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07080224 CITY OF CUPERTINO BUILDING DIVISION PERMIT INEpRMTIUN -- PERMIT NO. BUILDING ADDRESS: 022 KENMORE CT MCLEOD GEORGE E AND SANDRA 07080224 PERMIT ISSUE DATE OWNER'S NAME: MCLEOD GEORGE E AND SANDRA D 1022 KENMORE CT 08/27/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH p a LICENSED CONTRACTOR'S DECLARATION - Job Description m Sc'hereby affirm that I am licensed under provisions of Chapter 9(commencing U with ction 7(100)of Division 3 of the Business and Professions Code,and my license is REMOVE E) ROOF APPLY PLYWOOD AND ASPHALT ti in full force and effect. SHINGLE")v�z License Class Lic.8 G pare Contractor E ul a ARCHITECTS DECLARATION CLASS A 25 SQ FT I a< I understand my plans shall be used as public records iaV U. Licensed Professional t y OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the ,p Ofollowing reason.(Section 7031.5,Business and Professions Code:Any city or county %m which. 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 3q.Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $4550 t= (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or t that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of t��U�1 Number not more than five hundred dollars(x500). 36215033 . V V ❑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 Code:The Contractor's License Law docs 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.). eas owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractoes LL- cease Law does not apply to an owner of property who builds or improves dhemon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law. ❑I am ex ppt under Se�cj.. B&P C for this/reason Owner/ Unm"l - Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: Lj I have and will maintain a Certificate of Consent to self-insurc 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 arc: Cartier: Policy 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 come subject to the Workcrs'Compensation Laws of Calif ia.Date Applicant NOTICE TO APPLItANT.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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of ^.1.> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lender's Name Lenders Address I certify that 1 have read this application and state that the above information is U correct.I agree to comply with all city and county ordinances and slate laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City oC Cupertino against H(,,o) liabilities,judgments,toss 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. SO RCE REGAL"ATIONS.10 /^1115..0 �LZ ° Re-roofs Signature of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of'Zoof Will the applicant or future building occupantstom 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 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 emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new 1 naterials for inspection. District? ❑Yes 6K 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- niaHealth&Safety Code,Sections 25505,25533 and 25534.I understand thatif the building IV 11 [r does not currently have a tenantthat it is my responsibility to notify the occupant of the Date reqs' mens whicp mttstet prior to issuance of a Ccnificale of Occupancy. S ignatur0 Applicant Al C17 All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36215038 .00 DATE ISSUED. . . . . . . : 08,'27/2007 RECEIPT #. . . . . . . . . : BS000002479 REFERENCE ID # . . . : 07080224 SITE ADDRESS . . . . . : 1022 KENMORE CT SUBDIVISION . . . . . . CITY CU:?ERT INO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : MC:,EOD GEORGE E AND SANDRA D ADDRESS 1022 KENMORE CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4119 RECEIVED FROM . . . . : SCOTT MCLEOD CONTRACTOR . . . . . . . . LIC # *OWNER* COMPANY . . . . . . . . . . : MC-JEOD GEORGE E AND SANDRA D ADDRESS 1022 KENMORE CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4119 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- BPERMFEE VALUATION 4, 550. 00 115 .56 0. 00 115 .56 0. 00 BSEISMICRE VALUATION 4, 550. 00 0.50 0. 00 0.50 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 116 . 06 0. 00 116 .06 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 116. 06 660 --------------- TOTAL RECEIPT 116 . 06 OWNER-BUILDF',R VERIFICATION 1. (Check one) I or my immediate family parent, spouse or child) will perform: A. V All the work authorized by this permit B. _ A portion of the work C. _ None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. — All of the work B. — A portion of the we rk (complete section below) Contractor Address/City Phone # State License # Type of work to be performed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erf ormed ............................................................................................................. I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse side). - � /v 7 Property Owner's Signature: `► Date: �S' 2l Job Address: I U Z Z l\�r��x� C4– ('c,�►�-�� C 4 ��v►c` Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. CITY OF CUPERTINO C U CITY of PERMIT APDL KATION FORM APN# J Z �U L eV Date: 21 101 Building Address: C?Nvner's Name: Phone #: L. Contractor: License #: Contact: Cupertino Business License #. Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles )!( Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes X Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings y ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply.With Cupertino's Tear Off Policy: Job Description: I o ( 5 l�, /S �4SS -Z $ Residential [& Commercial ❑ Fire Zone: Yes ❑ No [ Confirmed with Planning Dept. if there are any restrictions: ❑ Cost of Project: Type of Construct n: Occupancy group: Qty. if Applicabli Fee ID Fee Description Fee Group BPER.MFEE l3ldg 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 permit issuance,you n1u ,t agl(,(: L(; comp]" with 1-`9" Lb( and manufacturers specifications on re-:•ooffng. 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 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 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 tae job site at the time on inspection. I understand and will comply with the above stated policy on re-rng. Homeowner's Name: Cil W 4�' S^VAS Job Site Address: Roofing Company Name: Applicant's Signature: Pill Date: L Greg Casteel Building Official Revise 111/2/04