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07090014 CITY 0TC1 77 T 1 BUILDING DIVISION PERMIT �� tTQ Is "— PERMIT NO. BUILDING ADDRESS: 11517 SILVER SPRING CT TBD — TO BE DETERMINED 07090014 PERMIT ISSUE DATE OWNER'S NAME: CARO MARK L AND GENEVIEVE H 09/05/2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH p z LICENSED CONTRACTOR'S DECLARATION Job Description m C I hereby affirm that I am licensed under provisions of Chapter 9(commencing z� with Section 7000)of Division3oftheBusinessandProfess�ionsCode.andmylicenseis RE—ROOF (HAS EXISTING PLYWOOD TITIAN FELTUNDER e�H in full force and effe � 1�6 3 e,n? License Lic•g a' 6LB r 26 SQS. ;Ftp DatcContractor . ARCHITECTS DECLARATION i a Q I understand my plans shall be used as public records )dU 'tL H Licensed Professional OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the .20 following reason.(Section 7031.5,Business and Professions Code:Any city or county e e,� which requires a permit to construct.alter,improve,demolish,or repair any structure r Z y prior to its issuance,also requires the applicant for such permit to file a signed statement F1000 Area Valuation < that he is licensed pursuant to due provisions of the Contractors License Law(Chapter 9 3(1 Ft. $12500 (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 1 ,%1 Number Occupancy Type not more than five hundred dollars(3500). 3665102 0 0 1,as owner of the property,or my employees with wages as their sole compensation, will dothework.andthestructureisnotintendedorofferedforsale(Sec.7044,Business Required Inspections and Professions Code:The Contractors 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.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors 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 Contractors License Law. 0 I am exempt under Sec. B&P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]1 have and will maintain a Certificate of Consent to self-insure for Workers Compeo- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 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 Compensation lnsu nee carrier and Policy num r arc: Carrier. Policy No CERTI•CATE 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 uta employ any person in any manner so as to become subject to the Workcri 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. z' ' CONSTRUCTION LENDING AGENCY E~" I hereby affirm that there is a construction lending agency for the performance of (Y+> the work for which this permit is issued(Sec.3097,Civ.C.) W A Lenders Name z Lenders Address U C I certify that I have read this application and state that the above information is (l ►- correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorize representatives of this city to enter upon ft W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against �e 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 APPLICANT UNDERSTANDS AND W LL COMPLY WITH ALL NON-POINT Issued by: SOURCE R q v Re-roofs signaiw of ApplicantlCy6traclor DareHAZAT Of Roof MATERIALS DISCLOSURE Type 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 R"o 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 materials for inspection. District? 0 Yes $'No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Code,Sections 25505,25533 and 25534.I understand that if die building does not currently have a tenant that it'lwny responsibility to notify the o5upa9i of the requirements met ' rto' of a Certificate of 0c Signature of Applicant Date �" All roof coverings to be Class"B" or better Owner or authorized agent Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl� : Lot: APN 36E51026 . 00 DATE ISSUED. . . . . . . : 09/ 05/2007 RECEIPT #. . . . . . . . . . BSC00002554 REFERENCE ID # . . . : 07(,90014 SITE ADDRESS 11_,17 SILVER SPRING CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CARO MARK L AND GENEVIEVE H ADDRESS . . . . . . . . . . : 11_,17 SILVER SPRING CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5132 RECEIVED FROM . . . . : THOMAS H MCKEE CONTRACTOR . . . . . . . : TBI) - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBI) - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 12, 500. 00 201.96 0. 00 201 .96 0. 00 BSEISMICRE VALUATION 12, 500. 00 1 .30 0. 00 1.30 0. 00 BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 . 00 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 310 .26 0. 00 310.26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 310.26 VISA --------------- TOTAL RECEIPT 310.26 o�Oq aot L+ --� CITY OF C"UPERTINO CUPEkTINO PERMIT APPLICATION FORM APN# — - Date: BuildinAddress: �, /vc�z z N C'ton OZ - Owner's Na e: Phone #: Contractor: License 9- Contact: Cupertino Business License #: LEa 5 t o 3©3 t o y 0, Type of R sof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles It Wood Shakes ❑ Wood Shakes Wood Shingles �� ❑ Wood Shingles � M ai4 (_ Other(Specify)��L� / Other(Specify).l.CC RIA Number of existing coverings ❑ Provide LC.B.O. Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cul)ertino's Tear Off Policy: Job Dens -ption: Residential 9 Commerc al ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: El Cost of Project: T e of Construction: 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