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06050189CITY 0F,.CUFUK1I.fvu BUILM•; DIVISION PERMIT BUILDING ADDRESS: 22283 N DE ANZA CL OWNER'S NAME: AUSTIN DONNA M AND L S Ice ;m U <d a� ? ;NE: ARCHITEC•rlENGINEER: 1 hereby affirm that I am licensed under provisions of Chaptcr 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. _ 3 Lie• 3 0 7 Date Class i - O Contractor r ARCHITECCS DECLARATION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 not more than five hundred dollars (5500). ❑ 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 and Professions Code: The Conuactoes License Law does not apply to an owner of 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.). 0 I, as owner of the property, am exclusively contracting with Licensedraetur�e construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Ui' cense Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant Contractoes License Law. Q I am exempt under Sec B & C for This reason Owner Date -------- WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty or perjury one of the following declarations: L] I have and will maintain a certificate or Consent to self -insure for Workces 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 Com easation Insurance carrier and Policy number are: Cartier: Va.4d PolicyNo.: DOGS%l b d Y E1 OR FICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE -1 CO I (This section need not be completed if the permit is for one hundred dollars ($14) or less.) I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Worker's Compensation provisions of the Labor Code,youmust ,Z forthwith comply with such provisions or this permit shall be deemed revo zP� r-� W ~ aQ �Z UO wH OU E -'a Uz H & W ROOFING 1890 CREWE C (415) 964 -4 945 PERMITNO- 06050189 PERMIT! ISSUE DATE 05/23/2006 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description GARAGE ONLY. TEAR OFF SHAKE AND REROOF WITH CLASS A SHAKE Floor Area W CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work For which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 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 building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemn•fy and keep harmless the City of Cupertino against liabilities, judgments, costs and a uses which may in an y accrue against said City in consequence of the granting this permit. APPLICANT UNDERSTA S AND WILL CO LY WITH ALL NON -POINT SOURCE REGULAaon y (, � `,2 7 Signature of ApplitorDatc OUS MATERIALS DISCLOSURE Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Cock, Section 25532(a)? Yes ❑ No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? Yes ❑ No I have read the by Dass materials c uincm u under Chapter 6.95 of the Califor- nia Health JS Safety Code tions 25505, 25533 25534.1 understand that if the building does not currently tenant, that it is my risibility to notify the occupant of the requirements wh' sr' be t or to "u of a Certificate of Occupancy. Owner or a thorize gent Date Issued by: Re -roofs Type of Roof W Required Inspections i Type Date -S---' 2J_v -, All roofs shall be inspected prior to any roofing material being installed. If a roof is installed W�thout first obtaining an inspection, I agree to remove all new materials fo nspection. of A licant Date All roof coverings to be Class "B" or better L CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work For which this permit is issued (Sec. 3097, Civ. C.) Lender's Name Lender's Address 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 building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We) agree to save, indemn•fy and keep harmless the City of Cupertino against liabilities, judgments, costs and a uses which may in an y accrue against said City in consequence of the granting this permit. APPLICANT UNDERSTA S AND WILL CO LY WITH ALL NON -POINT SOURCE REGULAaon y (, � `,2 7 Signature of ApplitorDatc OUS MATERIALS DISCLOSURE Will the applicant or future building occupantstorc or handle hazardous material as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety Cock, Section 25532(a)? Yes ❑ No Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? Yes ❑ No I have read the by Dass materials c uincm u under Chapter 6.95 of the Califor- nia Health JS Safety Code tions 25505, 25533 25534.1 understand that if the building does not currently tenant, that it is my risibility to notify the occupant of the requirements wh' sr' be t or to "u of a Certificate of Occupancy. Owner or a thorize gent Date Issued by: Re -roofs Type of Roof W Required Inspections i Type Date -S---' 2J_v -, All roofs shall be inspected prior to any roofing material being installed. If a roof is installed W�thout first obtaining an inspection, I agree to remove all new materials fo nspection. of A licant Date All roof coverings to be Class "B" or better CITY OF 7UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: 222 ti A An -L-e, C r PERMIT # 06 0 S° bt--' gL f OWNER'S NAME: PHONE # 1:5F2- :5F2GENERAL GENERALCONTRACTOR:t, # I am not using any subcontractors: ignature Date Please check a nlicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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 CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: amyw :m 1 of 1 COPY # : 2 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35602024.00 DATE ISSUED ....... 04513/2006 RECEIPT #......... : 06050189 REFERENCE ID # ••• SITE ADDRESS .....: 22283 N DE ANZA CL SUBDIVISION CUPERTINO CITY ............. IMPACT AREA ....... OWNER ............: AUSTIN DONNA M AND L S ADDRESS ••••• CITY/STATE/ZIP RECEIVED FROM ....: H & W ROOFING CONTRACTOR .......: HAINES, HARRY LIC # 1173 COMPANY ..........: H & W ROOFING ADDRESS 1890 CREWE CT CITY/STATE/ZIP ...: SAN JOSE, CA 95132 TELEPHONE ........: (415)964-4945 UNIT --FEE ID _ ----- ---------- BPERMFEE VALUATION BSEISMICRE VALUATION QUANTITY AMOUNT -------------------- 4,000.00 3,600.00 104.76 0.50 ____ 105.26 PD -TO -DT ---------- 0.00 0.00 __ 0.00 THIS REC ---------- 104.7 0.50 105.26 ---------- --NEW-BAL- 0.00 0.00 --------- 0.00 TOTAL PERMIT : ------NUMBER AMOUNT METHOD OF PAYMENT ------ ------- CHECK 105_26 6846 TOTAL RECEIPT 105.26 CITY OF CUPERTINO (X05 01bq REROOF CUPCITY Of El�TINO PERMIT APPLICATION FORM Building Address: Owner's Name: Contractor: Contact: ' Type of Roc Existing: ❑ Built -Up Roof ❑ Asphalt Shingles p," Wood Shakes ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings ❑ To be Removed I Have Read, Understand and Will Comply With Cup( r ob Description: T esidential Co ercial ❑ Fire Zone: Yes ❑ No Cost of Project: Type of Construct J Qty. if Fee ID BPERMFEE BENERGY BSEISMICRE BSEISMICOM BPLANCHK BUSLIC Date: C; Phone #: q6 -e J 6 - 1 License #: 7 Cupertino Business License #: f Covering: Proposed: ❑ Built -Up roof ❑ Asphalt Shingles BUILDING Wood Shakes ❑ Wood Shingles ❑ Other (Specify) ❑ Provide I.C.B.O. Report # ❑ Provide Mfgr. Installation Specs. rtino's Tear Off Policy. U i2t/'�'v� -r✓ c�� ' .S Ila C/asS s�ia/fir Confirmed with Planning Det. if there are any restrictions: LJ ion: Occupancy group: Fee Description Fee Grou 3ldg Permit Fees BUILDING Ener BUILDING Seismic Fee Res BUILDING Seismic Commercial BUILDING Plan Check Fee BUILDING Business License BUILDING