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12030045CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7611 KIRWIN LN CONTRACTOR: R E ROOFING & PERMIT NO: 12030045 CONSTRUCTION INC OWNER'S NAIVE: KIMBERLIN STEVEN R AND KATHLEE 15230 CLYDELLE AVE I DATE ISSUED: 03/082ol2 OWNER'S PHONE: 4082556290 SAN JOSE. CA 95032 PHONE NO: (41181676-9320 ❑ LICENSED f.ONTRAC'l�(OR'S IIECL. ION Li st'Ck ss Lic. q l �� n[metor � Date I �• herrM1y a mm nt I a censed under the provisions of Chapter9 (commencing with Section 70op) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm ander penalty of perjure one of the following two declarations: I have and will maintain a cenifiewe of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Ixmtii is issued. 1 have aid will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify dist I have read this application and state ilia the above information is correct. I agree to comply with all city and county ordinances mid state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property tier inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupenino against liabilities, judgments, costs, and expenses which may accrue against said Cit' in consequence of the granting of this permit. Additionally, the applicant understands mid will comply yvidf rlTro- oint source regulations per (lie Cupertino Municipal C e, Sectiat 9.18. t Signmal Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I ani exempt from the Contractor's License Law for one of the following onto reasons: 1, as owner of the property, or my employees with wages as their sole compensatiau, mill do the work, mid the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, ani exclusively contracting with licensed contractors to construct the project (Scc.7(144, Business & Professions Code). hereby affirm tinder penalty of perjurf one of the following three declarations: ' I have mid will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have aid will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the pcidann nce of the work for which this permit is issued. 1 certify that in the performance of the work forwhicI this permit is fss . not employ :ny person in :my manner so as o become subject to th 'orker's Compensation laws of Cali loads. If,aftermakingthiscertificae f'exemption.I become subject to the Worker's Compensaion provisions oftbe shot Code, I In forthwith comply with such provisions or this permit shalt be Been d revoked. APPLICANT' CERTIFICATION I certify that 1 have read this application and state that the above informaion is correct. I agree to comply with all city and county ordinances and state paws relating to building construction, and herebv authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnity and keep hmr dess the City of Cupertino against liabil ides, judgments, costs, and expenses which may accrue against said City in consequence of the gaming of this permit. Additionally, the applicant understands and will comply with 1 not i 1 t s�ircert Iittimsp r the Cupertino MunlC�ode, Sectitn Signauvel BUILDING PERMIT INFO: BLDG C ELECT i— PLUMB r NIECH C RESIDENTIAL r COMMERCIAL F - JOB DESCRIPTION: RE -ROOF: REMOVE EXISTING WOOD SHAKE, REPLACE WITH COMP SHINGLES CLASS A 34SOFT Sq. Ft Floor Area: I Valuation: $185W APN Number: 3592101200 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ate: RE -ROOFS: Crwfs5hail ected priorto my roofing material being installed. Ifa roof is rst btaining an inspection, I agree m remove app new materials for t, Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Salety Code, Sections 255(15, 25533, and 25534. I will nmintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health & Safety Codd Section 25532(a) should I store at- handle hazardous muterial. Additionally, should I use equipment (or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality planagenuent District 1 will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and (lie Health & Safety Code, Sections'25505, 25533, and 25 34. 'n oathez d„en i 1 Date: vvv l u CONSTRUCTION LENDING AGENCY I hereby affirm this there is a construction lending agency for the performance of nwmk's for which this pentad( is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCA ITECT :S DECLARATION I understand my plans shalt be used as public records. Licensed CUPERTINO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 i (408) 777-3228 - FAX (408) 777-3333 • bL'lldin0(r0cuoer;ino.orD PR= ADDRESS L/1"" Iia ✓� 1—a �V►d^ 1' OWN1 "E C� � I4 „ I �( I � n,, u 1 j PHONEI I �- Xl57 I ��� ' 1'flP E -MAB. STREET ADDRESS) � I( I I `w1N CRY, SPATE, ZI I.u[`nJ''N 1 I V `--9I3 FAX r APPLCAM NAME '(� ,' J U, A/N (� PHONE,626V \Z^ 2 E-MAIL Ni11utI 1 STREET ADDRESS l y C)v Cul CITY. STATE. 71P 5 , I - L)K, - � �(. FAX W _ 6 � (�❑ i I 0 OWNFA 0 OWNER -BLANDER ❑I.•OWNERAGEM CONTRACTOR 0 CONTRACTOR AGENT 0 mtmmiE T ❑ E mxs:R ❑ OEYFIOPFA TENANT CONFRACTOR NAMElj 10, a/ -(U I IICENSE NUMBER Z 7 G LI�Y�E� I lJi I ` BUS. IIT / ZU� 11-7 COMPANY NAME E -MAB. FAX FAX I [.STATE ZIP /` ( \1v�i �l, .�� STREET ADDRESS 1 Cd (M LK. m �1 aG /�l MONS {O L1u ARCHTTECTIENGINEERNAME i LCENSE NUMSER I BITS. LIG/ COMEANY NAME I� E -MAB. FAX STR c r ADDRESS C.:Y. STATE, ZIP I PHONE USE OF SFD r Duplex ❑ Multi-Farnily ROOF AREA:�j ^�1 STRUCTURE: ❑ Conmercial / VALUATION: EXISTING ROOF TYPE: 11 BUILT-UP ROOF HALT SFMNQI ES ❑ WOOD SHAKES ❑ WOOD SHLNm7S ❑ OTim (SPECIFY) AEMO /IL.PLACE S NO IF NO. a 1'�iS I PLYWOOD X'A' ❑ _ S' ❑ ire' PLYWD ❑ 050 PfiCFC )2 ROOF A PROPOSEDROOF TYPE: ❑ B= -UP ROOF HALT SKNM-'S G WOOD SHAKES ❑ WOOD SHINGi Fe 00=_ I ICC -ES REPORT a DES0UPTION OF WORK LJMa- cY— 'p,uuY I�1 `12`` LM I By my sigma r below, I ce to each of' he following: I am the property owner or authoriv-d agent to act on Lbe property u wets behalf. I have read this application and the inf - , cct av vided is avl a Description of Work e.�d verify it is ac I�agre m comply witb all applicable local ordinances d sate laws rlatiag consT .. I aitch '�• Neseaasives of CupeYi�e tc rnter the abo d tified proptNr, for inspe=on purposes. Signature ofA icant/Agene Date: �' SUPPLEMExTAl. I.*rFoluYLanorl xaQulxED�. _ If building is associated with a Home Owner's Association, provide letter ofroval from HOA. aPP _ Provide Planning approval to veru if there any rstrictiotts. r Provide copy ofManuaLTuser's Installation Specifications. Provide signed copy of Cupertino's Tear -06 Policy. - _ �-�TD>-REnNur�,�"-�.y: ' + �_- - — - ' RDrA'D-va;st:> „ xPRt:ss €Gm- vfEW :� NnnitD �.,. i•" � �� -- Reroof4pp-1011.doc revised 03/0)11 v CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7611 KIRWIN LN CONTRACTOR: R E ROOFING & PERMIT NO: 12030045 CONSTRUCTION INC OWNER'S NAIVE: KIMBERLIN STEVEN R AND KATHLEE 15230 CLYDELLE AVE I DATE ISSUED: 03/082ol2 OWNER'S PHONE: 4082556290 SAN JOSE. CA 95032 PHONE NO: (41181676-9320 ❑ LICENSED f.ONTRAC'l�(OR'S IIECL. ION Li st'Ck ss Lic. q l �� n[metor � Date I �• herrM1y a mm nt I a censed under the provisions of Chapter9 (commencing with Section 70op) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm ander penalty of perjure one of the following two declarations: I have and will maintain a cenifiewe of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this Ixmtii is issued. 1 have aid will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify dist I have read this application and state ilia the above information is correct. I agree to comply with all city and county ordinances mid state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property tier inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupenino against liabilities, judgments, costs, and expenses which may accrue against said Cit' in consequence of the granting of this permit. Additionally, the applicant understands mid will comply yvidf rlTro- oint source regulations per (lie Cupertino Municipal C e, Sectiat 9.18. t Signmal Date ❑ OWNER -BUILDER DECLARATION 1 hereby affirm that I ani exempt from the Contractor's License Law for one of the following onto reasons: 1, as owner of the property, or my employees with wages as their sole compensatiau, mill do the work, mid the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, ani exclusively contracting with licensed contractors to construct the project (Scc.7(144, Business & Professions Code). hereby affirm tinder penalty of perjurf one of the following three declarations: ' I have mid will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have aid will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the pcidann nce of the work for which this permit is issued. 1 certify that in the performance of the work forwhicI this permit is fss . not employ :ny person in :my manner so as o become subject to th 'orker's Compensation laws of Cali loads. If,aftermakingthiscertificae f'exemption.I become subject to the Worker's Compensaion provisions oftbe shot Code, I In forthwith comply with such provisions or this permit shalt be Been d revoked. APPLICANT' CERTIFICATION I certify that 1 have read this application and state that the above informaion is correct. I agree to comply with all city and county ordinances and state paws relating to building construction, and herebv authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnity and keep hmr dess the City of Cupertino against liabil ides, judgments, costs, and expenses which may accrue against said City in consequence of the gaming of this permit. Additionally, the applicant understands and will comply with 1 not i 1 t s�ircert Iittimsp r the Cupertino MunlC�ode, Sectitn Signauvel BUILDING PERMIT INFO: BLDG C ELECT i— PLUMB r NIECH C RESIDENTIAL r COMMERCIAL F - JOB DESCRIPTION: RE -ROOF: REMOVE EXISTING WOOD SHAKE, REPLACE WITH COMP SHINGLES CLASS A 34SOFT Sq. Ft Floor Area: I Valuation: $185W APN Number: 3592101200 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: ate: RE -ROOFS: Crwfs5hail ected priorto my roofing material being installed. Ifa roof is rst btaining an inspection, I agree m remove app new materials for t, Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Salety Code, Sections 255(15, 25533, and 25534. I will nmintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the Health & Safety Codd Section 25532(a) should I store at- handle hazardous muterial. Additionally, should I use equipment (or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality planagenuent District 1 will maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and (lie Health & Safety Code, Sections'25505, 25533, and 25 34. 'n oathez d„en i 1 Date: vvv l u CONSTRUCTION LENDING AGENCY I hereby affirm this there is a construction lending agency for the performance of nwmk's for which this pentad( is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCA ITECT :S DECLARATION I understand my plans shalt be used as public records. Licensed CUPERTINO REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 i (408) 777-3228 - FAX (408) 777-3333 • bL'lldin0(r0cuoer;ino.orD PR= ADDRESS L/1"" Iia ✓� 1—a �V►d^ 1' OWN1 "E C� � I4 „ I �( I � n,, u 1 j PHONEI I �- Xl57 I ��� ' 1'flP E -MAB. STREET ADDRESS) � I( I I `w1N CRY, SPATE, ZI I.u[`nJ''N 1 I V `--9I3 FAX r APPLCAM NAME '(� ,' J U, A/N (� PHONE,626V \Z^ 2 E-MAIL Ni11utI 1 STREET ADDRESS l y C)v Cul CITY. STATE. 71P 5 , I - L)K, - � �(. FAX W _ 6 � (�❑ i I 0 OWNFA 0 OWNER -BLANDER ❑I.•OWNERAGEM CONTRACTOR 0 CONTRACTOR AGENT 0 mtmmiE T ❑ E mxs:R ❑ OEYFIOPFA TENANT CONFRACTOR NAMElj 10, a/ -(U I IICENSE NUMBER Z 7 G LI�Y�E� I lJi I ` BUS. IIT / ZU� 11-7 COMPANY NAME E -MAB. FAX FAX I [.STATE ZIP /` ( \1v�i �l, .�� STREET ADDRESS 1 Cd (M LK. m �1 aG /�l MONS {O L1u ARCHTTECTIENGINEERNAME i LCENSE NUMSER I BITS. LIG/ COMEANY NAME I� E -MAB. FAX STR c r ADDRESS C.:Y. STATE, ZIP I PHONE USE OF SFD r Duplex ❑ Multi-Farnily ROOF AREA:�j ^�1 STRUCTURE: ❑ Conmercial / VALUATION: EXISTING ROOF TYPE: 11 BUILT-UP ROOF HALT SFMNQI ES ❑ WOOD SHAKES ❑ WOOD SHLNm7S ❑ OTim (SPECIFY) AEMO /IL.PLACE S NO IF NO. a 1'�iS I PLYWOOD X'A' ❑ _ S' ❑ ire' PLYWD ❑ 050 PfiCFC )2 ROOF A PROPOSEDROOF TYPE: ❑ B= -UP ROOF HALT SKNM-'S G WOOD SHAKES ❑ WOOD SHINGi Fe 00=_ I ICC -ES REPORT a DES0UPTION OF WORK LJMa- cY— 'p,uuY I�1 `12`` LM I By my sigma r below, I ce to each of' he following: I am the property owner or authoriv-d agent to act on Lbe property u wets behalf. I have read this application and the inf - , cct av vided is avl a Description of Work e.�d verify it is ac I�agre m comply witb all applicable local ordinances d sate laws rlatiag consT .. I aitch '�• Neseaasives of CupeYi�e tc rnter the abo d tified proptNr, for inspe=on purposes. Signature ofA icant/Agene Date: �' SUPPLEMExTAl. I.*rFoluYLanorl xaQulxED�. _ If building is associated with a Home Owner's Association, provide letter ofroval from HOA. aPP _ Provide Planning app, -oval to veru if there any rstrictiotts. r Provide copy ofManuaLTuser's Installation Specifications. Provide signed copy of Cupertino's Tear -06 Policy. - _ �-�TD>-REnNur�,�"-�.y: ' + �_- - — - ' RDrA'D-va;st:> „ s5 €cm- vfEW :� NnnitD �.,. i•" � �� -- Reroof4pp-1011.doc revised 03/0)11 v