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03070182 (2) CITY,OF CUPERTINO nw>r �txwn `' ,�r BUILDING DIVISION PERMIT 6ONTRACTOR INFORMATION.,:. - 13UILDINGADDRESS: LOS GATOS ROOFING PER"" 03070182 OWNER'S NAME:- 1771 SMITH AVE. PERMIT ISSUE DATE NE: SANITARY 0. (408) 298-9399 CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH y0Z, LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am hesitated under pmvixions of Content, p r 9(commencing wflh Section 7M(o of Division 3 o(Mc Beinus and Professions Codc,and my license is Zln in full forte and�_3 of cel. iqz Lima.Class � Lir.«�(Z(I�7D'J REMOVE EXISTING SHAKE, INSTALL 30 LB FELT Dart ARCHITECTS DEC coa �F{jQl� raj. j�j RK TL SHINGLES BY CERTAINTEED ECLAR I N v,?w 'y' �y aQ l understand my planssha11 M used u public..ads o 7y 3u� Licensed Por(cuinnal ZU�3 Can OWNER-BUILDER DECLARATION JUL 2 0 i I hereby aRrm Nat I em exempt from the Conuaclors License Law for the 00 following reason.(Section 9031.5,Business and Pmfesiou Code:Any city or county $ which requires a permit m ennsouct,ella,,impnwc,demolish,or repair any smucml4• brei prior m in issuance.also requires The applicant for such pemniuo flea signed nadmcnl; -IJBWq. s that he is licensed pursuant Inthe provisions of Ne ConmOur's License Law(Chapter 9 Ft. Floor Area Valua �Fo (commencing with Section 70M]of Division 3 of the Business and Fortuitous td(]fl Code)at 800 $ NN M is exempt therefrom and do buss for IM alleged esemption.Any viobtion or SeNon]NLS by any epplicam for a permit subjects Ne applicant o a civil Penalty of 3�•p�I I�T�er00 Occupancy Type notmort Nan raw hundred doll..(SSW). 0 I,as owner of the property,m my employee,with wage u their sole compensation, Will do the work,and The atm rurmre is not intended or offered for sale(Sm.7004,Business Required Inspections sod Proletarians Code:The Connar,Littnm law does and apply to an owner of - q p progeny who builds or improves Therenn,and who does such work himselfor through his 3055 — FRAME Own employees,provided tat men improvements are not intended oroRered for ale.If, 307 — INSULATION however,Ne building or improvement is sold within one year of completion,the owner. t builder will haw the burden of proving that he did not Mild or improve for purpose of 601 - ROOF TEAR OFF sale.). 01,as owner of the property,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL construct the project(see.7044,Business and professions Code:)The Convactur•s U. 603 — ROOF BATTENS. to.Law doe not apply to sa owner of progeny who Mild,or improves thereon,and 604 - ROOF IN-PROGRESS who contracts for such pmjeeu with a conlnrlor(m)licensed purauanno IM Contractors Limps,Law. 0 1 am exempt under Sec. ,B k P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby aRrm under Nulty of perjury one of Ne following declarations: have and will maintain a Cenificare of Consent o selbinsum for Worker's Compere on,a pfor by section 3]W of the labor Cnde,for the performance of the - M for whichhich this permit is issued. 0 1 hoe and will maintain Worker's Compensation lnsunntt,as required by section 37M or Ne Lahr Code.for Me perfolmmce of the work for which this permit is issued. My Worker's Cnm noti/o—n In,unntt am rand Policy numMnre,;,, �` Trier;S<,eo /—etNlSa Policy No.:2 Z7�Lf7 d_,? CERTIFICATE OF UEMMON FROM WORKERS' COMPENSATION INSURANCE ..lis sectimaIced not Mcampleard R the permit is fm one hundred dnllan(SIM) nr lcuJ 1 certify that in the performmce of the work for which this permit is Issued.I shall not employ any person in any manner so as in become subject to The Workeol Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should Weems Subject to the Worker',Compensation provisions of the labor Code,you must .,O forthwith comply with such provisions nn this perm itshall x deemed rtmked. 'z r CONSTRUCTION LENDING AGENCY (~ k(or by which that Nowise Cnn(See.3 97.Ging .) for The perfurmanli of C' 7 Ne work(or which this permit 6 issued(Sec.3097.Civ,C.) W0. z Lender's Name = z Lender's Address U 0 1 ccnify that l have read this application and sum that the trove information is Ly P correct.I agree to comply with all city and County ordinances and sum laws relating 10 0U building cmmwction,and hereby adhofim repreumatiwe of this City To enter upon the �a above-mentioned property for inspection purpose,. (We)ague m save,indemnify and keep harmless the City of Cupertino against I,) liabilities,judgments,costs and expenses which may in any way terms against said City U,'ZZ, in consequence of the granting of This permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SSD RECO TIONS. 9 'V Re-roofs Signature O(ApplichaViCoomicaor Dale HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant same or handle hazardous tumoral u defined by the Cupertino nicrpal Code,Chapin 9.12,and The tical to and Safely Code,Section25532(a)7All roofs shall be inspected prior to any roofing material being installed. 0 Ye, u Will the 11"licam or future buildingoccupam use equipment or deviaa which If a roof is installed without first obtaining an inspection,I agree to remove I ho,ardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. riu7 [I Yes >No I have reu1 the hmnrdress 25505,5533 and merm under ChaPmr6 an of dm Wilding nim HcaWg:Safcty Co lwndue .4tili,25533and25534.1undcu4nd thuifthc IOrO - 7"-Z Jots not curunll rad a tenant,Nat II Is my rtsfw,ulbility 10 notify IM cupant of Nc � � ^ �� rem cmL w 51 be m 110!Itt iiill •cem ficaN of Occupancy. C 7-L3�03 Signature of Applicant Date Owner ser emhorivcd age.. gam All roof coverings to be Class "B"or better 030 'A o/ SZ t�(! - CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN # 359 - /3 -() 3S 7 Date: - ' 2-3 u3 Building Address: 222-0 C/_ellan Owner's Name: Phone#: qO5 255- 9'y 6 0 Contractor: / Phone#: License#: �DS at.roS �. X08 meq$- y WO 70 Contact: Phone#: Cupertino Business License#: 1r2a a ori y08 23� 8 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles �( Asphalt Shingles Wood Shakes /❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) �L Other(Specify) Number of existing covering— El Provide I.C.B.O.Report# U To be Removed 1K Provide Mfgr.Installation Specs. S I Have Read, Understand and Will Com1 With Cu ertino's Tear Off Policy: • Job De;cript'on: 3G Residential Comme ial ❑ Fire Zone: Yes ❑ No Confirmed with Planning D,_ept. if there are an restrictions: u Cost of Pro' t Type o Construction: Occupancy grow : , Qty. if A licable 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 • BaildinsDlvisioa ! 10300 Torre Avenue • Cupertino,CA 95014-3255 Telephone: (408)777-3228 F= (408)777-3333 �. CUPERTINO Building Department - RERO F. 'TEAR ®FF POLICY revleed 6/75/01 1. You must schedule an inspection for the tear off the day before the date you wish the inspection to be made.The procedure is to call the Building Division (777-3228)between the hours of 8:OOam and 4:00 pm.for next day inspection. 2. .When the roof is torn off,the nails removed or driven in,and all of the dry- rotted wood has been replaced,then you gust call the City Building Division. An inspector will be there within one hour.There are special hours for this • service:between 8:00 a.m.and 11:00 a-m.and between 1:00 and 3:00 pML 3. If you call for the tear-off inspection and the job is not ready there will be a re-inspection fee of$100.00 charged,which must be paid before another inspection is made. Joe Antonucci (Chief Building Official) Building Division 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: (408)777-3228 CI 0 Fax: (408)777-3333 CUPERTINO Building Department Subject: Reroofing policy for the City of Cupertino. 1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards and manufactures specifications on reroofing. 2. New roof coverings shall not be applied without first obtaining all inspection 'arid written approval from the building inspector.A final inspection and approval shall be obtained from the building inspector when the reroofing 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) Preinspection and/or tear off approval 2) In progress inspection approval. 3) Final inspection approval a) Spark arrester installation. S. 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 that the proper City inspection can be performed. IMPORTANT: 1. Flat roofs must have a minimum of V"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 of inspection We understand the above policy on reroofing and will comply with this policy. Homeowners Name: Address: I;eroofngCompany Name: ze,<S Applicants Signature: Date: Q Joe Antonucci (Chief Building Official) 6/25/01 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • PERMIT INVOICE OPERATOR: christya Sec : Twp : Rng: Sub: Blk: Lot : APN . . . . . . . . : 35713033 . 00 INVOICE DATE. . . . . . : 07/23/2003 REFERENCE ID # . . . : 03070182 SITE ADDRESS . . . . . : 22201 MC CLELLAN RD SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BOGDANOVICH NICK AND SUSAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4062 CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481 COMPANY . . . . . . . . . . : LOS GATOS ROOFING ADDRESS . . . . . . . . . . : 1771 SMITH AVE . CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 298-9399 FEE DESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE ------------------------ ------------ --- ---------- ---------- ---------- PERMIT FEES 4116 P 157 . 00 0 . 00 157 . 00 SMIC FEE RES 2013 P 1 . 00 0 . 00 1 . 00 ------------ ------------ ------------ 158 . 00 0 . 00 158 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS •