05070131 (2) CITY OF CUPERTINO �€fir«.
BUILDING DIVISION PERNIIT WON 6111
BUILDING ADDRESS: PERMIT NO.0 5070131
10387 VISTA KNQT-T RT,VD
OWNER'S NAME: PERMIT ISSUE DATE
VUKADIN RADOMIR AND DORINA S 5
E: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PE!? MECH
0 0 0
40 LICENSED CONDUCTOR'S DECLARATION JbDescri tion
m� I hereby affirm Nat 1 am licensed under provinuou op
of Chapter 9(commencing
with Section 7")of Dividon 3 often Business seed Professions Cmc.aed my license Is
in full to=and effect. ROOF REPLACEMENT. 1/f AI MOMP. SHINGL
z seance eves sec.«
gig' Dam . Contractor
ARCHITECTS DECLARATION
if 1 understand my phos moll he used u public mcnrN o4
W LicensedProfeatonsl W- 005
2
O OWNER-BUILDER DECLARATION I�' L ser
i I hereby affirm that I am exempt Inner the Communes Licence Law for the
i a o following mean.(Smiles 703 1.3,Baines,and Professions Code:My city or county
$ which requires a permit to construct.mmn improve,demolish.or mpdr any structure $15000
prior 0 its iuuance.alsu requires thc applicant for such permit to file a signed moment
p < dwheislicensed purmanuomeprovision ofNeComments'sLiccomLaw(Chapmr9 Sq.Ft. Floor Area Tj Wation
s( $ (commencing with Section 70D0)of Division 3 of the Business and Profeuiav Code)or
— Nat he is aaempt therefrom and the buil fe,de shelf exemption.My vlolWon of
Serum 7031.5 by nary applicant for a permit subject,the applicant w•civil penalty of
r
oat ream Nu Ow hundred tical Wa($SW} -3 Atig Occupancy Type
Q 1,uowerofthepmprny,mmycmploycuw(thwgcau Ne4wlecompenudon,
will do the work and Ne stmcmm hnot(ntended cronered forsale(See.70th,Busimsa -'
and Penfeash u Cade:The Cmuscu Ys Liaise Law don sot apply to an owner of Required Inspections
property who builds or l m prove l Nmeon.and who dues such work himselfor thnnugh his
van employees,provided dutwch improvements art nalinun led mo@red forale.if.
however.the building or Improvement Is veld within one year of completion,Ne owner.
Wilder will haw the burden of proving Nat he did not build m Improve fm purpose of
ark.).
❑1.as owner of the property,am"elusively contracting with 0ansed eenvwtors w
construct de project(Sec.70".Business seed Professions,Code)The Cmmetm's Li•
ceue Law dm,not apply to an own"of property who builds or improve,Noreen,Ind.
who contracts for such pmjecu with a emnamor(s)licensed pursuant to the Contractors
License Law.
❑Lens see/,mJytsundo Seams B&PC fm this moon
Owner_f("'✓'E!/siY " m"—K-��/ DauQ
WORKERS COMPENSATIO DECLARATION
1 hereby Man under penalty of perjury cam of de following declarWans:
P,law and will maintain a Cenifiamal Cement to self-laum for Wurimes Compton.
sation,an provided for by Section 3700 of de Isom Cade,fm the performance of the
work for which this permit I.iamd.
❑1 haw and will maintain Wmkces Compensation Inamana,as,required by Schon
3700 of the Labor Code.for the performance of the worst fm which this permit is issued.
My Warkela Compensation Immeno carrier and Policy number am:
Cartier, Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This aauan toed not be completed if the permit hforonc hundred dolloa(SI W)
N lea)
I ceNfy Nat In the performance of Ne work for which this permit is issued.I flail no,
employ any person in any mannerwu c�c,bJ cttot Worycn'Compenution
Law of California.Data Applicant y
NOTICE TO APPLICANT:If.after making this Cerfiricimi-of Eumputsy should
hame to
esubject Ne Worker's Compensation provision of Ne lahm Code ym must
.J Q faMwiN comply with Inch provisions or Nu permit Mall he dared remkcd.
T CONSTRUCTION LENDING AGENCY
(-� I hereby Mem Nat dere!,•construction lemingagency fm Ore performance of
ai the wish for which Nis permit Is funded(See.3097,Civ.C.)
WM Q Lender's Name
Z)z Under's Add=
V Q 1 anlfy,that 1 haw read this application seed tote Nat the above mf.. m u
Ig. correct.I agree to comply with all city and county ominaa,and mak law misting to
OE building commotion,and hemby auNadm mpoesenuuvu of Ni,city to enter upon Nc
W show-mentioned property for Inspection purposes.
(We).9.to ace,indemnify wed hemp harmless,de City of Cupertino against
"y
liabilities,judgments,costs and expenses which may in any any aame.g.h,t said city
V z In consequence of the granting of this permit.
race APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU REGULATIONS. � ��
//its✓-l//1./1/ ,c4 7, Z �O,l Re-roofs
Sigoader NApplicutrCommuctor / 04M
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant mom or handle haumau mammal
u defined by the Cupenino Municipal Code.Chapter 9.1x.and the Health and Safety
16cmle. es x25532m)?0u Yrry YNo All,roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant or fu/tum building occupant use equipment or&vies which If a roof is installed without first obtaining an inspection,I agree to remove
,haaNau air contaminants u de0ned by the Bay Area Air Quality Management all new materials for inspection.
Disuict7
❑YeaJ No
I haw read the huurdms,mended,ad uimments under Chapter b.95ofthe Califor.
nim Health&Safety Coda Sectimu 25505,25533am125534.1 undersand thm ifde building
does tot coil,haw•tenan4 Nat it u my..imaslbility to notify de occupant of the
mm fits wh cn erns
=w iouoec of a een of Occa Signature of Applicant Date
O �� � All roof coverings to be Class"B"or better
Owner or egem I Date g
CITY OF CUPERTINO
I• 1 0£ 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 2
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 32613037.00
DATE ISSUED. . . . . . . : 07/21/2005
RECEIPT #. . . . . . . . . : 30459
REFERENCE ID # . . . : 05070131
SITE ADDRESS . . . . . : 10387 VISTA KNOLL BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : VUKADIN RADOMIR AND DORINA S
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1035
RECEIVED FROM . . . . : RADOMIR VUKADIN
CONTRACTOR . . . . . . . : LIC # ,
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
9E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
B.PERMFEE VALUATION 15,000.00 223.56 0.00 223.56 0.00
BSEISMICRE VALUATION 15, 000.00 1.50 0.00 1.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 225.06 0.00 225.06 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 225.06 166
TOTAL RECEIPT 225.06
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
C F Fax(408)777-3333
OUPEkTINO
Building Department
JOB/o387ssys�`� ,�yr�� ,g/v,C/, PERMIT 050 O 13
�( OWNER'S NAME: /lr- PHONE # 4v
GENERAL CONTRACTOR FAX#
xI am not using any subcontractors: ���-*�� � 7/Q oS
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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• CITY OF Telephone: (408)777-3228
CU w E RT'N O Fax: (408)777-3333
�J 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 arid/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: /\ atom/,r/ �}V
Job Site Address: ZC93 F 7 V 4S/a �/'l t?fX 1�/1�D�. 6�L(�
Roofing Company Name:
Applicant's Signature: Date: Z 110
• . Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper '
OWNER-BUILDER VERIFICATION
1. (Check one) I. or my immediate family (parent,spouse or child) will perform:A. , �L 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.
PersorVFunt 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). r 7
Property Owner's Signature: ,��tC�/ Date: //Z I /D
Job Address: f� 3 7 LdVla lf'-4(f CL �Y�• Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building DeparIn enj
10300 Torre Avenu
OF
C U PENT I NO Phone: (408)777-3228
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 yourself 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 compensatios
contributions.
There may be financial risks for you if you do not carry 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
0 5b�- 013 I
CITY OF CUPERTINO'
REROOF
0*CUPERTINO PERMIT APPLICATION FORM
APN# 3a co 13 034— 1 Date:
Building Address: /O \ / � p// e7
Owner's Name: �C,(oM/V 1�f��i�lpCPhone
Q�/� (�Gf 70,? #7.36—ZJ� S�
Contractor: V(rlo Phone #: License#:
Contact: n d0 Phone#: 7;3L
`Z� Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles :a' Asphalt Shingles
_N,- 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:
'MvJob Description: levo YeCP��/�!?/�- ��L J/ DS/rj YC� �t✓Gpkn .51�/ s
Residential Commercial ❑
Fire Zone: Yes ❑ No [� Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: 4
/sr��p Type of Construction: Occupancy group:
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