOTAL PERMIT 84.02 0.00 84.02 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ______________-___
OTHER 430.97 VISA
TOTAL RECEIPT 430.97
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -'------
502 FINAL FINAL PLUMBING ENERGY 506 GAS TEST
507 FINAL PLUMBING
•
CITY OF CUPERTINO
WATER HEATER
.CUPEkTINO PERMIT APPLICATION FORM OSb��493
APN# to J Date:
7 /s o-S
Building Address:
/Vl�
Owner's Name: Pho a14
#:
5vG -zz5c)
Contractor: Phone: — License#:
374S-7 -5
Contact: Phone: Cupertin Businne s License#:
Building Permit Info:
Bldg ❑ Elect ❑ Plumb Mech ❑
Job Desc ' tion:
So co
Residential Commercial ❑
Cost of Project:
7,5 o CTD
Strapped LJ On Platform El Bonded
New Location ❑ Replacement
Qty. if
Applicable Fee ID Fee Description Fee Group
BPWHEATER Water Heater/Vent BUILDING
PPERMrrFEE Plumbing Permit Issuance PLUMBING
BENERGY Energy BUILDING
BUSLIC Business License BUILDING