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07080054iTY OF CUI ERI 11 BUILDING DIVISION BUILDIIY5.1'�':NORWICH AVE OWNER'S NAME: HELEN TAI E: ARCHITECT/ENGINEER: PERMIT WINTER ROOFING INC 151 4083638032 PERMIT NO. 07080054 PERMIT ISSUE DATE Job Description CONTROL NO, BUILDING PERMIT INFO LICENbru i-ur' ..... ---- I hereby affirm that 1 am licensed under provisions of Chapter 4 (commencing REROOF—REMOVE (E),INSTALL 3 0 LB FELT , 4 0 YR Lith Section 7000) of Division 3 of the Business and Professions Code, and my license is I full force and effec Lic )_.. aensc Class Contractor a�c _ & A_ ARCHI.f.ECI-S DECLA ON I understand my plans shall he used as public records icensed Professional OWNER -BUILDER DECLARATION I hereby atTirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 703 1.5, 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 Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or leged that he is exempt tang applicant the basis or a permit subjectsr the thethe applicantto a cin. v l penalty of violation of Section 7031.5 by any app iPe not more than rive hundred dollars ($500). 0 1, az owner of the property, or my employees with wages az their sole compensation, will do the work, and the structure is not intended or offered rot sale (Sec. 7044. Business and Professions Code: The Contractor's License Law dors not apply to an owner of property who builds or improves thereon, and who does such work himself through his own employees, provided that such improvements are not intended or offeread 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 1, as'owner of the property, am exclusively contracting with licensed contractors iContracto- construct the project (Sec. 7044, Business and Professions Code:) liceoves nse cense Law does not apply to an owner of property who build to the Contractors who contracts for such projects with a contractor(s) licensed pursuant License Law. B & P C for this reason 0 I am exempt under Sec. Date Owner WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: LJ I have and will maintain a certificate of Consent to self -insure for Workers Compen- 700 of the Labor Code, for the performance of the sation, as provided for by Section 3 work for which this permit is issued. ve and will maintain Worker's Compensation Insurance, h required by Section 00 of the Labor Code, for the performance of the work for which this permit is issued. My Workers Co. pensation insurance carrier and Policy number are: Cartier. Policy No.; GTO ERTIFI ATE OF EMPTION FROM WORKER COMPENSATION INSURANCE (Chis section need not he 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 az to become subject to the Workers' Compensation Laws of California. Date ApplicantP you should NOTICE TO APPLICANT: If, after making this Certificate of Exem tion, y become subject to the Worker's Compensation proision"� he La drrCodede. you must z forthwith comply with such provisions or this pe C) CONSTRUCTION LENDING AGENCY r� 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.) a Q Lender's Name - + Lenders Address �z Icertify that I have read this application and state that the above information it CI comply with all city and county ordinances and state laws relating correct. agree to U building construction, and hereby authorize representatives of [his city to enter upon thi w above-mentioned property for inspection purposes. y C1, (We) agree to save, indemnify and keep harmless the City of against t s id Cit y liabilities, judgments, costs and expehich may in any way accrue against said Cit in conse uencSr,ppf the granting of thit. Z nvvt.t�ANP711NDERSTANI}S AX ILL COMPLY WITH ALL NON -POW SHINGLES 24 SQ, CLASS A—CONTRACTOR WINTER ROOFING PD FOR BL RENEWAL. 3162908" SOUaScction W25532(a)7 Sign Date MATERIALS DISCLOSURE material theure ipalCoding e. Chapter 9.12CCUpanLstorc ,anddthe Health and Safety Cupertd 0 Yes ° Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arra Air Quality Management District? �— O Yes 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 docs not curren0 ave a tenant, that it is my sponsihility m notify the occupant of the requirements h must met r i cc of a Certificate of Ocnipancy. Date Owner thorized a em Issued b. Re-roofE Are --a--- valuation $5210 ber Occupancy Type Required Inspections Type of Roof All roof 3 shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. f A licant Date 3ignatu.e o pp All roof coverings to be Class "B" or better 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31629087.00 DATE ISSUED.......: 08/C7/2007 RECEIPT #......... BS000002282 REFERENCE ID # 070E0054 SITE ADDRESS 102"3 NORWICH AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OPERATOR: suew COPY # : 1 OWNER ............: HELI�N TAI ADDRESS ..........: 102-73 NORWHICH AVE CITY/STATE/ZIP ...: CUPRTINO CA, 95014-2445 RECEIVED FROM JAVLER MARTINEZ CONTRACTOR MARPINEZ, JAVIER LIC # 21207 COMPANY WINTER ROOFING INC ADDRESS 151 WAYANDOTTE DR CITY/STATE/ZIP SAN JOSE, CA 95123 TELEPHONE 4083638052 UNIT QUANTITY AMOUNT PD -TO -DT THIS REC FEE ID ------ --- --NEW -BAL __ BPERMFEE VALUATION ---------- ---------- 5,210.00 126.36 0.00 0.00 126.36 0.60 0.00 0.00 BSEISMICRE VALUATION 5,210.00 0.60 107.00 0.-- 107.00 BUSLIC FLAT RATE 1.00 ---------- ---------- ------ ---------- 233.96 0.00 233.96 0.00 TOTAL PERMIT : METHOD OF PAYMENT AMOUNT REFERENCE -- NUMBER --- -------------------------------- CREDIT CARD --------------- 233.96 MC TOTAL RECEIPT 233.96 CITY OF CUPEI�TINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM �7 �OSOOS � APN #2 j^ � � Bldg Permit Fees Date: LJ ((� Energy — Building Address: Seismic Fee Res Owner's Name: BSEISMICOM Phone #: BUILDING BPLANCHK Y-0-2- License #: Contractor: IPhone #: Business License Y-0-97'Z - ' Contact: 1J Phone #: Cupertino usiness License #: At - Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof W- Asphalt Shingles 'Asphalt Shingles O 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 Ciertino's Tear Off Policy: Er Job Description: Residential Commercial ❑ � 1 Fire Zone: Yes ❑ No L — Confirmed with Planning Deft. if there are anrestrictions: Lf Cost of Project: Type of Constnlction: Occupancy group: -t�— 1 —►-= Qty. if Applicable ," Fee ID Fee Descriution 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 Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 CITY OF Fax: (408) 777-3333 CUPEk I O Building Department Subject: Re -roofing policy for the City of Cupertino 1. Prior to permit issuance, you must aF ree to comply with 1997 UBC Standards and manufacturers specifications on :-e-roofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the Tbuilding uthde 1 uldln inspector. hen the re -roofing on and approval'shall be obtained from g 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 ap Droval. 2) In -progress inspection approval. T 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. IMPORTANT: Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate 1.that there is no ponding. be on the job site at the time on inspection. 2. An I.C.B.O. report is required to I understand and will comply with the at,ove stated policy on re -roofing. Homeowner's Name: Job Site Address: Roofing Company Name: A plicant's Signature: Date: � Greg eel Building Official Revised 1/30/03 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # SUBCONTRACTO 0 �o 0 T- `7 BUSINESS LICENSE # OWNER'S NAME: ^ ' PHONE # — — GENERAL CONTRACTOR FAX # I am not using any subcontractors: Si e Date P1eaSe check applicable subcontra or d complete the following information: Owner/ Contractor Signature Date SUBCONTRACTO BUSI14ESS 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