07080181 CITE'OF CUPERTINO
BUILDING`DIVISION' PERMIT INE()RM�iTIUIY:
PERMIT NO.
BUILD) 1ES
l014PARADISE DR J SAENZ ROOFING 07080181
PERMrf ISSUE DATE
OWNER'S NAME:
NEMEC ROBERT R AND NANCY J 1592 MONTEVAL LN 08/20/2007
SANITARY NO. CONTROL NO.
NE:
(408) 997-3422
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
p C) LICENSED CONTRACTOR'S DECLARATION - Job Description
P: I hereby affirm that I am licensed under provisions of Chapter 9(commencing
;" rUu with Section 7000)ofDivision3oftheBusiness and
�Professions Code,and mylicense is REROOF-REMOVE 1/2" C S.X. INSTALL LANDMARK T.L.
y in full force and e�t C, Lic.# o Y�� CLASS A 21 SQUARES.
? License 1 `
a Date � -CO-Q 7 Contractor_
ARCHITECPS DEC TION
aa I understand my plans shall be used as public records
aU
'n.ti Licensed Professional
a OWNER-BUILDER DECLARATION
aN I hereby affirm that I am exempt from the Contractors 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,dcmoli%h,nr repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statementValuation
=o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $10500
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 Number Occupancy Type
not more than five hundred dollars(5500). 35916031
❑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 We(Sec.7044,Busin= Required Inspections
and Professions Code:The Conuactor'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(wilding 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 contractus to
construct the project(Sec.7044,Business and Professions Code:)The Contractors U.
cense Law does not apply to an owner of property who builds or improves thereon.and.
who contracts for such projects with a conuactor(s)licensed pursuant to the Contractors
License Law.
C]I am exempt under Sec .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declaradom
v 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.
❑I 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: S"'?a(& i w.�I Policy No.: 53S-5"
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 the Workcrs'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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z— CONSTRUCTION LENDING AGENCY
Fr►C..). I hereby alum that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
ALender's Name
Z Lenders Address
U C I certify that I have read this application and state that the above information is
C1. t- correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorise representatives of this city to enter upon the
W about-mentioned property for inspection purposes-
>_ CL (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 in consequence of the granting of this permit. Date -�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b`': -2
LATI
"t
SOURCE REGU
g^Lo- Re-roofs lf%
Signature of Iican Contractor Date Type of Roof
MATERIA DISCLOSURE yp
Will the applicant or future building occ ant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed.
Yes '
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 Area Air Quality Management all new materials for inspection.
District?
DYes 6N.
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 - �� i.-7
does not currently have a tenant,that it is my responsibility to notify the occupant tar dte
requirement%which t be met prior to issuance of a Certificate of Occupancy. Signa 'of Appl' nt Date
All roof coverings to be Class"B"or better
Owner uthorizcd agent Date --'
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Bl,,: Lot:
APN 35)16031. 00
DATE ISSUED. . . . . . . : 08/20/2007
RECEIPT # . . . . . . . . . BSDO0002429
REFERENCE ID # . . . : 07J80181
SITE ADDRESS . . . . . : 10374 PARADISE DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER NEAEC ROBERT R AND NANCY J
ADDRESS 10374 PARADISE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2914
RECEIVED FROM . . . . : J 3AENZ ROOFING
CONTRACTOR JESSE SAENZ LIC # 15481
COMPANY J 3AENZ ROOFING.
ADDRESS 1592 MONTEVAL LN
CITY/STATE/ZIP . . . : SAV JOSE, CA 95120
TELEPHONE (498) 997-3422
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 10, 500 .00 180.36 0 .00 180 .36 0. 00
BSEISMICRE VALUATION 10, 500 .00 1.10 0 .00 1. 10 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 181.46 0 .00 181 .46 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 181.46 8908
---------------
TOTAL RECEIPT 181.46
S Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
"UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
/b 3-7
OWNER'S NAME: PHONE # Y-o ,3 yZ Z
GENERAL CONTRACTOR: .fess S FAX # Yom 7_ q
I am not using any subcontractors:
S ignature Date
Please check applicable subcontractors and corn 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/ ontract r Signature Date
CIT` ' OF C"UPERTINO
CUPEkTINO PERMIT APPLICATION FORM
07
APN# s, / Date:
Building Address:
/037 .2
0vner's Name 7�/b
ne#:
e ,�eLZs3 -9 369
JA We = --- -- --- - - - - -- - - - -
Contractor: License,#:
�-, S 6 �8q6s
Contact: Cupertino Business License #:
Se55e S z—
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ;6d'- Asphalt Shingles
®— Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide LC.B.O. Report#
I f To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy:
Job Description:
6�GSS
Residential Commercial ❑
Fire Zone: Yes ❑ No [9-- Confirmed with Planning Dept. if
there are any restrictions:
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE 13ldg 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
L 1 rloj- to pt'rma iSs17ancc, )%Uil 111tisl Chir('_'' to cOn1ply \:� Wh f(_jV U,H' .
and manufacturers specifications on re--oofing.
2. New roof coverings shall not be appliec 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 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 perfc rmed.
7. NOTE: If you call for a plywood nail irspection 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: IV&Ve I e
Job Site Address: 103:7Y-
Roofing
037yRoofing Company Name:
Applicant's Signature: Date: o za-d 7
Greg Casteel
Building Official
Revise 111/2/04