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06120098DIVISION' PERMIT Ave FERhdrf ISSUE DATE _ 1-2-119 / 0C-0 CONTROL NO. ARCHMICrfENGINEEA: f� I �I I BLDG n E� vett �HUMBu MECH �u o LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm Nal I am licensed amid, Provinces or Chapter 9 (commencing Job Description p wish Section 7M0j of Division 3.(01 Bonn. and Professions Code.and my license is in run tore ane er a ' ���3 eau � e�/� � f -I �/1°I l�� ` 111 1U Damn. ARCHITECTSrDECLARATI ' 1 undcnunJ my plans shall he used as public rtes, a��+��� I 1 F b W/ d Q1A\0 C ✓ V 1 b �� _, �� Vs/ VV 1 V ' r Licensed Professional OWNER -BUILDER DECLARATION,1p., 1 hc¢hy aTrtn Nm I am exempt from the Contnnah LicenseLaw for she v a 't following reason. (Section 7031.5, Business and Pmfessium Code: Any city of county which requiem is permit to consumer, alcor. improve, demolish, or .pair any structure prior m its issuance, ass requires the applicant for such permit to rile a signed summent Nu he is fimead pursuant tote provisions or td. Coevacmn Liccnx Law (chapter 9 Sq. Ft. Floor Area Valuation (commencing with Section 7000) of Division 3 of dx Barrios and Professm. Code) or for Any Nat he is exempt therefrom and the basis the, alleged exemption. violation of Section 7031.5 by any, appli., fora permit subjects the ii,licmuo is civil penalty of AP Number Occupancy p y Type not... tun firs hundred dollars (5500), ❑ 1, u owrmr of the pmp ay, m my employcu with wages u Noir mle crmpemauon, Required Inspections will di work, and the structure is not In@nded W offered for said (Sec. 7044, Business and Pm(essiars code: The contractors License Law does ant apply to an owner of ,.,.y who builds or improves Neon. ane who dacesuc h work himself o, through his own employees, provided Nal such improvements are not intended or offered forsale. If. however. Ne building or improvement is sold within on, year orcrmpletion. Ne owner - builder will have the burden of proving that he did not build or improve far Intrinsic of - 0 z z 0 1. as owner, of the property. am exclusively convecting with licensed mnuacuus to swct the project (Sec. 7064. Business and Professions Cade) Th ConuactNs U. ac Law dors not apply he an owner of property who builds or improves thereon, and o contracts for such pmjec s with a eanlraceii licensed p ,avant to the, Contractor's Live Law. ED I am exempt node Sed B & P C far this. wn Owner Data WORKER'S COMPENSA71014 DECLARATION 1 hereby affine uMer penally of perjury on, of she following dmluauov: 1 have and will maintain a Certificate of Covent to self-imu. for Worker's Comped. .tion, as provided fm by Section 3700 of the labor Code, for the performance of Ne work for which this permit is issued. [_�}��a�c/d will maintain Worker's Compensation Insurance, as required by Section Tf00 oINC labor Code, for Ne peRomunce of the work for which Nu permit Is issued. Myworkce scope uom4uurarmcarri and Policynumberare: Cartier. Policy No.: f= CERnFTCATEOFEXE Pf10NFROM ERS' COMPENSATION INSURANCE (Ths section need not be completed dNe permit is Worse hundred dollars (SIM) or Ices.) I mrufy Out in she performance of Ne work for which this permit is issued, I shall not employ any person in any manner sin as to become Saa*CLto the Workma Compensation Laws of califamia. Date Applicant NOTICE TO APPLICAW. IL after making this Certificate of Exemption, you should became subject to the Worker's Compensation previsions of Nc Labor Code. you must forthwith comply with such provision or Nu permit shall be rimmed rmvked. CONSTRUCTION LENDING AGENCY I herehy off rm Nat Nem is a comuuctinn lending agency for the performance of the work for which this permit is issued (Sec 3097, Civ, C.1 Address I curafy Nat I have mad this application and state Na the above information is I agree m comply with all city and county oslinamxs and sure laws relating to g conrwnion. and hereby aurheme represenutiws of Nis city to enter upon me it nrucmed pmpcny fur inspection purposes. (We) agree to saw, indemnify and keep harmless the City of Cupertino against v, judgmenas, toss and expense which may in any way accrue aga m, id City v HAZARDOUS MATERIALS DISCLOSURE will Ne applicant or future building receptors atom or haMlc hvardov material donned by the Cupertino Municipal Code. Chapter 9. 12. and the Health and Safety de, Section 25532(a)? ❑Yet ON. FWill the applicant or future building occupant use equipment or devices which until ho ecus air contaminants as defined by the Bay Area Air Quality Management Disuict? ❑Yd. ON. 1 have mad the husNnus materials nequlremens under Chapter6.95 of dm Califar nu Hcuith&Safety Codc,Smd.nM5.25533.d25S36.lundcruandN ifdm building drew nolcummilly havey.nan. Nat it u sxApeandulyy, tpnmry td. occupont or Nc Issued by: Re -roofs Type of Roof Date All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ,'�. /�%" icy'" / r Signature oFxpplicant Date All roof coverings to be Class "B" or better Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS:t ' PERMIT�2cr-9g OWNER'S NAME: %PHONE # GENERAL CONTRACTOR: C FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and com Tete the following information: Signature 2 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 Signature 2 Date ,� K_ • COYOF CUPEfi,TINO E 0 CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN # -3—Ir 11 J 05B Bldg Permit Fees Date: BENERGY Energy BUILDING Build'ndress: Seismic Fee Res BUILDING BSEISMICOM N BUILDING Owner's Name: Beck-) p) t►-� Plan Check Fee Phone #: 3 � - 3000 BUSLIC Business License . Contractor: License #: C 1 73 (5-3 Contact: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles B --Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles I ❑ Other (Specify)'j jr E ❑ Other (Specify) Number of existing coverings] ❑ Provide I.C.B.O. Report # M/- o be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: EI N L,v _ . _.. E esidential ©/ Commercial ❑ Fire Zone: Yes ❑ No ®-' Confirmed with Planning Dept. if there are any restrictions: ❑ Cost of roject:T e of C nstruction: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Groan 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 M • 2 ITEMS OF 2 • CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37511058:00 DATE ISSUED.......: 12/19/2006 RECEIPT #........1: BS000000024 REFERENCE ID # ...: 06120098 SITE ADDRESS .....: 10081 STERN AVE. SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: BECKY SKOKAN ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: amyw COPY # : 1 RECEIVED FROM ....: RECEIPT INTERFACE CONTRACTOR .......: MIGUEL CASTILLO LIC # 24741 COMPANY ..........: M C ROOFING ADDRESS ..........: 14800 MCVAY AVE . CITY/STATE/ZIP ...: SAN JOSE, CA 95127 TELEPHONE ........: (408)729-3436 • FEE ID - UNIT QUANTITY - --------- AMOUNT PD -TO -DT THIS REC NEW BAL --------- BPERMFEE VALUATION 5,800.00 ---------- -- 126.36 -- 0.00 ---------- 126.36 ---------- 0.00 BSEISMICRE VALUATION 5,800.00 0.60 0.00 0.60 0.00 TOTAL PERMIT ---------- --------- 126.96 0.00 ---------- 126.96 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 126.96 --------------- 126.96 REFERENCE NUMBER -------------------- VISA 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) h1 -progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. i/ 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: MR"V i L/ t.1 Job Site Address: 262OE 7 , 51�f Y -I J A`7 Roofing Company Name: �-� C _ 9_C9(1 -rt ti f, Applicant's Signature: i % Date: 2az � V/.--) 6 — • Greg Casteel Building Official Revised 11/2/04