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07090032 CITY OF CUPERTINO R#�M�PERMI`I`NO. r�BUILDING DIVISION PERMIT BUILDING ADDRESS: 11176 LINDA VISTA DR AMERICA' S ROOFING 07090032 PERMIT ISSUE DATE OWNER'S NAME: SUZUKI RODD Y AND MIDORI 11650 S. 7TH ST 09/10/2007 SANITARY NO. CONTROL NO. NE: (408) 661-6501 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 ee 0 LICENSED CONTRACTOR'S DECLARATION Job Description V C I hereby affirm that I am licensed under provisions of Chapter 9(commencing ;yam, with Section 7000)of Division 3ofthe Business and Pr unst ode,andmyliccnscis REMOVE 1 SHAKE ROOF & INSTALL OSB, COMPOSITION y in full force and effpt VI z License s �' Lie.dr CLASS A 4 . 5 SQ FT. paw Contractor !tk ARCHITECTS DECLARATION i a Q 1 understand my plans shall be used as public records iyU ' U.y Licensed Professional o a OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License law for the 3 p as following reason.(Section 703 1.5,Business and Professions Code:Any city or county m 9 which requires a permit to construct,alter,improve,demolish,or repair any structure prior to its issuance•also requires the applicant for such permit to file a signed statement <,q.Ft.Floor Area Valuation z e that he is licensed pursuant to the provisions of the Contracwr s License Law(Chapter 9 $9000 F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or w 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 356160133 .1" Number not more than five hundred dollars($500). ❑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.7N4,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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Coottactoes Li- cense taw 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. ❑1 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: ❑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. ❑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's a pespuon Insure ce tanker and Poli Ho Carrier. rcPol'Y CERTIFICATE of EXEMPTION m O S 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,1 shall not employ any person in any manner so as to become subject to the Workers'C0mpentsation 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. z, CONSTRUCTION LENDING AGENCY C4 1 hereby affirm that there is a construction lending agency for the performance of a> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name �z Lender's Address I certify that I have read this application and state that the above information is LUL correct.I agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize reprcscntativcs of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against 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 ►-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POI Issued by SOURCE REGULATIONS. l Re-roofs Signature of Applicant/Conuactor Date T of Roof HAZARDOUS MATERIALS DISCLOSURE Type Will the applicant or future building occupantstore or handle hazardous material as defined by the Cupertino Muni• I 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 No 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 Arca Air Quality Management all new rr aterials for inspection. District? ❑Yes u 1 have read the hazardous materials requirements under Chapter 6.95 of the Califon- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant that it is my responsibility to notify the occupant of the E requirements whichtlµtst be met prior to issuance of Certificate cy Signature O Ap nt Date `�"✓ — All roof coverings to be Class"B"or better Owner or authorized agent Dat 0709 003 CITY OF (:UPERTINO w REROOF CUPEkTINO PERMIT APPLICATION FORM APN# -3S. i �O 13 ' n Date: f�'_ I✓ Building Address: Own s Naje� Phone#: � �U ll �� Contractor: Licens Conta Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ i t-Up roof ❑ sphalt Shingles Asphalt Shingles Wood Shakes ❑ Wood Shakes C3Wood 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 Ctr)ertino's Tear Off Policy: b Description: _ Residential Commercial ❑ (p— Ito S `V( Sq bzy-b Fire Zone: Yes ❑ NoConfirmed with Planning Det. if there are any restrictions: IJ Cost of Project: - Type of oust ,tion- Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group I 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-=100fing. 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'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 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 :)f$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 c m y ' h e above stated policy on re-roofing. Homeowner's Name: Job Site Address: I "' f �_ t Roofing Company Name: Applicant's Signature: Date: o — Greg Casteel Building Official Revis(d 11/2/04 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 35616013 . 00 DATE ISSUED. . . . . . . : 09/ LO/2007 RECEIPT #. . . . . . . . . : BSO )0002584 REFERENCE ID # . . . : 070 )0032 SITE ADDRESS . . . . . : 11116 LINDA VISTA DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER SUZ-JKI RODD Y AND MIDORI ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4770 RECEIVED FROM . . . . : CHRIS CASTILLO CONTRACTOR . . . . . . . : CHRIS CASTILLO LIC # 27100 COMPANY . . . . . . . . . . : AMERICA'S ROOFING ADDRESS 165) S. 7TH ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (403) 661-6501 FEE ID UNIT QUANTITY AKOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 9, 000. 00 158 .76 0. 00 158 .76 0. 00 BSEISMICRE VALUATION 9, 000. 00 0.90 0. 00 0.90 0. 00 BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 .00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 266. 66 0. 00 266 . 66 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CASH 266 . 66 CASH --------------- TOTAL RECEIPT 266 . 66 - 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