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07080067 77777 CITY ®F CUPERTINO PERMIT IL I BUILDING DMSION PEL�MI1 PERMIT NO. BU11LD1NG DD ESS: 1651 N PORTAL AVE ARMSTRONG INSTALLATION 07080067 PERMIT ISSUE DATE IOWNER'S NAME: ' FREDRICKSON RAYMOND L AND 4575 SAV SANIT RY O. CONTROL NO. E:TT TTN T (510) 777-1234 BUILDING PERMIT INFO ARCHITECT/E;afrimn EER: BLDG ELECT PLUMB MECH �� (� (� 0 z CENSED CONTRACTOR'S DECLARATION Job Description 1 hereby that I am licensed under provisions of Chapter 9(commencing withScction7000)ofDivision3of[hcBusincss�ndProfessiuns and my TEAR OFF (E) WOOD SHINGLES AND INSTALL NEW 3016 Z in full force and feet. Jl FELT AND LIFETIME GAF COMP SHINGLES, 2100 SQ FT 4 Z Licensc L10' p DatcContraCtor ARCHITEC13DECLA INCH PITCH CLASS A 21 SQ FT u 1 understand my plans shall be used as Public records U t- Licensed Professional J OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the oa following reason.(Section 7031.5,Business and Professions Code:Any city or county li which requires a permit to construct,alter,improve,demolish,or repair any structure - Valuation w prior m its issuance,also inquires the applicant for such permit m file a signed statement t' Ft.Floor Area that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 `�q $19000 e (commencing with Section 7000)of Division 3 of the Business and Professions Code)or a0 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 316300 9 6p`UO Number not more than five hundred dollars(5500). C]I,as owner of the property,or my employees with wages as their sole compensation, Required Inspections do the work and the structure is not intended or offered for sale(Sec.7044,Business 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.). ❑I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contrdors U- cens Law does not ply to an owner of property who builds or improves thereon,and. who contracts or such projects with a contra or(s)1 tensed pursuant to the Contractors License Law. B&P C for this reason Q I am exempt under Sec Owner---------------- Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insure Cor 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. I have and will maintain Workers 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 Compe sation1nsuranee Cartier ad Policy n mbcr are: Carrier T Policy No.: CER FICA. F EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is or 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 Workers Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. 0 CONSTRUCTION LENDING AGENCY y ate•. 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 Nirnc Z Lender's Address I certify that I have read this application and state that the above information is Ocorrect.I agree to comply with all city and county ordinances and state laws relating to C) building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. y (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accme a ainst said City in consequ a of the granting of this permit. Date APPLI ERSTANDS AND WIL M WI NON-POINT Issued bt': SOU ATIO S. Re-roofs Signalu of ApplicanUContractor Dare Type of]Zoof 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 Codc,Section 25532(a)7 All roof, shall be inspected prior to any roofing material being installed. ❑YesIf 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 haYardous air contaminants as defined by the Bay Area Air Quality Management all new I naterials for inspection. District? D Yes kNo I have read the hazardtws materials requirements under ChayLcr 6.9 o the Califor- niaHcalth& tyCodc,Secuons25505,25533and25534. ndersin at the building docs not fly h a tenant,that it is my r nsib' to nouf c cupant n(the Date require whit ustb�metprior are caPancy' Slgnatur-OfAppli ant All roof coverings to be Class"B' or better Owner or authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN 31630096 . 00 DATE ISSUED. . . . . . . : 08,'08/2007 RECEIPT #. . . . . . . . . . BS000002300 REFERENCE ID # . . . : 07080067 SITE ADDRESS 10581 N PORTAL AVE SUBDIVISION . . . . . . CITY CU-?ERTINO IMPACT AREA . . . . . . OWNER FR:i,DRICKSON RAYMOND L AND JUDI ADDRESS 10581 N PORTAL AVE CITY/STATE/ZIP CU?ERTINO, CA 95014-2447 RECEIVED FROM ARMSTRONG INSTALLAT CONTRACTOR HOWARD FINE LIC # 22581 COMPANY ARMSTRONG INSTALLATION ADDRESS 4575 SAN PABLO AVE CITY/STATE/ZIP . . . : EMERYVILLE, CA 94608 TELEPHONE . . . . . . . . : (510)777-1234 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---------- --------- BPERMFEE VALUATION 19, 000. 00 266.76 0. 00 266 .76 0. 00 BSEISMICRE VALUATION 19, 000. 00 1.90 0. 00 1.90 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 268.66 0. 00 268. 66 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ------------------- CHECK 268. 66 868 --------------- TOTAL RECEIPT 268. 66 Community Development 51� 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIV OF Fax(408)777-3333 `'UPEkTINO Buildin De artment IORR'S B ADD ESS: PERMIT # `st I �f w/ NAME: C C tPHONE # v GENERAL CONTRACTOR: A,., , # R7 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the followinginformation 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile owner/Contractor Signature Date CITE' OF C'UPER`I'INO C"Y T FORM SSS 16 CAPPLICATION tJ�'��T6�10 PERMIT APN# 366`i6 . a 0 Date: � \z O Building Address: Phone ty,-14T sov111 - • / C ntractor: � � `l � �r License#- u Y nt �� Cupertil7o� �es�s u _L�icense #: �ct� , b Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles )k Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes AL Wood Shingles L1Wood Shingles El (Specify) Ll Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand a!]A Will Comply With Cu)ertino's Tear Off Policy: Jo Description: t ti C,S CAV` rS ` �'' �t . �' •mac.. , Residential-lp+. Commercial ❑ Q�a Fire Zone: Yes ❑ No %6 Confirmed with Planning Dept. if there are any restrictions: ❑ Cos Project: Type of o stru-Aion: Occ a c group: v DZz Qty. if Applicable Fee ID Fee Description Fee Group BPERMF'EE 31dg 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 Fax: (408)777-3333 Building Department Subject: Re-roofing policy for the City of Cupertino (. Prior [o perrnit issuance,you must a"ro e', t(> c1zzpIV with 997 UI_X' SLincf irck and manufacturers specifications on re--oofing. 2. New roof coverings shall not be applies 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 perfc rmed. 7. NOTE: If you call for a plywood nail irspection 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 above stated policy on re-roofing. Homeowner's Name: l' f,'�-C`'fa'1 Job Site Address: /y��l /!/. /�• fy. y'� Roofing Company Name: — G Applicant's Signature: Date: Greg Casteel Building Official Revise 311/2/04