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07080128 CITY C.F CUPERTINO ER T��f7� p �� BUILDING DIVISION P1ii�lYll 1 PERMIT NO. 6UI_LL DIrc�.. gss:SAN FELI PE RD CORNER TONE ROOFING 07080128 ' i PERMIT ISSUE DATE OWNER'S NAME: VINH IRAN 1605 MCNTELLANO err Q8 /1412-007 SANITARY NO. CONTROL NO. (408) 957-9788 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH (� E _ z LICENSED CONTRACTOR'S DECLARATION Job Description C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing UL with Section 7000)ofDivision 3 ofthe Business and Professions Codc,and my license is REMOVE SHAKES/ INSTALL 2 PLY 301B IN STALL N L eneClassdcffectr—S� Lic.N �SZ� LITEWE7.GHT TILE CALSS A 41 SQFT z License Class G� �(„rte ® Contractor RATI tta0 Date � l ARCHITECTS DECLARATION CORNERSTONE ROOFING PAID FOR BL 08/14/07 i I understand my plans shall be used as public rcccrds U _ Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the ofollowing(Cason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter•improve,demolish•or repair any structure Valuation � prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area that he is licensed pursuant to the provisions of the Contractor's Li censc Law(Chapter 9 q $18000 o (commencing with Sccdon 7000)of Division 3 of the Business and Professions Code)or `4 that he is exempt therefrom and the basis for the alleged exemption.Any violation of pN Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 4 2 2 2 0`12P Number not more than five hundred dollars($500). 0 I,as owner of the property,or my employees with wages as thew sole compensation, Required Inspections will do the work and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his awn employees,provided that such improvements are not intended or offered for sale.If, however,the building or improvement is sold within one year of completion,the owner- builder will have the burden of proving that he did not build or improve for purpose of sale.). 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044.Business and Professions Code:)The Contractors Li- cense Law does not apply to an owner of property who builds or improves thereon,and. who contracts for such projects with a contractors)licensed pursuant to the Contractors License law. ,B&P C for this reason Q I am exempt under Sec Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: .have and will maintain a Certificate of Consent toself-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Workers C,[om nsation Insurance carrier and Policy number ate: /_ 7�y� Cartier. `A l r Policy No.:CQ S'$lo CERTIFICAI F EXEMPTION 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,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 Z 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.) a Q Lender's Name 2 Lender's Address 1 certify that I have read this application and state that the above information is Ocored.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 w above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against ti V) liabilities,judgments,costs and expenses which may in any way accrue against said City 'Z in consequence of the granting of this permit. 4 Date ' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued Ly: SOU EGULATIOIS. �y4- �- �� 7 Re-roof; C .� Signature of Applicant/Contractor Dam Type of Roof HAZARDOUS MATERIALS DISCLOSURE YP Will the applicant or future building occupant store or handle ha-rardous 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. CYes � If a roo is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspec*'tion. District? / Yes o I have.read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafetyCode,Sections 25505,25533 and 25534.I understand that if the building /J6S'^' �J docs not currently have a tenant,that it is my responsibility to notify the occupant of the Date requireme ch must he met p' r to issuance of a Certificate of Occupancy. S lgnatu f e of Applicant All roof coverings to be Class"B" or better Date Owner or authorized agent Community Development 10300 Torre Avenue fy Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Building Department JOB ADDRESS: PERMIT # fo '3 'SAY) Fe- � T?4 ' 1,'-?p �- OWNER'S NAME: Me -1IZAvt PHONE # P -26--CS-7 GENERAL CONTRACTOR: C' N ,�-� t�a, ,.� FAX# I am not using any subcontractors: �� / Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSI14ESS 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 -19� :3�-- Owner/Contractor Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT' RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34222092 .00 DATE ISSUED. . . . . . . : 08 /14/2007 RECEIPT #. . . . . . . . . : BS'000002372 REFERENCE ID # . . . : 07)80128 SITE ADDRESS 10535 SAN FELIPE RD SUBDIVISION . . . . . . . CITY CU?ERTINO IMPACT AREA . . . . . . . OWNER VI:l7H TRAN ADDRESS 10335 SAN FELIPE RD CITY/STATE/ZIP CUPERTINO, CA 95014 RECEIVED FROM CORNERSTONE ROOFING CONTRACTOR . . . . . . . : BIPTLE, RUSSELL LIC # 21215 COMPANY CORNERSTONE ROOFING ADDRESS 1605 MONTELLANO CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95120 TELEPHONE . . . . . . . . : (408) 997-9788 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - ---- ---------- ---------- ------ --------- BPERMFEE VALUATION 18, 000. 00 255 .96 0. 00 255 .96 0. 00 BSEISMICRE VALUATION 18, 000. 00 1.80 0. 00 1 . 80 0. 00 BUSLIC FLAT RATE 1. 00 107. 00 0. 00 107 . 00 0. 00 TOTAL PERMIT 364 .76 0. 00 364 .76 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 364 .76 6055 --------------- TOTAL RECEIPT 364 .76 XPERTINO CITY OF C -iml- A CUPEI Al Fr kTINO PERMIT APPLICATION FOIA G APN# � 2 O ( Z Date:`1 Z2 Building Address: I Iota_ owner'sNarne: Phone #: Contractor: License 1 : CvRri�,S�oN e 1NvCJ Fr•-7 L-;S'7t�� Cupertino Business License #: Contac -7_ -03 -Z 2 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles J- Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) 4a- Other(Specify) ! �� l �G' �2 t�S 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 Cupertino's Tear Off Policy: ❑ ss Job Description: lac nv�� S reS rl ll t o do rN sot 1 Z' -.Cj+_ L7� �® Residential Commercial ❑ •Fire Zone: Yes ❑ No �. Confirmed with Planning Dept. if there are any restrictions: ❑ Cost of Project: T e of Constrruu3tion: Occupancy group: 191 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 Prior to permit issnz�«ce, you inust agre > to comp(- with r aQ U1�C: St<<ru{arc's 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 City, the following steps are required: 1) Pre-inspection and/or tear off apprc val. 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 inspection 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 he 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: Roofing Company Name: Applicant's Signature: - — Date: Greg Casteel Building Official Revised 11/2/04