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07090174 CITY OF CUPERTINO PERMIT . .....::.:.::...: :. BUILDIN(;DI�`ISr.:;.. :. �:CTQ�t.I�fi��M ESN BUfLDiNGr�DESSADRIANA AVE TOMAN CAROL J P07090174 J OW NERR'SUNAME: PERMIT ISSUE DATE TOMAN CAROL J 10132 ADRIANA AVE 09/25/2007 )NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o p LICENSED CONTRACTOR'S DECLARATION U p 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description ;z� with Section 7000)ofDiv ision3ofthe Business and Professions Code,and mylicenseas TEAR OFF, RE-ROOF W/ASPHALT SHINGLES, 30LB FELT, r y in full force and effect. t n Z License Class ic.# CLASS A 19 S Q. '-a Date Contractor ARCHITECTS DECLARATION i a< 1 understand my plans shall be used as public records >yU U. ti Licensed Professional .H OWNER-BUILDER DECLARATION '} I hereby affirm that I am exempt from the Contractors License Law for the :00 following reason.(Section 7031.5,Business and Professions Code:Any city or county V which requires a permit to construct,alter,improve,demolish,or repair any structure zy prior to its issuance,also requires the applicant for such permit to file a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $2000 Valuation t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of ypj�Number Occupancy Type not more than five hundred dollars($500). 32620011:tj Cl' ❑I,as owner of the property.or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuactoes License Law does not apply to an owner of q P property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). ((I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&qP C for this reason Owner L/^ °( p'�^�'��!�,. Date l-as7-617 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: '❑I have and will maintain a Certificate of Consent to self-insure for Worker's Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier: Policy No,- CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is forone hundred dollars($100) or less.) I cerrify,that in the performance of the work for which this permit is issued,1 shall not employ any person in any magger sg ytio he"c subject to the Workers'Compensation Laws of CalifoJ�^11a.Dal- Applicant T - NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must ,J 0 forthwith comply with such provisions or this permit shall be deemed revoked. z" CONSTRUCTION LENDING AGENCY 4 I hereby affirm that there is a construction lending agency for the performance of 7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lender's Address U C) I certify that I have read this application and state that the above information is �- correct.I agree to comply with all city and county ordinances and state laws relating to nU building construction,and hereby authorize representatives of this city to enter upon the � U ahovc-mentioned property for inspecuon purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against ,may liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: NS LA RE S SOUKTI . C `1-.2 S-C 7 Re-roofs _a ��✓ Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of F oof Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532(a)? ./ All roofs shall be inspected prior to any roofing material being installed. ❑Yes ptf No which If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices emit hazardous air contaminants as dcftncd by the Bay Area Air Quality Management all new rr aterials for inspection. District? ❑Yes [(No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant or the _ T,l.A-C ty"�"L✓`-d'N" / requirements which must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date �. q-a5=67 All roof coverings to be Class"B" or better Owner or authorized agent Date -07 oq Ot 7 e-f CITY OF CUPERTINO RE'ROOF CUPEitT1NO PERMIT APPICATION FORM APN# 2 a O 0 t I (� Date: Building Address: Owner's Name: Phone#: 0"C"Vol q-6VIS_9 i _('1536 Contractor: License#: Contact: Cupertino Business License #: t�clr'Jl /GYY�.kh Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles N( 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 Cupertino's Tear Off Policy: C` Job Description: j-e[-Czf- wAk c1sg -301-h fe-L-F Ig Residential Commercial M L �f Fire Zone: Yes ❑ No rK Confirmed with Planning Dept. if there are any restrictions: U Cost of Proj t: Type of Constru,-tion: Occupanc gr 7,9, 6 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 1 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 agrc e 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 bu:lding 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 apprcval. 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 f irst obtaining an inspection, will require the removal of all new mat?rial 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. n Homeowner's Name: C..aro TC mouvt Job Site Address: I 3 . A.(4 r I a in d. UP er (nt . C A Y 5(-' 1 Roofing Company Name: v�8 Applicant's Signature: l -J �1 �7^^ Date: Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 32( 20011 .00 DATE ISSUED. . . . . . . : 09/ 25/2007 RECEIPT #. . . . . . . . . : BS(100002763 REFERENCE ID # . . . : 07090174 SITE ADDRESS . . . . . : 101.32 ADRIANA AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER TOPIAN CAROL J ADDRESS . . . . . . . . . . : 10:_32 ADRIANA AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1126 RECEIVED FROM . . . . : CAROL L TOMAN CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : TOTIAN CAROL J ADDRESS . . . . . . . . . . : 10:-32 ADRIANA AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1126 TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY 2�MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 2, 000. 00 83 .16 0. 00 83 .16 0. 00 BSEISMICRE VALUATION 2, 000. 00 0.50 0. 00 0.50 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 83 .66 0. 00 83 . 66 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 83 . 66 MC --------------- TOTAL RECEIPT 83 . 66 Community Development 10300 Torre Avenue r Cupertino CA 95014 Telephone(408)777-3228 civ OF Fax(408)777-3333 'WEkTINO Building Department I JOB ADDRESS: PERMIT # 16( 3 :�, Ad�«vu. OWNER'S NAME: L rc 1 PHONE # 46F- I `f rQ—0 530 GENERAL CONTRACTOR: ®/ FAX # I am not using any subcontractors: C ,� a ,�cam. - s=L`7 Si mature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork I 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