07090055 7-77777777-777777
CITY OF CUPERTINO � 10"TQ I RMATIQ :
BUILDING DIVISION PERMIT
PERMIT NO.
BUILDING ADDRESS:
1093 K-ENMORE. CT T_r_P RTr'
OWNER'S NAME: K
CT p CONTROL NO.
V
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
Z LICENSED CONTRACTOR'S DECLARATION Job Description
%O
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 of the Business and Professions Code.and my license is
;y in full force and effect. PLYWOOD ROOF 50 YR ELK PRESTIGE ASPHALT SHINGLES
Z License Class Lte•#
3 Q Date Contractor 1/2" PL"WOOD, 3 0LB FLT, 24 SQS.
ARCHITECTS DECLARATION
-� I understand my plans shall be used as public records
F' Licensed Professional
j OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
jO following reason.(Section 7031.5,Business and Professions Code:Any city or county
�i 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 Sq.Ft.Floor Area Valuation
.,4 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or
i.. 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 APN Number
not more than five hundred dollars(5500).
0 I,as owner of the property,or my employees with wages as their sole compensation, 3 6 215 O 3 . 00
will do the work and the structure is not intended or offered forsale(Sec.70",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
s�ale.).
jr•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 Law.
0 I am ex rept under Se B&P C for this reason
Owner
i. Date —1 l W 1
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insure for Workers 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 Workers Compensation Insurance carrier and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF 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 not
employ any person in any m ncr so as to come subject to the Workers'Compensation
Laws of CalifRmia D}tc* ')'�
Applicant�
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Codc,you must
1 z forthwith comply with such provisions or this permit shall be deemed revoked.
r
O CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
0 Lender's Name
• Z Lenders Address
� I certify that 1 have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
j U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
f>, (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
Z in consequence of the granting of this permit. Date
APPLICANT UN ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
S=
RC,E R GU TI s. _ 1—a" Re-roofs
S= f
S gnature of Applicant/Contractor Date T of Roof
HAZARDOUS 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)? y/ All roofs shall be inspected prior to any roofing material being installed.
0 Yes Elk?
I_ 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
it hazardous air contaminants as defined by the Bay Arca Air Quality Management all new rr aterials for inspection.
✓istrict?
0 Yes OIu
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.I understand"if the building v r
does not currently have a tenant,that it is my responsibility to notify the occupant of the
rememos w rch ust m t prior to issuance of a Certificate of occupancy. Signature of Applicant ieant Date
gyyF� 1/-�- x'-11'0.7 - All roof coverings to be Class"B"or better
Owner or authorized agent Date
070 U0s
CITY OF CXPERTINO
:" RETZOOF
CUPEkTiNO PERMIT APPLICATION FORM
APN# Date:
Buildin Address: A
Ter's Na e: Phone#:
Contractor: License#:
(D•-
Contactr:,� Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 'k Asphalt Shingles
X 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: � f
Residential J< Commercial ❑ i'Z"
S �-
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy grol
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
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agre E! 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 building 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 apprcval.
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 f irst obtaining an inspection,
will require the removal of all new mat?rial 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" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on-he job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: Lar c` V + -
job Site Address:
d 2� 1��-. rte- �- ;,,�,�,"-�.,*..ti C_s S-0
Roofing Company Name:
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36215037 .00
DATE ISSUED. . . . . . . : 09/11/2007
RECEIPT #. . . . . . . . . : BS000002606
REFERENCE ID # . . . : 07090055
SITE ADDRESS . . . . . : 1023 KENMORE CT
SUBDIVISION . . . . . . .
CITY CUFERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VEIT RICHARD W AND MARCELLA K
ADDRESS . . . . . . . . . . : 1023 KENMORE CT
CITY/STATE/ZIP . . . : CUFERTINO CA, 95014-4119
RECEIVED FROM . . . . : RICHARD VIET
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : VEIT RICHARD W AND MARCELLA K
ADDRESS . . . . . . . . . . : 1023 KENMORE CT
CITY/STATE/ZIP . . . : CUFERTINO CA, 95014-4119
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ------
BPERMFEE VALUATION 4, 000. 00 104.76 0. 00 104 .76 0. 00
BSEISMICRE VALUATION 4, 000. 00 0.500. 00 0.50 0. 00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 105 .26 0. 00 105 .26 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CASH 105.26 CASH 4 PERMIT
---------------
TOTAL RECEIPT 105 .26