07080147CITY OF CUFEKI11NU
BUILDING DIVISION PERMIT
eulLDl Yg$: RI:ssWOODBURY DR
OWNER'S NAME
MARILYN BECK
iE:
ARCHITECTIENGINEER:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and effect. * — S ✓?��'
License Class Lie. ti
Date Q9! _J� Contractor
ARCHITECTS DECLARATION
I understand my plans shall he used as Public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
prior m its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions 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 ($500).
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 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.).
❑ 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
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
Lic°� Law. B & P C for this reason
❑ 1 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-insum 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 ve and will maintain Workers Compensation Insurance, as required by Section
3706 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance
carrier and Policy number ate:
Carrier. ?' E ��Y p Policy No.:� � 'rye, R (,3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION I14SURANCE
(This 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
C5 forthwith comply with such provisions or this permit shall be deemed revo c .
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
ahove-mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, toss and expenses which may in any way accrue against said City
Aconisme of the granting of this permit.
UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
GULATIO ��r�^--•---._. Date
V (/ -HAZARDOUS MATERIALS DISCLUSUttt
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)7
Cl Yes o
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor.
nia Health &Safety Code, Sections 25505, 25533 and 25534.1 understand that if the building
doe i -o prmnOy have a tenant, that it is my responsibility to notify the occupant of the
L( fit( is which must & mel ptis(Ulissuance ora Certificate of (.�pcypancy.
Owner or authorvs agent V U Date
PERMIT NO.
JIM KR7.USE ROOFING 07080147
PERMIT ISSUE DATE
2310 DIANA AVE
SANITARY NO. CONTROL NO.
(408)7"'9-0704
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
NO EXISTING WOOD SHAKES 1 LAYER, SHEET 7/16 OSB,
301B FELT LANDMARK TL COMP SHINGLES
Sq. Ft. Floor Area
32619007`. Number
Issued E
Re -roof
Type of Roof
valuation
$13000
occupancy type
Required Inspections
All roof's shall be inspected prior to any roofing material being installed.
If a roo r is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature 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
Buildin De
art
OB ADDRESS: PERMIT #
OWNER'S NAME: PHONE # Yoe
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: ) )
Signator Date
_1__..L7...,..1.. 4 -...,,.1 - +ha fnllnwina information:
�r-a
Owne " ontractor Signatur
e—/S7,-
Date
—/S",-Date
60
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
�r-a
Owne " ontractor Signatur
e—/S7,-
Date
—/S",-Date
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: B1{: Lot:
APN ......... 32519067.00
DATE ISSUED.......: 08/15/2007
RECEIPT #.........: BS300002390
REFERENCE ID # ...: 07380147
SITE ADDRESS 21884 WOODBURY DR
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OPERATOR: CathyS
COPY # : 1
OWNER MARILYN BECK
ADDRESS : 21884 WOODBURY DR
CITY/STATE/ZIP ...: CUPERTINO, CA 95014-1148
RECEIVED FROM EDWARD A GREGORY
CONTRACTOR KFAUSE, JIM LIC # 21415
COMPANY JIM KRAUSE ROOFING
ADDRESS . 2310 DIANA AVE
CITY/STATE/ZIP ...: MCRGAN HILL, CA 95037
TELEPHONE (908)779-0704
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
-----------------------
BENERGY PERMIT FEE
----------
201.96
----------
96.94
----------
0.00
0.00
96.94
201.96
0.00
0.00
BPERMFEE VALUATION
13,000.00
201.96
0.00
1_ 30
0_00
BSEISMICRE.VALUATION
13,000.00
1.30
-----
------
TOTAL PERMIT
300.20
0.00
300.20
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
300.20
---------------
300.20
REFERENCE NUMBER
--------------------
MC
CITY OF IEUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # Z
[ U (� v
-
BUILDING
Date:
Building Address:
JCS c� v� vz
b
BSEISMICRE
Owner's Name:
BUILDING
BSEISMICOM
Pho (- D �- ,3v 7/
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
Contractor:
��
Business License
License #:
Contact:
Cupertino Business License #:
J
�rl1`Y'lL
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑
Built -Up roof
❑ Asphalt Shingles
6 Shakes
�
❑
Asphalt Shingles
Wood Shakes
Wood
❑ Wood Shingles
❑
Wood Shingles
❑ Other (Specify)
Number of existing coverings
❑
( ❑
Other (Specify)
Provide I.C.B.O. Report #
XTo be Removed
❑
Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com I With Cupertino's Tear Off Policy:
Job Description:�j/p �� f 1,' , } W vd d 4 h z / 4 y e
r lT B >%ib 3aJ 3c, lb lei h,
Residential
Commercial , ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Det. if
LJ
there are any restrictions:
Cost of Project:
Type of Constniction:
Occupancy group:
/:3 o0o
Qty. if
I- TT -N
FPP DPcr.rintion
Fee Group
Appiicanie 1,Uk-, 11-1
BPERMFEE
- -- — -----r -
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 agr 2e to comply with 1997 UBC Standards
and manufacturers specifications on rE-roofing.
2. New roof coverings shall not be appliE d without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the bt ulding 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 Cite, 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 . inspection is required.
6: Any roofingwhich 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 per:'ormed.
7. NOTE. If you call for a plywood nail nspection 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:
Roofing Company Name:
Applicant's Signature: o Date:
Greg Casteel
Building Official
Revised 11/2/04