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07080187 CITY OF CUPERTINO C�N��A� t)R IOIZM.�TI�N BUILDING DIVISION PERMIT T° PERMIT NO. BUILDING ADDRESS: 7499 DE LA FARGE DR ECONOMY ROOFING 07080187 PERMIT ISSUE DATE OWNER'S NAME: WANG, JIM 825 CAMLEN AVE 08/20/2007 SANITARY NO. CONTROL NO. NE: (408) 86E-1800 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH a'Z LICENSED CONTRACTOR'S DECLARATION Job Description O W P I hereby affirm that I am licensed under provisions of Chapter 9(commencing UW with Section 7000)of Division3ofthcBusinessandProfessionsCode,andmylicenseis TEAR OFF' EXISTING SHAKE AND INSTALL ASPHALT N in full force and c[ t Lic/i �, SHINGLE.. Z License Cl s O Datc zO 12 Contractor e- F_w ARCHITECTS DECLARATION 4f V IR-1 1 understand my plans shall be used as public records 0.0 u.F Licensed Professional a OWNER-BUILDER DECLARATION a 1 hereby affirm that 1 am exempt from the Contractor's License Law for the :n O following reason.(Section 703 1.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure i-N prior to its issuance,also requires the applicant for such permit to file a signed statement ; .Ft.Floor Area Valuation z a that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 q $11000 i f= (commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of �}p�N Number not more than five hundred dollars(5500). 3592602-_ `�U ❑I,as owner of the property,or my employees with wages as their sole compensation, will do the work.and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuactoes License Law does not apply to an owner of property who builds or improve$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 themon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractoes License Law. ❑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: 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 Compensation insurance carrier and Policy number are: Carrier: PolicyNo.: 1'001Oro L27 CERTIFICATE F 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 Workers'Compensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z►• CONSTRUCTION LENDING AGENCY i hereby affirm that there is a construction lending agency for the performance of fZ > the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 2 Lender's Address I certify that I have ad this application and state that the above information is CUt. recorrect.t agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the W ahovc-mentioned properly for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against Hr/l 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 -2 d r+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b): _ R10E REGULATIONS. S F> 20Re-roofs Sig ture of ApplrcanUContractor I Dare Type of hoof HAZARDOUS MATERIALS DISCLOSURE yP 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)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ®No (� If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which ,nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection. District? ❑Yes �Nu 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 T does not currently have a tenant,that it is my responsibility to notify the occupant of the cmcnts wh' must be met prior to issuance of a Certificate o Occup ex Signature:of Applicant Date All roof coverings to be Class"B"or better OwAcr or authori'rcd agent Date -'- CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35926021. 00 DATE ISSUED. . . . . . . : 08/20/2007 RECEIPT #. . . . . . . . . BS000002432 REFERENCE ID # 07C80187 SITE ADDRESS . . . . . : 74S9 DE LA FARGE DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER WAI�G, JIM ADDRESS . . . . . . . . . . : 74S9 DE LA FARGE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : PAUL HORSAGER CONTRACTOR . . . . . . . : HOF'-SAGER, PAUL B LIC # 19307 COMPANY . . . . . . . . . . : ECONOMY ROOFING ADDRESS . . . . . . . . . . : 82E, CAMDEN AVE CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (4(18) 866-1800 FEE ID UNIT QUANTITY IsMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPERMFEE VALUATION 11, 000 . 00 180.36 0 .00 180 .36 0 . 00 BSEISMICRE VALUATION 11, 000 . 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 ----------------- --------------- -------------------- CREDIT CARD 181 .46 MC --------------- TOTAL RECEIPT 181 .46 10MR" CITY OF CUPERTINO CUPEkTENO PERMIT APPLICArTION FORM . 07ogo187 APN# Date: o�1. 00 �' zo ol- Building Address: O��mez's Naive: 4oPhone#: i u— Contractor: License#: Contact: , I A Cupertino Business License #: Type of R)of Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 1K Asphalt Shingles �il_ 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. 1 I Have Read,Understand and Will Comply With Cul>ertino's Tear Off Policy: r X2`0 l NS'-fi4I z i icwc o Job Description: ��-��2 p�'/-- � � [,,,� FAA S f�l I 3® L, ,S -Z—I— w Residential _K Commercial E] -Se) Sq ►P Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: El Cost of Project: Type of Construction: Occupancy group: &1200 G etas S;�L _ K--3 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 Department Subject: Re-roofing policy for the City of Cupertino I ICII' to pe)-mit ISsuIaiz cl_'� you aws`L Llore(' t07 cOmpl)T WIth U��_ C�di`�tS 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 bui'ding 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 appro-ial. 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 matE 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 of$176.18. The re-inspection fee must be paid before another inspection can'),e 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 tie job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: f.A t Job Site Address: ��I D E L A Roofing Company Name: C. v Applicant's Signature. Date: t12�- Greg Casteel Building Official Revised 11/2/04 Community Development 10300 Torre Avenue '. Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ':UPEkTIN0 Building Department JOB ADDRESS: PERMIT # 67-o �-vt & 7 OWNER'S NAME: -W4M PHONE # GENERAL CONTRACTOR: FAX# q(X-j&G- Z 7c7 I am not using any subcontractors: Signature - ate Please check applicable subcontractors and complete 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 ate Owner/Contractor Signature