06090202 CITY OF CUPERTINO
BUILDING DIVISION PERMIT , CONTRACTOR INFORMATION
BUILDING ADDRESS: KATE MATKOVIC PERMITN0.06090202
923 S TANTAU AV
OWNER'S NAME: PERMIT ISSUE DATE
KATE MATKOVIC 09/21/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i 0 o LICENSED CONTRACTOR'S DECLARATION 106 Description
1 U5 1 hereby affirm Nal 1 am IiccvM under Provisions of Chapter 9(commencing P
i�aa s with Section 7")of Division 3o the Buvnecs and iom ProfcssCode,and my Re".in
.QC. nfulllanceaadef(ccs REROOF- TAKE OFF OLD ROOF AND REPLACE TORCH PAP
,,era= License Class Lic.N CLASS A. 24 SQUARES
c F o Data Contractor
ARCHrrECrS DECLARATION
i a i I understood my plans shall W used as public«cords
yU
Q�
. Licensed Professitnai
3 OWNER-BUILDER DECLARATION
I bereby affirm Nal 13M eacmPi from the CommitteesLicense Law rot the
p o following mason.(Section 7031.5.Business and Profcaio s Code:Any city or county
which requires a Permit re construct,.Iter,improve,marmlah,or repair my suudure
-iy prior to its issuance.abut requires tW applicant for such permit m file a signed summem
< me,he is licensed Fatalism to the provisions of the Contractor's Licemm Law((.Mprv9 Sq.Ft.Floor Area ValuatiQ16000
u�$ (commencing with Section 7000)of Division 3 or dm Business and Profesnions Code)or
that he ti exempt tMmfmm and dm baso for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjcen Oc appliCWL 10 a civil pwlty Of qpN Number Occupancy Type
Met m..arm five handled dollars(M). 3 7 5 38048 . 00
❑1,as owner of use property,or my employees with wages a5 their sole compensation,
will da the work.and Ne suu«um u not immMed or offered forsaic(Sec.7044,Bus.
and Profession Calc The Comdxrers License law does rot apply in an Owner of Required Inspections
property who Wilds«improtsu thuean.andwW the 00tchworkhimselr«tNoughh.
Own employes,provided prsuchimprowmenaare net ear ofc orafferes!mpledw.f«sale.r.
however,the building or improvement u cold within aro year or improve
for the owned
Wilder wit naw tiro b«den of proving dol he did not Wild or improve far puryssa of
ale.).
11'as owner of the prop5rty,am exclocanty contacting with licensed romuam.m
e pmjem(see.7044,Business and Rofasiartt Code:)The sahmmn.Lid
CO.[ease oLawme dot pal apply m an owner of praputy once sed p or improver Wertoq and, /
W hOcamaaCLi(art ueh pmfeCtl Wldl aCa1111Y1ar(S)llcemAd parYamlbllm Cantael0(3
Licema taw. /
C]12M oder Sec ,B&PCI thrs van
Ow C� Dam 9 "C'
/// WORKER'S COMPENSATION DECLARATION (!/J/
'�cmby a(Ron under Penalty of perjury mm of des following deelv.0ame O
I baa and will maintain a CuGftaa of Consent to set(imure f«Workers Compeo- /
salion,az provided for by Section 3700 of the Labor Code,for the pedormtmm of tie l0
work for which this permit is Issued.
❑1 haw and will maintain Workers Compensation Insurance,az required by Section
3700 of Ne label Code.for the pedo...of the work fa wbi,h Nu permit is issued.
My Workers Compensation Insurance prier and Policy number am:
Cartier. Pali,No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ihs scCO.need not W Completed time permit is(.,.a.bundmicinllaa(SIW)
or less.)
I certify Nat in the performs c M work f«which this Permit u issued.I shall am
employ any peram in any m, azob came abjan to the W«kers'Compensation
Laws of Califomla.Date.,.
APpli.., r
NOTICE TO APPUC :If.afar making this m C,alki of Eacmption,you should
become subject m tW Orkers Compensation provisions of the labor Code,you must
.J O forthwith comply with such provisions or this permit shall W deemed revoked.
Z Vy CONSTRUCTION LENDING AGENCY
't—m^ I hcmby affirm that thcrt is a c«uwctinn lending agency for the performance of
aithe walk fur which this permit is issued(Sec,3097,Civ.C.)
Lender's Name
CL
m'7 z Lenders Add.
U C 1 certify that 1 have read this application and sate that the above information is
(LF correct,1ago«to comply with all city and county ordinaectand sum laws relating to
O U Wilding Conswnion,and herby amh.nno rtpms mouns.f this City to Cmcrapon the
W Iwvcmcnduned property for inspection pugmses.
(Wc)a rte m save,indemnify and keep harmless the City of Cupertino against
mFi f�'A Iiabili0ca' g cns.cosu antl espcnsex which may in any way accrue against aid City
U Z in Coo
toe c f the panting of this permit.
^ APP NDERSTANDS AND WILL COMPLY WITH LL ON-POINT Issued by: Date �i 2,1,-/-
50 ULATIONS.
Re-roofs ------
tiro ianUConuana' Date
/ HAZARDOUS MATERIALSDISCLO URE Type of Roof
Will tha applicant m llmure building occupant smm«handle hava com material
az&I by dm Cupertino Municipal Code.Chapter 9.13,and ftHealth and Safety
Code.Seen..0y. XNu, All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or furore building occupant use equipment it Qu or devices which P g
' emit hvardnus air conuminanu u definctl by IW Bay Ara Air Quality Manag<mcnt all new mplls for inspection.
DisuiaToyes �t
I have mail the hamadeusuraterials requimrnew under Chapter 6.95 of dm Califon
nu Flea a(my Code.Suctions]5505.25533 and 25511.1 undersand and if&Wilding a
1 mly have a tenant,that id's my rosPomihility m noul'y the occupant of the /
ro t which must to met Par I. cu cy. Sign U 0 Applicant D e
nth mCctl.,Ca, aD,m All roof coverings to be Class"B"o better
Community Development Department
4 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.
Homeowners Name: 4 ��x/�Z n
Job Site Address: � �7 �L�/2/�/ ///✓ c
Roofing Company Name:
Applicant's Signature: Date: ;
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . 1 — : 37538048 . 00
DATE ISSUED. . . . . . . : 09/21/2006
RECEIPT # . . . . . . . . . 36136
REFERENCE ID # . . . 06090202
SITE ADDRESS . . . . . : 923 S TANTAU AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : KATE MATKOVIC
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : KATE MATKOVIC
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : KATE MATKOVIC
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- --- ------- ---------- - --------- ----------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ------- --- ------ ----
TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- --------- --- ------------------
CHECK 126 . 96 5676
TOTAL RECEIPT 126 . 9G
•
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—uorzed
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.
PersorV irm Address/City Phone,Number Type of work to be
performed
.............................................................................................................:.......................:...............................................
I declare under penalty of perjury that the above is true.and correct. I have read and understand the
Owner-Builder Information(reverse side).
Property Owner's Signature: �/ Date: 2 6
i
Job Address: Permit#
AU changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
•
n, Community Development
F' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
fUPERTINO
Building De artment
JOB ADDRESS: PERMIT #
OWNER'S NAME: PHONE # 9
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: 2/
Signature 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
•
Owner/Contractor Signature Date
Slu- CITY OF OF CUPERTINO
m- REROOF
CUPETINO PERMIT APPLICATION FORM
APN# Date:
IA 10.6
Building Address: P
Owner's Name: Koff wa*c0c Ph e#:
Contractor: License
Contact: Cupertino Business License #:
I/ G
Type of Roof Covering:
Existing: Proposed:
$ Built-Up Roof S- Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ 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 Policy:
Job e criptio _
ro Q�rtti� Q2 -
Residential 'Commercial
Fire Zone: Yes ❑ No [3] Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Pro' ct: Type of Construction: Occupancy grpup:
6; 000If
. _ s
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
•