07010091 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
ca�tT , rax Irat� M� �ar�
PERMIT NO.
BUILDING ADDRESS:
10465 S DE ANZA BLVD ALIAN PERMrrlssuEDATE
OWNER'S NAME:
CALI FINANCIAL 1250 CA14PBELL AVE 01/17/2007
SANITARY NO. CONTROL NO.
ZONE:
(408) 261-2595
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION Job Description
e u F I hereby affirm that I am licensed under provisions of Chapter 9(commencing
=z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is NEW F I R�S T ONE 4 5 MIL T P 0. NO TEAR OFF, NO
y in full force and effect. Z RE S HEET.
? License Class Lk.#. M99
I.-
° °ate--�= eonvaetor CLASS A
ARCHITECTS DEC TI
a U 1 understand my plans shall be used as public records
a
L y Licensed Professional
A y OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
K ff which requires a permit to construct,alter,improve,demolish,or repair any structure
In prior to its issuance,also requires the applicant for such permit to rile a signed statement S Ft.Floor Area Valuation
_ that he is licensed pursuant to the provisions of the Contractor's Licertse Law(Chapter 9 q $31000
t–$ (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 Occupancy Type
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of[35917019 APN Number
not more than rive hundred dollars($500).
❑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 oroffered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs trot 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 convectors to
construct the project(Sec.7044.Business and Professions Cork:)The Contractor's Ir-
ccnse taw does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a conuactor(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:
❑1 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.
bfZ)havc and will maintain Worker's Compensation Insurance,as required by Section
700 of the Labor Code,for the performance of the work for which this permit is issued.
My workeAlcompenaation Insurance avi and Policy number are:
ti) (' LZ.r91D9
Carrier. JI/��J'•Cu. 9r eY No.:
CERTIFICATE O EXEM ON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one 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 Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
E..r t... 1 hereby affirm that there is a construction lending agency for the performance u[
fYi r7 the work for which this permit is issued(See.3097,Civ.C.)
W Q Lender's Name
Cr Lender's Address
V 0 1 certify that 1 have read this application and state that the above information is
(L correct.t agree to comply with all city and county ordinances and state laws relating to
0 U building construction.and hereby authorise representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against _
liabilities,judgmcnts,costs and expenses which may in any way accrue against said City
V Z
in consequence of the granting of this permit. Date {/ I
APP NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b�:
SO EGULATIO S.
7'� Re-roof:
Signutve of Applicant/Contractor Dale T of Roof
HAZARDOUS MATERI DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munic'al Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roof;shall be inspected prior to any roofing material being installed.
❑Yes l
Will the applicant or futurgbutldrng occupant use cyuipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conte n adefined by the Bay Area Air Quality Management all new naterials for inspection.
District?
❑Yes No
I 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
Idorso%j;�tsently haveatenantththis my responsibility to notify the occupant of the
rcqu' which must met ri to issuance of a Certificate of Occupancy. Signatul a of Applicant Date
All roof coverings to be Class"B"or better
Owner or authorized ffl, t 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 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 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 first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be per.'ormed.
7. NOTE: If you call for a plywood nail nspection 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 abov 2 stated policy on re-roofing.
Homeowner's Name: 0- y� C
Job Site Address: _/0�Vb, 0,A
Roofing Company Name: A ( i c., c o
J
Applicant's Signature: etWILk 2 Date:
Greg Casteel
Building Official
Revised 11/2/04
6 �to � Doc) I
CITY OF CUPERTINO
RF ROOF
CUPERTINO PERMIT APP] JICATION FORM
APN# 35q-' 1 f—1 w O' Date:
cJ7
Building Address:
�
A2 b -5 , � a4 =s �l�d t w 4, Q � s ��
4
Ow is Name: Phone#:
Contractor: License#:
r
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) n
Number of existing coverings )1( Provide I.C.B.O. Report# & to
❑ To be Removed l�( Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cul ertino's Tear Off Policy: ❑
Job Description: - / rt 510 t e
Residential ❑ Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: 1p Type of Constntction: Occupancy group:
0 3 7 oo o �_
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