07080179CITE' OF CUYEK11NO
BUILDING DIVISICN PERMIT
BUILDIN(3 ADDRESS:
7612 RAINBOW DR
OWNER'S NAME:
HELEN LEWIS
lE:
ARCHITECTIENGINEER:
0 0 LICENSED CONTRACTOR'S DECLARATION
v t-- 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
z w with Section 7000) of Division 3 of the Business and Professions Code, and my license is
y in full force and effectt j4
? License C1 LictY
t—p
DContra
ctor
ARCHITECTS DECLA
i a a 1 understand my plans shall be used as public records
yU
W H Licensed Professional
O a OWNER -BUILDER DECLARATION
ia 1 hereby affirm that I am exempt from the Contractors License law for the
: n 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
prior to its issuance, also requires the applicant for such permit to rile a signed statement
? < that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
F (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 1, 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 dos 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 contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Li-
ccnse 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 contactors
License Law.
0 I 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.
I have and will maintain a Certificate of Consent to self -insure for WorkeesCompen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
1 have and will maintain Workers 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 Insurance carrier and Policy number are:
Carrier. QRTC 1'20 IsuPolicy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
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 she 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
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.)
Lender's Name
Lender's Address
1 certify that 1 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 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
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOURCE REGU AT(
Signature of App t UContr� Date
HAZARDOUS MATERIALS DISCLOSURE
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)?
0 Yes No
Will the applicant orf. tore building occupant use equipment or devices which
-mit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
0Yes No
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 dtc building
docs not currently have a tenant, that it is my responsibility to notify the occupant of the
rcyuircment�hic st be m or to issuance of a Certificate of Occupancyst be m or to issuance of a Certificate of Occupancy.
Owner ora hon -zed agent Date
KNIGHT ROOFING SERVICES
42035 OSGOOD RD
(510)4-8-9077
PERMIT NO.
07080179
PERMIT ISSUE DATE
08/202007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB
Job Description
TEAR OFF SHAKE AND INSTALL COMP SHINGLE
Ft. Floor Area
366110_,6 V' Number
Issued b
Re -roof:
Type of Roof
vajuatlon
$8640
Occupancy 'lype
Required Inspections
All roof; shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
- Z Z &A-11 -7
Signature of Applicant Da(e
All roof coverings to be Class "B" or better
2 ITEMS OF 2
CITY OF CUPERTINO
PERMIT' RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36611036.00
DATE ISSUED.......: 08/20/2007
RECEIPT #......... BS000002426
REFERENCE ID # ...: 07080179
SITE ADDRESS .....: 7612 RAINBOW DR
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OWNER ............: HELEN LEWIS
ADDRESS ..........: 7612 RAINBOW DR
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
RECEIVED FROM ....: KNIGHT ROOFING
CONTRACTOR .......: DAVID RICE LIC # 27646
COMPANY ..........: KNIGHT ROOFING SERVICES
ADDRESS ..........: 42035 OSGOOD RD
CITY/STATE/ZIP ...: FREMONT, CA 94539
TELEPHONE ........: (510)438-9077
OPERATOR: bethe
COPY # : 1
FEE ID UNIT
QUANTITY
AMOUNT PD -TO -DT
THIS REC
----------
NEW BAL
----------
-----------------------
BPERMFEE VALUATION
----------
8,640.00
--------------------
158.76
0.00
158.76
0.00
BSEISMICRE VALUATION
8,640.00
0.90
0.00
0.90
----------
0.00
----------
TOTAL PERMIT
---------- ----------
159.66
0.00
159.66
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
--------------------
NUMBER
----------------- ---------------
CHECK
159.66
10485
---------------
TOTAL RECEIPT
159.66
CITY OF CUPERTINO
RU[OOF
PERMIT APPLICATION FORM 010 g p 17 9
APN# 360 -//-03(c.00
Building Address:
7612 Rainbow Dr. Cupsrtir
Owner's Name:
Helen Lewis
Contractor: Phone #:
Knight Roofing Services 510 438 9077
Contact: Phone #:
Existing:
❑
Built -Up Roof
❑
Asphalt Shingles
)4"
Wood Shakes
❑
Wood Shingles
❑
Other (Specify)
Number
of existing coverings 1
❑
To be Removed
Type of ]toof Covering:
Date:
7-16-07
Phone #:
408 738 4221
License #:
844108
Cu uu ' ss License #:
27646
Proposed:
❑
Built -Up roof
jq
Asphalt Shingles
❑
Wood Shakes
❑
Wood Shingles
❑
Other (Specify)
❑
Provide I.C.B.O. Report #
❑
Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With C u ertino's Tear Off Policy:
Job Description: Tear off shake roofing. Install sheathing-
Install
heathing.Install Class A Composition Shingle. 29 Sq.
Residential Commercial ❑
Confirmed with Planning Dept. if
Fire Zone: Yes ❑ No there are any restrictions: lJ
Type of Con cctilon: Occupancx gro:
T
Cost of Project: Re roof
$ 8,640
Qty. if Fee Description Fee Gro
Applicable Fee IDBUILDING
MBSEISMICOM
RMFEE BldgPermit Fees BUILDING
ERGY
Energy
Seismic Fee ResBUILDINGISMICRE BUILDING
Seismic CommercialBUILDING
ANCHK Plan Check FeeBUILDING
LIC Business License
CITY OF
'UPEkTINO
JOB ADDRESS:
Build:in
7612 Rainbow Dr.
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Department
PERAUT #
OWNERS NAME: Helen Lewis PHONE #408 738 4221
GENERAL CONTRACTOR: Knight Roofing S e ry i SAX # 510 438 0604
I am not using any subcontractors:
ignature Date
pin-mca A-harlr n -m nlirahla aiihrnnitrarfnrc and rmmnlpfp the following information:
2�
Contractor Signature t Date
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
T' e
2�
Contractor Signature t Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
'4'V.a
CITY OF Fax: (408) 777-3333
CUPEf�T1N0
Building Department
Subject: Re -roofing policy for the City of Cupertino
1. Prior to permit issuance, you must agi ee to comply with 1997 UBC Standards
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 ar y 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 inspection and the job is not ready,
you will be charged a re -inspection fey 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: Helen Lewis
Job Site Address: 7 612 Rainbow Dr.
Roofing Company Name: Knight Roo:= ing Services
Applicant's Signature: Date:
Greg Casteel
Building Official
Rev sed 11/2/04