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07080260 CITE'OF CUPERTINO BUILDING DIVISION PERMIT 0. IEURlA4TIq►N, PERMIT NO. BUILDIr�DplEssBERKSHIRE CT PRO ROOFING 07080260 UU (UJ PERMIT ISSUE DATE OWNER'S NAME: GILLEY MICHAEL T AND SAKARA 100 BLOSSOM WAY 08/30/2007 SANITARY NO. CONTROL NO. NE!n (831) 440-9100 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 0 04 Z LICENSED CONTRACTOR'S DECLARATION o Job Description vC 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 70(10)of Division 3 of the Business and ProfcssiDons Code,and pty license is TEAR OFF PLYWOOD 7/16 0 S B 40 YEAR 1—3 0 LB COMP #32 y in full force and ect._ 5 5 ,n? License ClassLic.N SQFT t-wDate Contractor � ARCHITECTS DECLARA ON on sista d my plans shall be used as public records aU o in Licensed Professional t ti-1 OWNER-BUILDER DECLARATION r 1 hereby affirm that 1 am exempt from the Contractor's License Law for the !p O following reason.(Section 703 1.5,Business and Professions Code:Any city or county Qi which requires a permit to construct,alter,improve,demolish,or repair any structure ?Z y prior to its issuance.also requires the applicant far such permit to file a signed statement Ft.F100I AIea Valuation =G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �q $12000 [- (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 P Number Occupancy Type not more than five hundred dollars(5500). 342121061. 0 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 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 side.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.). ❑I,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 thereon,and who contracts for such projects with a contractor(s)licensed pursuant to the Conlractoes License Law. ❑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: v 1 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 Workees Compensation Insurance carrier and Policy number am: � Carrier: Z� CZ>�`t'I Policy No.: ,•� CERTIFICATE OF EXEMPTION FROM WO ERS' 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 Worker's Compensation provisions of the Labor Code,you must Z forthwith comply with such provisions or this permit shall be deemed revoked. Z OCONSTRUCTION LENDING AGENCY a I hereby affirm that there is a construction lending agency for the performance of (Yy > the work for which this permit is issued(Sec.3097,Civ.C.) aQ Lender's Name a z Lcndees Address U 0 1 certify that I have read this application and state that the above information is LT correct.I agree to comply with all city and county ordinances and state laws relating to O U building construction.and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against -i rA liabilities,judgments,costs and expenses which may in any way accrue against said City tJ Z in consequence of the granting of this permit. Date +� APPLICXWUNL DERSTANDS AND WILL COMPLY WITH ALL N N-POINT Issued by: —�Y/ SO ATIO� b ^ V Re-roofs Sig ature of Applicant/Contractor are HAZARDOUS MATERIALS DISCLOSURE Type Of F.00f 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 0 N If a roof s 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 n laterials for inspection. District? ❑Yes ❑No I have read the hazardous materials requirements under Chaptcr 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building r� does.not current y ha a tenant,that it is my responsibility to notify dre occupant of the requrcmcn ich ust be met prtato issuance of a Ccrtificaic ygayo� Sign turf of Applicant Date },: L4".V/ L� All roof coverings to be Class"B"or better Owner or authorized agent CITY OF ("'UPERTINO � E Z G F CUPERTINO PERMIT APPLICATION FORM APN# Date: ,.... yZl ZL�ts� OE � o Building Address: 10102- C-,-/-,— Phone Pone :Cuner's Nm f 6"? -(CS Contractor: �� License#-: � ;�. Contact: C ,. Cupertino Business License #: Type of R)of Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles W Asphalt Shingles 0 Wood Shakes ❑ Wood Shakes Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# C0 To be Removed El Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cupertino's Te Off P li : ❑ Job Description: "' Residential - ComInercial ❑ } 3 2— S Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: ❑ Cost of Project: Type of Construction: Occupancy group: 2 � d -3 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE IUg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING /&Lei,�� L7 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 ]. Prior to penrot issuance, you must Litre'' to compty wi.t1Z 2 197 U1 <_:Si�,lzdarci;; and manufacturers specifications on re--oofing. 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 gal. 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" Der 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: Job Site Address: O Roofing Company Name: �d Applicant's Signature: �C/L Date: d 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 r,UPEkTINO Building Department JOB ADDRESS: PERMIT # U l 4�1 'L- Q -t A`�-2 car— 0-7 v Z� OWNER'S NAME: P -,c�-l�-1N-.� PHONE # -- 12'x- / GENERAL CONTRACTOR: Orb FAX # 6 F I am not using any subcontractors: -�LV t�'� f C- ®� 0 0,/0 2— Si,;nature Date 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 Owner/Contractor Signature Date CITY OF --UPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34212106 .00 DATE ISSUED. . . . . . . : 08/30/2007 RECEIPT #. . . . . . . . . : BS000002516 REFERENCE ID # . . . : 07080260 SITE ADDRESS . . . . . : 10102 BERKSHIRE CT SUBDIVISION . . . . . . . CITY CUFERTINO IMPACT AREA OWNER . . . . . . . . . . . . : GILLEY MICHAEL T AND SAKARA AP ADDRESS . . . . . . . . . . : 10102 BERKSHIRE CT CITY/STATE/ZIP . . . : CUFERTINO, CA 95014-5600 RECEIVED FROM . . . . : PRC ROOFING CONTRACTOR . . . . . . . : KAF.LO SIMIC LIC # 22547 COMPANY . . . . . . . . . . : PRC ROOFING ADDRESS . . . . . . . . . . : 10C BLOSSOM WAY CITY/STATE/ZIP . . . : SCOTTS VALLEY, CA 95066 TELEPHONE . . . . . . . . . (8-1) 440-9100 FEE ID UNIT QUANTITY 7,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPERMFEE VALUATION 12, 000. 00 191.16 0. 00 191 .16 0. 00 BSEISMICRE VALUATION 12, 000. 00 1 .20 0. 00 1.20 0. 00 BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 . 00 0.00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 299 .36 0. 00 299 .36 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 299 .36 977 --------------- TOTAL RECEIPT 299 .36