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07080195 CITY OF CUPERTINO BUILDING DIVISION PERMIT �1�' gtACO]K'I�tEQRM 'TI(JN� -� PERMIT NO. BUIL QIIVG�Ql N:ORTHVIEW SQ FOUR SEASONS ROOFING 07080195 (J L� PERMIT ISSUE DATE OWNER'S NAME: NORTHPOINT HOMEOWNER' S P 0 BOA: 1210 08/21/2007 SANITARY NO. CONTROL NO. IA!-'C n n T T rl't T nAT (408) 2; 8-0330 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 0 a °C z LICENSED CONTRACTOR'S DECLARATION Job Description vP 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing REMOVE (E) ROOF SYSTEM TO DECK, INSTALL 30# FELT Zw with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in fullocc an ft Lic.N CA Tj �((�g j NDERLI tYMENT AND NEW GAF FRAND CANYON ASPHALT z Licens LQ Date Contractor - LQ RCHITECTS DECLARATION SHINGLES i a a I understand my plans shall be used as public records �yU U. Licensed fsional oa OWNER-BUILDER DECLARATION 1 hereby alTirm that 1 am exempt from the Contractor's License Law for the ,no following reason.(Section 7031.5,Business and Professions Code:Any city or county r which requires a permit to construct.alter,improve,demolish•o repair any structure i—y prior to its issuance,also requires the applicant for such permit to file a signed statement Sq,Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $22000 t=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)tar that he is exempt therefrom and the basis for the alleged exemption.Any violation of }N Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 316360'18 CN not more than five hundred dollars($500). ❑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 Required Inspections and Professions Cade:The Contractors License Law does not apply to an fawner 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors 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 contractor(s)licensed pursuant to the Contractors License law. ❑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 declarations: L]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 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 Insurance carrier and Policy number are: 1), cy 1�C,�t 1l vl ) Cartier. Poli No. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ibis 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z. t CONSTRUCTION LENDING AGENCY E.r I hereby affirm that there is a construction lending agency for the performance of fY. the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name Z Lender's Address I certify that I have read this application and state that the above information is LUO 1. cortcct.I agree to comply with all city and county ordinances and state laws relating to CU building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. L1. (We)agree to save,indemnify and keep harmless the City of Cupertino against HV) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. late U V �+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued )y: GUL 1-6 Re-roo.rs / Signature of ApplContractor Dam T e o`Roof 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 Rre. If a roc f is installed without first obtaining an inspection,I agree to remove Will the applicant or fuwrc building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes o 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 Ines not currently have a otcnam�, at it is my responsibility to notify Uta occupant of UteDate rcquircmentswhichmustrwissaanccofaccrtircatcorOccopancy. Signatu4Alicant a 1�� All roof coverings to be Class"B"or better Owner or authorized ag Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS: PERMIT# SIT OWNER'S NAME: H _ PHONE # � -S--O GENERAL CONTRACTO : FAX# 74 _O I am not using any subcontractors: S_gnature Date Please check applicable subcontractors and corrlete 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 er/Contractor Signature Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31636048 .00 DATE ISSUED. . . . . . . : OE /21/2007 RECEIPT #. . . . . . . . . . B:'000002442 REFERENCE ID # . . . : 0, 080195 SITE ADDRESS . . . . . : 1(804 NORTHVIEW SQ SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : NORTHPOINT HOMEOWNER'S ASSOCIA ADDRESS . . . . . . . . . . : 1(804 NORTHVIEW SQUARE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-0542 RECEIVED FROM . . . . : FOUR SEASONS CONTRACTOR . . . . . . . : DJAZ, ALFRED LIC # 21323 COMPANY . . . . . . . . . . : FOUR SEASONS ROOFING ADDRESS P 0 BOX 1210 CITY/STATE/ZIP . . . : AI,AMO, CA 95407 TELEPHONE . . . . . . . . : (4:08)278-0330 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 22, 000. 00 299 .16 0. 00 299 .16 0. 00 BSEISMICRE VALUATION 22, 000. 00 2 .20 0. 00 2 .20 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 301 .36 0. 00 301.36 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 301.36 007179 --------------- TOTAL RECEIPT 301 .36 F *c1r.10 CITY OF CUPERTINO REROOF CUTINO PERMIT APPLICATION FORM YiPN # Date: Building Address: o sr-/y_ - Phone#: ()wnez's Name: yGg_ 2��To�� License#: Contractor- Phone#`: s s Contact: Phone##: Cupertino Business bice ise#: Type of Roof Covering: I�xisting: Proposed: 13 Built-Up roof Cl Built-Up Roof u Asphalt Shingles t9''`Asphalt Shingles C] ��'ood Shakes L3 Wood Shakes Cl Wood Shingles c3 Wood Shingles w-' 1sther(Specify) c3 Other(Specify) — Nuinber of existing coverings l ❑ Provide I.C.B.O.Report# _ u To be Removed ❑ Provide Mfgr.Installation Specs. Have Read, Understand and Will Co nply With (:u ertino's Tea�101ffl PolicA/G +v� > 'Ole- Job:Description: V -/ G ��' 1'�tArt st.rxr►*' 'i CA�-..i.�A�' �''.�.a s�a�r9 /�a►/� ..�.hi��''c S :kesidentiai Commercial ❑ ^sire.Zane: Yes ❑ No Confirmed with PlanniIIg I )t. if there are any restrictiojl s_:__ most of Project: Type of Construction: Occupancy up'. ciaa1�!' ' Qty, it Fee Description .E,'ee 13rou Applicable, Fee ID BU' SING BPERMFEE BldgPermit Fees — BENERGY iergy KIILI LNG ^� BSEISMICRE Seismic Fee Res B`�ILI►ATG Bi!'1LI►LVG BSEISMICOM Seismic Commercial BPLANCHK Plan Check Fee BUILI)LNG B+ BUSLIC Business License _11LI►ATG