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07010020 CITE('OF CUPERTINO BUILDING DIVISION PERMIT � � � PERMrrNQew^ BUILDING ADDRESS- (f DDRESS•I o" �^ � 1E. J PERMiT E DATE OWNER' NAME:�y�� y ,�� ,/� Vol ' O )NE-791- la'/^t/'�` �/�►/V'�� ✓✓ � '� SANITARY O. CONTROL NO. , `� �/ a BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH O p LICENSED CONTRACTOR'S DECLARATION Job Description c u I hereby affirm that I am licensed under provisions of Chapter 9(commencing ,(//�///�� {1 =Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is C(? �W a Of i v� / 1 • 1 a„ in full force and efftct�n ` ? License Claw [ 7 F p Date . X11 Contractor �' ('r3m� ARCHITECTS Dff A ATION 111���✓✓✓ r I understand my plans shall be used as public records -Z6 <) IVA/V�•' , ws c I/V 1`^s y Licensed Professional n y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the i 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county K m 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 S Ft.Floor Area Valua 'on that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q E t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). ❑1,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 Contractor's License Law docs 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Cade:)The Contractor's Li- cense Law docs 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&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 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 Wor er Compensauon Insurance carrier and Policy number are: Carrie-.^ Poliq No.: 8yo NQL,.% b _RTIFICATE F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars($100) 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 Workers Compensation provisions of the Labor Code•you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY H rr 1 hereby affirm that there is a construction lending agency for the performance of p,> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Genders Address I certify that I have read this application and state that the above information is U correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against rHu liabilities•judgments,costs and expenses which may in any way accrue against said City U'Z" in consequence of the granting of this permit. Date —( / r� APPLICANT UNDERST ND AND L COMPLY WITH ALL NON-POINT Issued by: SOURCE S x=07 Re-roofs attireo lican onDare T of Roof HAZARDOUS OUS MATERIALS DISCLOSURE Type 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 Will If a room is installed without first obtaining an inspection,)agree to remove ll the applicant or future building occupant use equipment or devices which mit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes 1 have read the hazaudms 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,lha ' ' my rcaponsibility W notify the occupant of de requirements w ' e W aattce mf a certificate of Occupancy. Date -D 7 Signature of Applicant ,owne orAll roof coverings to be Class"B"or better autharizcdagcnt Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMI`[' RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Bl-.c: Lot: APN 36325023 .00 DATE ISSUED. . . . . . . : 01/04/2007 RECEIPT #. . . . . . . . . : BS)00000130 REFERENCE ID # . . . : 07)10020 SITE ADDRESS 10500 E ESTATES DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER POSSEMATO PAUL ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TU_ AZ, 85749 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : HANK OLOCKI LIC # 26739 COMPANY . . . . . . . . . . : ROOF ROOFING ADDRESS . . . . . . . . . . : 5577 VASSAR DR. CITY/STATE/ZIP . . . : SAN JOSE, CA 95118 TELEPHONE . . . . . . . . : (408)265-9270 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- -------- BPERMFEE VALUATION 7, 800. 00 147 .96 0. 00 147 .96 0. 00 BSEISMICRE VALUATION 7, 800. 00 0.80 0. 00 0. 80 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 148.76 0. 00 148.76 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 148.76 19365 --------------- TOTAL RECEIPT 148.76 Community Development 10300 Torre Avenue ' ;- Cupertino CA 95014 Telephone(408)777-3228 CITY Of Fax(408)777-3333 CUPERTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # I{'OJ" 2.657 �� D GENERAL CONTRACTOR FAX # S-r- I am not using any subcontractors: l S� ature 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 lumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile 'r �7 Owner/Contractor Signature Date 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 agree to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be applie I without first obtaining all inspection and written approval from the buildin,;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 an'sT roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre-inspection and/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:=irst obtaining an inspection, will require the removal of all new ma':erial down to the sheathing, so a proper City inspection can be perfDrmed. 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 car 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: �Q-%� -f_4�oAP Job Site Address: ,©SAO A-_1S Roofing Company Name: Vcxe � a Applicant's Signature: / Date: Greg Casteel Building Official Revis=_d 11/2/04 Oq of CO2-D CITY OF C-1UPERTINO RE ROOF CUPEkTINO PERMIT APPLICATION FORM APN# Date: _-3 Uq- Building Address: i X6©19 � 5��.-� �. Owner' Name: Phone#: �1D-1- 4-z1- ([0S-2 Contractor License#: Contact: Cupertino Business License #: �a.,� Type of f:oof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles 1101— 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: Job Description: t nn Residential Commercial ❑ Fire Zone: Yes ❑ NoConfirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Constmetioon: 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