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07080058 7-7777777777777777 CITY OF CUPERTINO fit' BUILDING DIVISION PERMIT L ` " PERMIT ` — PERMIT NO. BUILDR�G,(\Q9�SS:JOHNSON AVE DAN ELLIOTT' S ROOFING CO 07080058 l(J�j PM1IIT ISSUE DATE OWNER'S NAME: CURTIS LEE P 0 BOX 26 SANIT RY N CONTROL NO. J (408) 559-7327 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH Z LICENSED CONTRACTOR'S DECLARATION Job Description 0 f-- I hereby affirm that 1 am licensed undo provisions oCChaptcr 9(commencing - U with Section*X))ofDivision 3 ofthe Business and Professions Cade,and my license is REMOVE BUR-TRIM FASCIN - INSTALL OSB, GUTTERS, 2 in full forccand- ct. Lcensc1 Lic•8 LAYERS FELT, 30 YEARS FIBERGLASS CLASS A STANDARD z i -� p Date Contracwr CHL S DECLARATION GRADE FIBERGLASS SHINGLES OVER 2 LAYERS -- I and a m Ian blit records F- icensed Pru cssionaL a OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the Or� following reason.(Section 7031.5,Business and Professions Code:Any city or county fi 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 Glc a signed statement 9 Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 > m (commcncing with Section 7000)of Division 3 of the Business and Professions Code)or $7266 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 p Number Occupancy Type not more than five hundred dollars($500). 37528023 . E ❑1,as owher 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)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 Contractors 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: U I 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. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the perZEMPITION of the work for which this permit is issued. My Wo s om ensation I urr and Policy`number am: Carrier Policy No./— CERTIFICATE CERTIFICATE OFROM WORKERS' COMPENSATION INSURANCE Cniis 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 Workers Compensation provisions of the labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. O CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of r>_ the work for which this permit is issued(Sec.3097,Civ.C.) ] Q Lender'sNamc 2 Lender's Address 0 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 ahovc-mentioned property for inspection purposes. y (We)agree to save,indemnify and keep harmless the City of Cupertino against y liabilities,judgments,costs and expenses which may in any way accrue against said City Z in consequence of the granting of this permit. Date ►- AP CANT UNDERSTANDS AND WILL CO LY WITH ALL NON-POINT Issued by SRdkrGULATIONS.CW Re-roofs Signature of ApplicanNContracnr Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE yp 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 - no � If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new rr aterials for inspection. District? ❑Yes �No 1 have read the hazardous materials requirements undcrChaptcr 6.95 of the Califor- / /1 ria Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building r l � r+' docs �uretuyyly have a tenant.that it is my responsihi ty to iroriry the occupant of the req "em nls v(4 ich must be mel t iss or rampancy. Signature of Applicant Date 76 34 All roof coverings to be Class"B" or better Own r or authorized agent Date Community Development 10300 Torre Avenue Cupet ino CA 9--5014 Telephone(408)777-3228 I F Fax(408)777-3333 PfkT-1 NO B licii D , � - JOB ADDRESS: PERMIT# ka�5o J�� ns�; v, NQf h� OWNER'S NAME: Mr C 1,\s L eE. PHONE # GENERAL CONTRACTOR: ( o. 1S FAX # �c7 I am not using any subcontractors: / i� ature Date Please check applicable subcontractors and da ete the folloWmi information: LS 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 Q Roofing , Septic Tank Sheet Metal Sheet Rock ile Owner/Con tr c r Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 E T Fax: (408)777-3333 CIDP �, �0 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 C qty;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 n�dl inspection is required. 6. Any roofing which is applied without first obtaining aninspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be`pErformed. 7. NOTE: If you call for a plywood nailrinspec-tiori and the job is not ready, you will be charged a re-inspection f ae of$176.18. The re-inspection fee must be paid before another inspection_em be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of?'4" per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be cn the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: \NNr r ��s -?--e lo�5G` ` Job Site Address: Roofing Company Name: lbeL h Applicant's Signature: Date: "�`(�'1 Greg Casteel Building Official Rei ised 11/2/04 Pr nraa nn Recmied Paper CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 37528023 . 02 DATE ISSUED. . . . . . . : 0E/07/2007 RECEIPT #. . . . . . . . . . BE000002285 REFERENCE ID # . . . : 07080058 SITE ADDRESS . . . . . : 10650 JOHNSON AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CLPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . CLRTIS LEE ADDRESS . . . . . . . . . . : 10650 JOHNSON AVE CITY/STATE/ZIP . . . : CLPERTINO, CA 95014 RECEIVED FROM . . . . : DPN ELLIOTTS ROOFIN CONTRACTOR . . . . . . . : DPN ELLIOTT LIC # 21466 COMPANY . . . . . . . . . . : DPN ELLIOTT'S ROOFING CO ADDRESS . . . . . . . . . . . P 0 BOX 26878 CITY/STATE/ZIP . . . : SPN JOSE, CA 95159 TELEPHONE . . . . . . . . : (408) 559-7327 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 7, 266. 00 147 .96 0. 00 147 .96 0. 00 BSEISMICRE VALUATION 7, 266 . 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 13038 --------------- TOTAL RECEIPT 148.76 CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN# 3 � Z�� Date: � Building Address: r fL2 s U Owner's Name: Phone#: Contractor: hone : License#: c%,-Y\ ra �� r 6� (Oki 3 �� Contact: Phone IF: Cupertino Business License#: GL 41 tC C' S fi,rlLl 4 co Type of Roof Covering: Existing: Proposed: ® Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles W Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings O Provide I.C.B.O.Report# a To be Removed ❑ Provide Mfgr.Installation Specs. ave Rea , erstand and Will Comply With Cupertino's Tear Off Policy: 19 Job Descri tion: ` �)�'kehers` sidential Commercial E] r '3c tarry F'iy k S Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions. LJ Cost of Project: Type of Constriction: Occupancy gro p: �—' 1 Z t17 fi 0 S''� 4--be Cl VVI S f4 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 Pl`x ?�G c��s��ss �a,Y1��A `CC� - �(tke S1��no�le � e��er� � rs tt'v; L\ass Sh r1Cr��