07090006 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C(ITIZ�.GTox i4 �QN
PERMIT NO.
BUILg11 ��Dj2ESPARADISE DR J SAENZ ROOFING 07090006
l !� PERMIT ISSUE DATE
OWNER'S NAME:
FRENCH JOHN S AND SALLY R 1592 MONTEVAL LN 09/04/2007
SANITARY NO. CONTROL NO.
ME:
(408) 99'7-3422
BUILDING PERMIT INFO
ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH
0 ZLICENSED CONTRACTOR'S DECLARATION
0 - Job Description
m P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
zUW with Section 7000)of Division3ofthcBusinessandProfessionsCodc.andmyliceascis REMOVE SHAKE, RE—SHGEET W 1/2 " GDX. INSTALL ARCH
y in full force andeIT t. E7
v�z License Class ` Lam• COMP.
t- Date Q=t[T--el r Contractor t ��
ARCHITECT'S DECLARATION
i a< 1 understand my plans shall be used as public records
a.U
u.l- Licensed Professional
< OWNER-BUILDER DECLARATION
}
1 hereby affirm that 1 am exempt from the Contractor's License Law or the
ip o following reason.(Section 7031.5,Business and Professions Code:Any city or county
$6� which requires a permit to construct.alter,improve,demolish,or repair any structure
"y prior w its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation
?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq $9200
t= (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 �1 Number
not more than five hundred dollars($500). 3591602 V
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's U-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Caw.
❑lam exempt on rSe B&PSC for
this,reason
Owner Dale =L
WOR S C PENSlnON DECLARATION
hereby afri under penalty of perjury one of the following declarations:
rl I ha ve and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance cattier and Policy number are:
Carrier.S?LcL An Fee...� Policy No.: S 3$S 6
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is tar anc hundred dollars($100)
or less.)
1 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 O CONSTRUCTION LENDING AGENCY
HCl) I hereby affirm that there is a construction lending agency for the performance of
N 7 the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
az Lender's Address
V 0 I certify that I have read this application and state that the above information is
w E correct.I agree to comply with all city and county ordinances and state laws relating to
U building construction•and hereby authorise representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
P. (We)agree to save,indemnify and keep harmless the City o[Cupertino against
rA 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 J
�-+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b):
SOURCE REGULATIONS.
Re-roofs
Signature of Applicant/Comractor Dam Type of Roof
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.
0 Yes [3 No
If a roof is installed.withoutfzrst 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 r laterials for inspection.
District?
❑Yes >`]No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- /,
nia Health&SafctyCodc,Sections 25505.25533 and 25534.1 understand that if the building �-7 -a 7
docs not currently ha a tenant. at it is my responsibility to notify the occupant of the
requirements whit ust be prior to issuance of a Certificate of Occupancy. S lgn rt:of Applicant Date
All roof c rings to be Class"B"or better
Owner o uthoriscd agent Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 35516027 . 00
DATE ISSUED. . . . . . . : 09/04/2007
RECEIPT #. . . . . . . . . : BSCO0002541
REFERENCE ID # . . . : 07C90006
SITE ADDRESS . . . . . : 10424 PARADISE DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : FRENCH JOHN S AND SALLY R
ADDRESS . . . . . . . . . . : 10424 PARADISE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2914
RECEIVED FROM . . . . : J SAENZ ROOFING
CONTRACTOR . . . . . . . : JESSE SAENZ LIC # 15481
COMPANY . . . . . . . . . . : J SAENZ ROOFING
ADDRESS . . . . . . . . . . : 15112 MONTEVAL LN
CITY/STATE/ZIP . . . : SAN JOSE, CA 95120
TELEPHONE . . . . . . . . : (408) 997-3422
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- --
BENERGY PERMIT FEE 169 .56 81.39 0. 00 81 .39 0. 00
BPERMFEE VALUATION 9, 200.00 169 .56 0. 00 169 .56 0. 00
BSEISMICRE VALUATION 9, 200. 00 1 .000. 00 1.00 0. 00
----------- ---------- ---------- ----------
TOTAL PERMIT 251.95 0. 00 251.95 0. 00
METHOD OF PAYMENTAMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 251.95 #8947
---------------
TOTAL RECEIPT 251.95
� . j09 � 0D
CITE' OF CUPERTINO
CUPEkTINO PERMIT APPLICATION FORM
APN# — c� a-7Date:
3� q1 (P , �� '7- y-o_7
Building Address: +
Owner' Name: Phone. #:
- --- -- -- qO 8
04 ti/ - --- ---- - -
Contractor ---- -- - License#�V8 q6 S
S �z
Contact: Cupertino Business License #:
S " Z
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles tr*- Asphalt Shingles
S.. 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.
I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy:
Job Description: i ► T /
{ L
Residential Commercial ❑
Fire Zone: Yes ❑ No ®' Confirmed with Planning Dept. if
there are any restrictions: ❑
Cost of Prg*ect: Type of Construe tion: Occupancy group:
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
REROOF TEXTZ OFF POLICY
1. You must schedule an inspection for the tear off the day before
you wish the inspection to be made. The procedure is to call the
Building Division (408) 777-3223 between the hours of 7:30 a.m. and
3:30 p.m. to request a next-day inspection.
2. When the roof is torn off, the nails have been removed or driven in,
and all of the dry-rotted wood has been replaced, you must call the
City Building Division. An inspector will be there within one hour.
There are special hours for this Service: from 7:30 a.m. to 10:30 a.m.
and 1:00p.m. to 3:30 p.m., Monday through Thursday and from
7:30 a.m. to 10:30 a.m. and 1:00 p.m. to 2:30 p.m. on Friday. (Note:
Building inspectors are on lunch break from 11:30 a.m. to 12:30 p.m.
and will not be called during that time. City Hall is closed between
12:00 and 1:00 p.m. daily.)
3. If you call for a tear-off inspect.on 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.
Greg Casteel
Building Official
Revised 8/13/04