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07010121 CITE OF CUPERTINO BUILDin!(;DIVISION PERMITTQ ZMTI� " PERMIT NO. BUILDING ADDRESS: IT UE DATE OWNER'S NAME: ALICE LEE 2310 DIANA AVE 01/19/2007 SANITARY NO. CONTROL NO. ONE: (408) 779-0704 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p 0 LICENSED CONTRACTOR'S DECLARATION Job Description w;: I hereby affirm that I am licensed under provisions of Chapter 9(commencing "iU with Section 7000)of Division 3 of the Business and Professions Code,and my license is REROOF- RESHEET WITH CDX, 30LB FELT, INSTALL 'may in full force and effect 3 Lic.B 3 I LANDMARK TL AND LIFETIME COMP SHINGLES, CLASS A, ? License =F pare ContracWr ARCHITECTS DECLARATION 25 SQUAF E S UI understand my plans shall be used as public records u.in Licensed Professional �.O< OWNER-BUILDER DECLARATION nm-t 1 hereby affirm that 1 am exempt from the Contractor's License Law for the c o following reason.(Section 7031.5,Business and Professions Code:Any city or county y 9 which requires a permit to construct.alter,improve,demolish,or repair any strocturc prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft.Floor Area Valuation -Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 )q $15000 %Fs-o (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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 35701032 .W Number Occupancy Type not more than five 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 or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Contractor's 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.). ❑1.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7144,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&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. have and will maintain Worker's Compensation Insurance,as required by Section 00 of the Labor Code,for the performance of the work for which this permit is issued. My Workees Compensation Insurance carrier and Policy number arc: Carrier. 5,J-,�4- Policy No.:W 5-CAj V r) 3 CERTIFICATE OF EXEMPTION 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,1 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. z" ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of a..� the work for which this permit is issued(Sec.3097,Civ.C.) (Ia Q Lender's Name Lender's Address U 0 1 certify that I have read this application and state that the above information is ;.T. correct.1 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 U above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against ►�.r 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 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SO EGUIrA ONS. —� 5 -° Re-roofs Signature ofApWic9UConthttcir Date HAZARDOUS ATERIALS DISCLOSURE Type of F.00f Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Cade,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 ❑No Will the applicant or future building occupant use equipment or devices which If a roof s installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ❑No 1 have read the hazardous materials requirements under Chapter 6.95 of thc Califor- nia Health&Safcty Code,Sections 25505,25533 and 25534.1 understand that if die building does not currently have a tenant,that it is my responsibility to notify the occupant of the rcqui which mus;be met p�npr to issuance of a Certificate of Occupancy. S ignaturc of Applicant Date C ✓��v►P'2� /--i �7 All roof coverings to be Class"B"or better Owner of authorized agent 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 agre 2 to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be apphec.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 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 first 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 utspection 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 he job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: Job Site Address: /"c ' 7 �' SSS P/c e P Roofing Company Name: �) Applicant's Signature: -ti- � � `` Date: Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 35701032 . 00 DATE ISSUED. . . . . . . : 01,19/2007 RECEIPT # . . . . . . . . . : BS000000265 REFERENCE ID # . . . : 07010121 SITE ADDRESS . . . . . : 10:.78 CASS PL SUBDIVISION . . . . . . . CITY CUIERTINO IMPACT AREA . . . . . . . OWNER AL---CE LEE ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2728 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : KRAUSE, JIM LIC # 21415 COMPANY . . . . . . . . . . : JITI KRAUSE ROOFING ADDRESS . . . . . . . . . . : 23:_0 DIANA AVE CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037 TELEPHONE . . . . . . . . : (418)779-0704 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 15, 000. 00 223 .56 0. 00 223 . 56 0. 00 BSEISMICRE VALUATION 15, 000. 00 1.50 0. 00 1 .50 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 225 . 06 0. 00 225. 06 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 225 . 06 MC --------------- TOTAL RECEIPT 225 . 06