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07080105 CITY OF CUPERTINO n� � �� BiiTLDINGUIV]SION ��1WA11 PERMIT NO. """ G ss: WOODS RODFING_ 07080105 - (�� BYERLY CT pERMITISSUE DATE OWNER'S NAME: 3 12007 . ANI L GODBOLE 10 2 0 H I CKOR SANITARY NO. CONTROL NO, E: (831) 637-5576 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 e 0 LICENSED CONTRACTOR'S DECLARATION Job Description C I hereby affirm that F am licensed under provisions of Chapter 9(commencing essandprofessionsCode,andmylicenseis REMOVE SHAKE ROOF REROOF OSB COMP 50YR SHINGLES — withScction70(1U)ofDivision3ofthcBusin F in full force and if 3 5 J 370 C LA:S A Vi LIC,ti 7 Liccnsc Class ContractorirlfrlsrG p Date ty ARCHITECf-S DECLARATION . I understand my plans shall he used as public records V l- Licensed Professional a OWNER-BUILDER DECLARATION `a I hereby affirm that 1 am exempt from the Contractor's License Law for the ny city or county O following reason.(Section 7031.5,Business and Professions Code:A �i which requires a permit to construct,alter•improve,demolish•or repair any structure Valuation y prior m its issuance,also requires the applicant for such permit to rile a signed statementF Ft.Floor Area $17332 G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9a' F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or Occupancy Type F that he is exempt therefrom and the basis for the alleged exemption.Any violation of1�Number Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of3421208-- . V not more than five hundred dollars($500). 0 1,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.). p 1,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 does not apply to an owner of property who builds or improves thereon,and F who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. B&P C for this reason ❑i am exempt under Sec Date Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: "f have and will maintain a Certificate of Consent to self-insure for Workces compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑1 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 Worker's Compensation insurance carrier and Policy number arc: ``� Policy Cartier.rZl� 1_ �v�—Poli No.: CERTIFICATE OF EXEMPITON FROM WORKERS' COMPENSATION INSURANCE (•Ibis 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. :C) CONSTRUCTION LENDING AGENCY a rte- 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 Z Lender's Address I certify that i have read this application and state that the above information is Ocorrect.1 agree to comply with all city and county ordinances and state laws relating to C> building construction,and hereby authorize representatives or this city to enter upon the y W ahove-mentioned property for inspection PurPoses. L>~ (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in anyway accmc against said City Date ' Zin consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b.- SOU E R ATTONS. ,A ! to 7 Re-roofs 4( Signature of ApplicaDO °a" Te of Roof HAZA HAZARDOUS MATERIALS DISCLOSURE y 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 roof;shall be inspected prior to any roofing material being installed. C]Yes NO If a roof is installed without first obtaining an inspection,I agree to remove "Jill the applicant or future building occupant use equipment or devices which all new materials for inspection. ardour air contaminants as defined by the Bay Area Air Quality Management Di. ,,? Yes F.3,N° I have read the haTardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building Date docs not currently have a tenant that it is my responsibility to notify the occupant of the 'e of Applicant requirementswiticlijustbe met prior to issuance of a Ccrtific of Occupancy Signatu: -/307 All roof coverings to be Class.,B" or better Date Owner or authorized agent Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF ''UPEkTINO nt Buildi�l ie artme LD1 CSS JOB ADDRESS: . PERMIT PHONE # � OWNERS NAME: ti' r FAX# ;;z C.;GENERAL CONTRACTOR: �� ` _•�✓ = �^' eF f_;; I am not using any subcontractors: Date Signature Please check a licable subcontractors and complete the followingBLT NESS LICENSE # SUBCONTRACTOR BUSIrIESS NAME 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 Date Owner Contractor ignature CITY OF CZJPERTINO OPERATOR: CathyS PERMIT -2ECEIPT COPY # 1 2 ITEMS OF 2 Tom; Rng: Sub: Blk: Lot: Sec: 34212081.00 APN • 08/=-3/2007 DATE ISSUED. • • • • . ' : 08/--300007 RECEIPT #- • • " " ' ; 07030105 REFE2346 RENCE ID # SITE ADDRESS 10209 BYERLY CT SUBDIVISION • • • . . . CUF-ERTINO CITY . . . . . . . . . . . . IMPACT AREA . . . . AN--L GODBOLE OWNER " " " ' 1p!�09 BYERLY CT ADDRESS . . " ; 10 ERTINO, CA 95014-5647 CITY/STATE/ZIP • • • LAWRENCE WOOD LIC # 20810 RECEIVED FROM WCOD, LAWRENCE E CONTRACTOR WCODS ROOFING COMPANY • • • " " ; 1020 HICKORY CT ADDRESS • HOLLISTER, CA 95023 CITY/STATE/ZIP (831) 637-5576 TELEPHONE . . . . . * • ' THIS REC NEW BAL AMOUNT PD-TO-DT ---------- UNIT QUANTITY ------- ---------- ----- --- 0. 00 FEE ID -------- ---------- --- 96 0.00 96 0. 00 ------ -- 255 . 17 , 332 . 00 0.00 1.80 ----- BPERMFEE VALUATION 17 , 332 .00 1 .80 ---------- ---------- ----- -- 257 .76 0 .00 BSEISMICRE VALUATION ----257 .76 p_00 TOTAL PERMIT AMOUNT REFERENCE-AMBER__ METHOD OF PAYMENT --- ----- _ ------ ---- 257 .76 VS CREDIT CARD --------------- 257 .76 TOTAL RECEIPT : CITY OF CUPERTINO RI 01y0r PERMIT APPLICATI®N FORM C) D (jj p S CUPERTIN Date: APN# (� -13� v 7 Build)ng Address: ,� 7 7` d o?O Phone#: Owner's Narne: o_D l9--- - - ---------- -- License#: Contractor: ,/� 5 A"—J 3 — wG�> s 1' �� Cupertino Buses icense #: Contact: Type of Roof Covering: Proposed: Existing: ❑ Built-Up roof ❑ Built-Up Roof �° Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes Ji` Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) ❑ Provide I.C.B.O. Report# Number of existing coverings __— ❑ Provide Mfgr.Installation Specs.- To be Removed �QH�aveRe�ad, nderstand and WillComply With Cupertino's Tear Off Policy: 5_0 7W Job Description: n pa�� (j S jj ��m�`' S��rtiG'� d Residential Commercial ❑ Confirmed with Planning Dept. if Fire Zone: Yes ❑ No there are any restrictions: ❑ Occu an grow - ost of Project: CType of Constn ction: p Qty. if Fee Description Fee Group Applicable Fee ID BUILDING 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