07080172 CITY OF CUPERTINO T� IEpRM�TION'
BUILDING DIVISION PERMIT �NTLG :
PERMIT NO.
BUILDING ADDRESS:
10741 SANTA LUCIA RD TBD — TO BE DETERMINED 07080172
PERMIT ISSUE DATE
OWNER'S NAME:
/2007
ERIC CARLSON 2 0
SANITARY NO..
CONTROL NO.
NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
0 � 0
94
Z LICENSED CONTRACTOR'S DECLARATION Job Description
Wp I hereby affirm that I am licensed under provisions of Chapter 9(commencing
zUUJ with Section 7000)of Division 3 of the Business and professions Code,and my license is REROOF—'GEAR OFF WOOD SHAKE, INSTALL OSB TYPE PLY
=y in full force and ct. Lic ,jt3U 30# 50 '�R LAMINATED SHINGLES 24SQ CLASS A.
v�Z License lass
p Date Contractor
ARCHITECTS DECLA A ON
i a< I understand my plans shall be used as public records
�yU
u H Licensed Professional
a OWNER-BUILDER DECLARATION
cm I hereby affirm that 1 am exempt from the Contractors License Law for the
:00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
�i which requires a permit to construct,alter,improve,demolish,or repair any structure
I"- prior to its issuance,also requires the applicant for such permit to file a signed statement S Ft.Floor Area Valuation
?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $10000
i F= (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of p pJ�j Number Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 4 217 0 91 .Ul7
not more than five hundred dollars($500).
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 oroffered 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.).
O I,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-
ccnse 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 Contractor's
License Law.
Q 1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
J I have and will maintain a Certificate of Consent to self-insure for Worker's 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 Worker's mpenssaai on insurance carrier and Polity nu be are:oe
Carrier. // h Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is forone hundred dollars(EI00)
or less.)
I cermif-v 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 O CONSTRUCTION LENDING AGENCY
[�rA I hereby affirm that there is a construction lending agency for the performance of
x > the work for which this permit is issued(Sec.3097.Civ.C.)
W A Lender's Name
aL Lender's Address
U C) I certify that I have read this application and state that the above information is
LT• correct.I agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorize represenutives of this city to enter upon the
above-mentioned property for inspection purposes.
a (We)agree to save,indemnity and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
r—)Z in consequence of the granting of this permit. Date
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE RE ULATION
• =- sem K — 0 2 . Re-roof:;
Signatu of Applican Contractor Date Type of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
Will the applicant or future building occupantstore or handle 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.
0Yes ix. If a roofis installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which all new materials for inspection.
_..at hazardous air contaminants as defined by the Bay Area Air QualityManagement
District? L/
❑Yes u
1 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
docs not currently have a tenant,that it is my responsibility to notify the Ocupant of the Date
requirements which must be ei rior to issuance of a Ccnificate of Occupancy. Signatu-e of Applicant
`20- All roof coverings to be Class"B" or better —
Date
Owner or authorized agent
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 34217091. 00
DATE ISSUED. . . . . . . : 08/20/2007
RECEIPT #. . . . . . . . . BE000002420
REFERENCE ID # . . . 07080172
SITE ADDRESS . . . . . : 1C741 SANTA LUCIA RD
SUBDIVISION . . . . . .
CITY CLPERTINO
IMPACT AREA . . . . . .
OWNER EFIC CARLSON
ADDRESS 1C741 SANTA LUCIA RD
CITY/STATE/ZIP . . . : CLPERTINO CA, 95014-3939
RECEIVED FROM . . . . : ALARCON ROOFING
CONTRACTOR TED - TO BE DETERMINED LIC # 00096
COMPANY TED - TO BE DETERMINED
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
BPERMFEE VALUATION 10, 000 . 00 169. 56 0 .00 169.56 0. 00
BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 .00 1. 00 0 . 00
BUSLIC FLAT RATE 1. 00 107 . 00 0 .00 107 . 00 0. 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 277.56 0 . 00 277 .56 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 277 . 56 1879
---------------
TOTAL RECEIPT 277 . 56
i Community Development
10300 Torre Avenue
.�' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�'UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
Y u 0
OWNER'S NAME: Epl G ti PHONE # _
GENERAL CONTRACTOR: PteP y FAX # _ 1,2
I am not using any subcontractors: � - i�� ,• �- G J
Signature Date
Please check applicable subcontractors and com-:)lete the following information:
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
14
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
I CITY OF ("UPERTINO
V ROOF
CUPEkTINO PERMIT APPLICATION FORINT
APN;# f� l•, % Date: a
Buildin5Address:
�a
FO-wner's, Name: e Phone#:
1ACenSe#:
Contractor: 7
Contact: � J Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
V Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
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 Cu3ertino's Tear Off Policy:
Job Description: , �� p- (,via �� ,L�S l` 6 -S,) y
Residential ' Commercial EJ
Q
Fire Zone: Yes ❑ No ❑ Confirmed with Pla i Dept. i
there are any restrictions: ❑
Cost of Project: l0 Qap Type of Construction: 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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building I!Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to purl-111't issuaiice, you zrEust agree to comply with _1 7 U1,)" StanUAI-CL:
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applie 1 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 ani,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 'irst obtaining an inspection,
will require the removal of all new mal erial down to the sheathing,
so a proper City inspection can be perf armed.
7. NOTE: If you call for a plywood nail iispection 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 ab^ovE stated policy on re-roofing.
Homeowner's Name: ,1,1 C__ae-k O A
Job Site Address: Q 2 q f Sam-71a Gl
Roofing Company Name: e /Z k(fid G z-* 9'
o
Applicant's Signature: Date: 0 0 a
Greg Casteel
Building Official
Revised 11/2/04