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07090024 CITY OF CUPERTINO J BUILDIN%D'%,'iS-'O.q PERMIT +Cfi� TIt lGTQ ��'QRMATI N. RESS: PERMIT NO. BUILDN �d�$ MILKY WAY LEGACY FOOFING & 07090024 OWNER'S NAME: PERMIT ISSUE DATE JILL DURKIN 1 1698 ROCERS AVE 09/07/2007 .VE: SANITARY NO. CONTROL NO. (408) 461-0150 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH 0 (� p O LICENSED CONTRACTOR'S DECLARATION Job Description VI hereby affirm that I am licensed under provisions of Chapter 9(commencing z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is T/0 WOOL, SHAKES, (N) PLYWOOD ON 1/2 0 F HOUSE, 30# t=H in full force and effect. av2b 5 �z LicenseCj�ss) Lic.if — FELT, PEES SHINGLES, 32 SQ CLASS A :—a Date '(�7�—Contractor �i R ARCHITECTS DECLARAIYON i C I understand my plans shall he used as public records �yU 'm y Licensed Professional y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve.demolish,or repair any structure Z} prior to its issuance,also requires the applicant for such permit to rile a signed statement c Ft.Floor Area Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 (1 $12000 F (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 ,j�Number Occupancy Type not more than five hundred dollars(5500). 3 6219002 M ❑I,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 Q p 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.). ❑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 Contractor's License Law. ❑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: ❑I 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 Worker's Compensation Insurance carrier and Polity number arc: Cartier: A Z C Policy No.: N142-20 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Chis section need not be completed if the permit is for one hundred dollars(SI00) 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 ,J 0 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 a, 5 the work for which this permit is issued(Sec.3097,Civ.Q CW Q Lender's Name z Lcndees Address U C) 1 certify that 1 have read this application and state that the above information is LTcorrect.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorise representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Hliabilities,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 WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE LA NS. •..r4.� 9/7/07 Re-roofs l`" ::_7 Signature of p i NContracar Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE 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(x)? All roofs,hall be inspected prior to any roofing material being installed. ❑Yes $Fb If a roof i� installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes )qNo 1 have read the hazardous materials requirements under Chapter6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand am if the building K,r.ir✓` 1,07 docs not currently have a tenant,that it is my responsibility to notify the occupant of the require men hie t be met rior to issuance of a Certificate of Oc c. Signature )) Applicant Date ? _ All roof coverings to be Class"B"or better Owner or authori!p.rd agent Date 070 `7 0oaV CITY OF C'UPERTINO REROOF CITY Of CUPEkTINO PERMIT APPLICATION FORM APN# � ��/�7 Building Address: 10$3 M:tk Owner's Name: Phone#: z1:1t lJ V,.k:VI Vag --2 i 1 Contractor: License#: Lc ac�4 W:K 8026 Contact: Cupertino Business License#: Type of Roof Covering:. Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X. Asphalt Shingles A 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 Cu)ertino's Tear Off Policy: Job Description: 32 TIo w" 0141ces 0 wood do ` OT lik>vSe 30;t �ilf, -PrtS. 5Wv1 Ie5 ept5 Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Debt. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: 411,00o (L�dcn l Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE :31dg 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 1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 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 bu:lding 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 Citythe following steps are required: 1) Pre-inspection and/or tear off apprc val. 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 mat trial 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 Df$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 the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: 7:1k ZDvdk:v1 Job Site Address: 10$3 M:1144 W02,r Roofing Company Name: LPq+c_y(4a Tom, Applicant's Signature: ° ' Date: 9 0 7 Greg Casteel Building Official Revise 111/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIZ RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 36219002 . 00 DATE ISSUED. . . . . . . : 09/07/2007 RECEIPT #. . . . . . . . . : BSC00002573 REFERENCE ID # . . . : 07C90024 SITE ADDRESS . . . . . : 10E3 MILKY WAY SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUFERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . JILL DURKIN ADDRESS . . . . . . . . . . : 10E3 MILKY WAY CITY/STATE/ZIP . . . : CUFERTINO CA, 95014-5008 RECEIVED FROM . . . . : RYPN A LAUBACH CONTRACTOR . . . . . . . : ROFERT LAUBACH LIC # 24091 COMPANY . . . . . . . . . . : LECACY ROOFING & WATERPROOFING ADDRESS . . . . . . . . . . : 1698 ROGERS AVE CITY/STATE/ZIP . . . : SAIS JOSE, CA 95112 TELEPHONE . . . . . . . . : (4C8)467-0150 FEE ID UNIT QUANTITY PMOUNT 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 ---------- ---------- ---------- ---------- TOTAL PERMIT 192 .36 0. 00 192 .36 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 192 .36 MC --------------- TOTAL RECEIPT 192 .36