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07080102 7_77-777777777— CITY OF CUPERTINO BUILDING DIVISION PERMIT WILDING ADDRESS: PERMIT NO. 7527 TIPTOE LA MBROWN CONSTRUCTION, INC 07080102 OWNER'S NAME: PERMIT ISSUE DATE YAMADA KO W AND JOANN S 702 S• D SA I ARY O. CONTROL NO. (408) 260-1260 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH z LICENSED CONTRACTOR'S DECLARATION o Job Description E- I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)ofDivision3ofthcBusiness and Professions 7Cod^c,andmylicenscis REMOVE 1 LAYER OF SHAKE AND INSTALL APROX. 37 �-- in full force and cct �7I��7�u / Lic.q-ate LLLL�� COMP z License Class "- o Date Contractor ARCHITECTS DECLARATION CLASS A ROOF AND SHEATING -�' I understand my plans shall be used as public records U t" Licensed Professional a OWNER-BUILDER DECLARATION a 1 hereby affirm that 1 am exempt from the Contractor's License Law for the Ofollowing reason-(Section 7031.5,Business and Professions Code:Any city or county �i which requires a permit to construct,alter,improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area 0f with Section 7000)of Division 3 of Ore Business and Professions Code)or $6000 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 Number Occupancy Type not more than five hundred dollars($500). 35928010 . V V 0 1,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 oro(fered 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 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors 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 contractors License Law. 0 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: 0 I have and will maintain a Certificate of Consent to self-insure for 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. 0 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 Workers C tttie�is tion 1nran(�airier and Polity number are: Carrier. fin Policy No.: CERTIFICATE OF EXEMPTION FROM WO COMPENSATION INSURANCE (This section need not be completed if the permit is Cor 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 Califomia.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 O forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY �+ 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.) I Q Lender's Name Z Lender's Address Q 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 Ubuilding construction,and hereby authtrrae representatives of this city to enter upon the y above-mentioned property for inZs ion purposes. y 1� (We)agree to save,indcmn'y and keep harmless the City of Cupertino against r/I liabilities,judgments,costs and cx rises which may in any way accrue against said City z in consequence of the granting o is permit. Date �� U APPLICANT AND WILL COMPLY WITH AL NON- OINT Issued by: _ SOURCE REG ��76 A ` Re-roofs 2 Signature of Applicant/Contractor ate HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store or bandit 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. 0 Yes 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 n.aterials for inspection. District? 0 Yes Qy4u 1 have read the hazardolmatcrials requirements under Chapter 6.95 orthe Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building \� docs not currently have a tens t,that it is my re risibility to notify the occupant of the requirements which must be tiny t°isx ce of a Ccrdricate of Occupancy Signature of Applicant Date Owner or authori-rsd agent Dat All roof coverings to be Class"B" or better -t Community Development h. 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '7UPEkTINO Building Department JOB ADDRESS: PERMIT # O R'S NAME: ; Gl M GX PHONE # 4/0:� -2 3 0 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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/ ontractor Signature ate CITY OF CUPERTINO Rl,ROOF CUPEkTiNO PERMIT APPLICATION FORM APN# U ,� !\ Date: Building Address: Ian I Owner's Name: I YYIPhone#: f Q ad o-, "! 0 3 Contractor: ense Sf OfZZ Contact: C �a Cupertino Business L'cense #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles Wood Shakes El 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 C u ertino's Tear Off Policy: Job Description: PemGv-e, i 1 A jcr 5-�AaC.e gOCA uK"i1 ofJ'C,—• �'F �m� qSs I^Z�b �i/J I Residential Commercial ❑ Fire Zone: Yes ❑ No E•1� Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Construction: — Oceu pancy gr9Ap- 3 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 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 buildutg 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 arty 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 nai 1 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 performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fe�of$176.18. The re-inspection fee must be paid before another inspection c&-t 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 or.the job site at the time on inspection. I understand and will comply with the above st ted policy on re-roofing. Homeowner's Name. Job Site Address: Roofing Company Name: �a/o7 Applicant's Signature: Date: Greg Casteel Building Official Revi:,ed 11/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 35928010. 00 DATE ISSUED. . . . . . . : 08/10/2007 RECEIPT #. . . . . . . . . . BS000002338 REFERENCE ID # . . . : 07080102 SITE ADDRESS . . . . . : 7527 TIPTOE LA SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : YAMADA KO W AND JOANN S ADDRESS . . . . . . . . . . . 7527 TIPTOE LA CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5836 RECEIVED FROM . . . . : M BROWN CONST CONTRACTOR . . . . . . . : CHRIS BROWN LIC # 25108 COMPANY . . . . . . . . . . : MPROWN CONSTRUCTION, INC ADDRESS . . . . . . . . . . : 702 S. DANIEL WAY CITY/STATE/ZIP . . . : SAN JOSE, CA 95128 TELEPHONE . . . . . . . . : (408) 260-1260 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 6, 000.00 126 .36 0. 00 126.36 0. 00 BSEISMICRE VALUATION 6, 000. 00 0. 60 0. 00 0. 60 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 126 .96 0. 00 126.96 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 126.96 AX --------------- TOTAL RECEIPT 126.96