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07080109CITY OF CUFEKI IINU BUILDING !15IVISION PERMIT BUILDIg 6 9 LOLN OWNER'S NAME: MATHIS ATHYLIN H TR AND . rJAT) T V ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am Ii used under provisions of Chapter 9 (commencing x'ith Section 7000) of Djisio 3 of the Business and Professions Code, and my license is n full force and effect 3� �� ', �� License Class Lic. # _ Date t — C tactor ARCHITE77 CLARA I understand my plans shall be use33 a records \ Licensed Professional OWNER -BUILDER DECLARATION 1 hereby 'affirm that I am exempt from the Contractor's License Law for the following rcasori. (Section 703 1.5, Business and Professions Code: Any city or county whichrequites 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 statcmcnt that he is licensed pursuant to the previsions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 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 not more than five hundred dollars (5500). 0 I, 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 salt (Sec. 7044. Business 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.). 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Professions Code:) "fie Contractor's U - cense Law does not an of property who contracts for such projects with arh c ntractor(s) Olicensed pursuant to the Contractoes License:Law. B & P C for this reason 0 1 am exempt under Sec Owner Date WORKI3t5 COMPENSATION DECLARATION O a Q �z )0 U H �a H �z -- PERMIT NO. R E ROOFING & CONSTRUCTION 07080109 - PERMIT ISSUE DATE 15230 CLYDELLE AVE ns/1212007 SANITARY NO. CONTROL NO. (408)626-9320 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH G_J 1 hereby affirm under penalty of perjury one of the following declarations: I hate and will maintain a Certificate of Consent to self -insure for Worker's Conrpen- au , as provided for by Section 3700 of the Labor Code. for the performance of the , which this permit is issued. �jj I have and will maintain Worker's Compensation Insurance. u required by Section of the Labor Code, for the performance of the work for which this permit is' sed. Ay Worker's compensation Insurance carrier and Policy n b�iare- varier. Poliry No.: CERTIFICATE UP fcAtmriION FROM WORKERS' COMPENSATION INSURANCE (This section need not be compacted if the permit is for one hundred dollars ($100) nr less.) I certify that in the performance of the work for which this permit's 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 Worker's Compensation provisions of the Labor Code, you must 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-) Lender's Name Lender's Address 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 above-mentioned properly for inspection purposes. (We) agree to save, indemnify and keep harmless the City of Cupertino against liabilities, judgments, casts and expenses which may in any way accrue against said City in consegAence��(�m,•c granting of this permit. . _ „.e.&1 rn•wrnc Alen wit i_ rnMPLY WITH ALLtNON-POINT Job Description REMOVE (E) 1 LAYER OF WOOD SHAKES, INSTSALL 1/2'' CDX 30# FELT & ASPHALT COMP CLASS A Sq. Ft. Floor Area $9500 valuation VN Number I occupancy iyUa 359190 9 Signature of Applica6 c. - Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hic us material as defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? 0 Yes Xf. Will the applicanbuilding occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality ManagcmcAt, District? 0 Yes o r 1 have read the hazardous m rials requirements under Chapter 6.95 of the,Califor- nia Health & Safety Code, Sections 25505, 25533 and 25534. I understand that if the building does.rrorcu sly have a tenant, that it is my tSs nsibility to notif the occupant of the. iequircmcnL ich st !�Zwl qer totissuapcc j a Ccrifica o cup Owner or authorbzd agent Date Issued 1 Re -roof Required Inspections Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a rocf is installed without first obtaining an inspection, I agree to remove aH�agw mate ' r inspection. Signat(.re of Applicant Date All roof coverings to be Class "B" or better Community -Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: �rNlk � i �, PERMIT #vtY l OWNER'S NAME: PHONE # GENERAL CONTRACTOR: - FAX # ori I am not using any subcontractors,--. S Date Please check applicable subcontractors and cum pielu ULC 1VuV vvu Lr, uL=W1==Lu"W1 SUBCONTRACTOR BUSINESS NAME L. BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Flooring: PG Linoleum / Wood / 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 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIP RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN 35919029.00 DATE ISSUED.......: 08/13/2007 RECEIPT #.......... BS000002351 REFERENCE ID # ...: 07080109 SITE ADDRESS .....: 869 LONNA LN OPERATOR: CathyS COPY # : 1 SUBDIVISION ....... CITY .............. CL PERTINO IMPACT AREA ...... OWNER ............: MP.THIS ATHYLIN H TR AND CHARLE ADDRESS ........... 8E9 LONNA LN CITY/STATE/ZIP ...: CLPERTINO, CA 95014-4324 i RECEIVED FROM ....: R E ROOFING :• CONTRACTOR .......: PF.00TOR, PAUL LIC # 20615 COMPANY R E ROOFING & CONSTRUCTION INC ADDRESS ..........: 1`_230 CLYDELLE AVE CITY/STATE/ZIP ...: SlN JOSE, CA 95032 TELEPHONE ........: (4:08)626-9320 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ----------------------------- `BERMFEE VALUATION 9,500.00 169.56 0.00 169.56 0.00 $SEISMICRE VALUATION 9,500.00 1.00 ------- 0.00 1.00 0.00 ----------- TOTAL PERMIT :_ 170.56 0.00 170.56 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ------ CHECK 170.56 11236 _ TOTAL, RECEIPT 170.56 y CITY OF ("UPE `L^ Il O r r e� EkT C UPI O PERMIT APPLICATION FORM a-�o8o 1v� APN # 3 G �j6 s -I, j C --_ -- -----r -- Bldg Permit Fees Energy Seisnuc Fee Res Seismic Commercial Date: BPLANCHK Building Address: q Low BUILDING OMiner's Marne. R"5 Business License Phone Y - -- - -- - -- - Contract License #: 1215 Contact: ,� Cupertino Bus Ie Li ense #: �L Type of itoof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof Asphalt Shingles ❑ Asphalt Shingles Wood Shakes ❑ Wood Shakes L] Shingles Ll Wood Shingles Li (Specify) ❑ Other L] Other (Specify) Provide I.C.B.O. Report # Number of existing coverings Li To be Removed L) Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cripertino's Tear Off Policy: Job Description: '�y;rlo k �A I�j i tj L( uaL_ 1N 0 1m S U KKC-) Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if ❑ there are any restrictions: Cost of Proje 4 • �� Type of Constriction: Occupancy grou C7 5 Qty. if T __ TT% FPP TiPcrrintinn Fee Group Applicat) rcc iL BPERMFEE BENERGY BSEISMICRE BSEISMICOM --_ -- -----r -- Bldg Permit Fees Energy Seisnuc Fee Res Seismic Commercial BUILDING BUILDING BUILDING 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 1'1"I(J1' tU p(1')illL ISSUa)_ZCc, /loll Il1tlSt agl'�';' [()comp! �' l`�1Lli _��/ l)ESL �� and manufacturers specifications on re-roofilzg. 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 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 performed. 7. NOTE: If you call for a plywood nail vispection 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: Job Site Address: WC Roofing Company Name: 1 Applicant's SignaturDate: ............. Greg Casteel Building Official Revised 11/2/04