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07080148 CITY OF CUPERTINO BUILDING DIVISION PERMIT � ` � � URTI(�N. PERMIT NO. BUILDING ADDRESS: 1024 NOVEMBER DR SHADOWFAX ROOFING 07080148 PERMIT ISSUE DATE OWNER'S NAME: ROGERS LARRY G AND NANCY L 1366 SANTA FE DR 08/15/2007 SANITARY NO. CONTROL NO. JE: (408) 265-2490 BUILDING PERMIT INFO ARCHITECTlENGINEER: BLDG ELECT PLUMB MECH 9 Z LICENSED CONTRACTOR'S DECLARATION o Job Description VP I hereby affirm that I am licensed under provisions of Chapter 9(commencing z UUJ with Section 7000)of Division 3 of the Business and Professions Code,and my license is REMOVE ?IND ERPLAC E (E) ROOF SWITCH COMPOSITION in full!fPrce and cffe 'L '3 v�Z License 1 a Lic.# Contractor ARCHITECTS DECLARATION 1 a a I understand my plans shall be used as public records yU O H Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the :p o 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 Z r prior to its issuance.also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation =Q that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq $13170 t_ (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 ofNumber Occupancy Type not more than five hundred dollars(SSW). 36215 0 0 8 � 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 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 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.). 0 I,as owner of the property,am exclusively contracting with licensed convectors to construct the project(Sec.7044,Business and Professions Code:)The Contractors U. cense Law docs 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 exem t under Sec B& C for this reason Owner _ WORKER'S COMPENSATION�DECLARA�TION' I hereby affirm under penalty of perjury one of the following declarations: 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 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 Compensation IInsuran-c rricr and Policy number am'. Ca SAM I Policy No.:--iff-0 a CERTIFICATE OF EXEMPTION FROM WORKERS 2a0 COMPENSATION INSURANCE (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 �Z forthwith comply with such provisions or this permit shall be deemed revoked. z OCONSTRUCTION LENDING AGENCY (~- vim+ 1 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.) QLender's Name Z) Z Lender's Address U C) I certify that I have read this application and state that the above information is Ll.. correct.I agree to comply with all city and county ordinances and state laws relating to CUbuilding construction.and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City U'Z iA,C�quencSA granting oC this it. Date d RSTANDS A ILL COMPLY WITH ALL N N-POI Issuedb3:IONS. Re-roofs ucon tar D Type of Roof HAZARDOUS RIALS DISCLOSURE yP Will the applicant or future building occupant store or hand a 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 lu Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new r laterials for inspe .ion. District? 0 Yes I have read the hazardous material requirements under Chapter 6.95 of the Califor- nia Health alifor-niaHealth afclyCode.Sections 2550,25533and 25534.1understand that ifthebuilding (/ docs n c ntly have a tenant,Lha i y responsibility to notil'y txxup t of the -- rcq - n which must be met ssu a Ccrtific f c}tpatt� Ignaturt; Ap icantD e ✓L All roof coverings to be Class"B"or better ncr or authori-r age Dat CITY OF C'UPERTINO CUPETINO PERMIT APPI,ICATI®N FORM APN # �� v CQ Date: �J � Building Address: 672,2 LK OL ON«leer's Name: Phone#: Contractor '✓ License#: Contact: Cupertino Busi ess License #: � Type of hoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# 6Z—To be Removed ❑ Provide Mf,-r.Installation Specs. I Have Read,Understand and Will Comply With Cupertino's Tear Off Policy: Job Description: A&Apoe�-e, e s S Residential [ee Commercial ❑ Fire Zone: Yes ❑ No�&J Confirmed with Planning Dept. if there are any restrictions: ❑ Cost of Project: Type of Constru tion: Occupancy group: 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 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36215008. 00 DATE ISSUED. . . . . . . : 08/15/2007 RECEIPT #. . . . . . . . . : BS000002391 REFERENCE ID # . . . : 07080148 SITE ADDRESS . . . . . : 1024 NOVEMBER DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER RCGERS LARRY G AND NANCY L ADDRESS 1024 NOVEMBER DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4123 RECEIVED FROM . . . . : JERRY L SHAFFER CONTRACTOR . . . . . . . : JERRY SHAFFER LIC # 27342 COMPANY . . . . . . . . . . : SHADOWFAX ROOFING ADDRESS 1366 SANTA FE DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95118 TELEPHONE . . . . . . . . : (408)265-2490 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 212 .76 102 .12 0. 00 102 .12 0. 00 BPERMFEE VALUATION 13, 170. 00 212 .76 0. 00 212 .76 0.00 BSEISMICRE VALUATION 13, 170. 00 1.40 0. 00 1.40 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 316 .28 0. 00 316.28 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 316 .28 MC --------------- TOTAL RECEIPT 316 .28 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 I. Prior to permit issuance, You must Llgr< (� !r) compky �vnh L)9' U L:;C_' S�z�rl�lar�I 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 bu'.lding 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 mat?rial 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 z)f$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: i Job Site Address: Roofing Company Name: _ Applicant's Signatu Date: ! Greg Casteel Building Official Revise.111/2/04