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07090056 777�� 77777777777 CITY OF CUPERTINO BUILDING DIVISION PERMIT C� 1 'RA � IEE}RMATIUI�• PERMIT NO. BUILDING ADDRESS: AT\TII M U A OWNER'S NAME: S CONTROL NO. --•7N . 4082787296 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH a 0 0 a j 0o LICENSED CONTRACTOR'S DECLARATION Job Description r- I hereby affirm that I am licensed under provisions of Chapter 9(commencing U with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force andect. Lte(� ? 4S REMOVE _7=STING ROOF & INSTALL LIFETIE COMP ROOF License ClassLie•i o Date aj, /1/1019 Contractor (PRE S T.L. ) CLASS A ARCHITECTS DECLARATION -� I understand my plans shall be used as public records �V F Licensed Professional OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the j Or� following reason.(Section 7031.5,Business and Professions Code:Any city or county 5.In 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 Ll;q.Ft. Floor Area Valuation o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 - (commencing with Section 70DO)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 Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars(5500). C]1,as owner of the property,or my employees with wages as their sole compensation, 3692603 ) . 00 will do the work,and the structure is not intended or offered for sale(Sec.7M,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.). ❑I,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. ❑I am exempt under Sec. B&P C for this reason Owner Dale WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to self-insum for Workers Compen- .don,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 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 WorkeeslC�ompensatiooIIns^uta�n/�c�cartier and Policy number ate:g�� Carrier.�- ti w `-`�'" - Policy No.: `/� ` CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis section need riot 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 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 t 0 forthwith comply with such provisions or this permit shall be deemed revoked. 0 CONSTRUCTION LENDING AGENCY rte- 1 hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(See.3097,Civ.C.) QLender's Name Lender's Address 1z 0 1 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 slate laws relating to j CF.) building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. /17 ` (We)agree to save,indemnify and keep harmless the City of Cupertino against v) liabilities,judgments,costs and expenses which may in any way accrue against said City f Z in consequence of the granting of this permit. Date ►'� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SO REGUL Z,/1-/C 7 Re-roofs Signature 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)? All roofs:hall be inspected prior to any roofing material being installed. ❑Yes ❑No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove :mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes ❑No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the Ir rc cols ��which must be met prior to issuance of a Certificate of Occupancy. Signature �f ApplicaIrnt Date 0 7— 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: Blk.: Lot: APN . . . . . . . . . 36S26039 .00 DATE ISSUED. . . . . . . : 0911/2007 RECEIPT #. . . . . . . . . : BSC00002607 REFERENCE ID # . . . : 07C90056 SITE ADDRESS . . . . . : 10481 E ESTATES DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER JOINSON JACQUELINE J ADDRESS 10481 E ESTATES DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4565 RECEIVED FROM . . . . : D01 QUALITY ROOFING CONTRACTOR . . . . . . . : LOPEZ, ALBERT LIC # 21104 COMPANY D 7,ND M ROOFING ADDRESS 9K 2ND ST CITY/STATE/ZIP . . . : SAN JOSE, CA 95118 TELEPHONE . . . . . . . . : 4U2787896 FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPERMFEE VALUATION 11, 900. 00 191.16 0. 00 191 .16 0. 00 BSEISMICRE VALUATION 11, 900. 00 1.20 0. 00 1.20 0. 00 BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 . 00 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 299 .36 0. 00 299 .36 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 299 .36 #1419 --------------- TOTAL RECEIPT 299 .36 0 CITY OF I�UPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM Date: / G APN#o � D 7 d��• � v ! / Building Address: ,,-a yQ ( j_'_ ^ 5 0 Owner's Name: Phone#: ;�01n-rnS�'l 9019-x'13--1/o$ Contractor: �ZPV�* 10 A, V, oc At t 45 Contact* Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles tr—Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# 6 01'To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cupertino's Tear Off Policy: kb Description: / �C e S tsn cc� �► S fiC )) Li 2 �i� Irl Ace eS C Residential 12o' Commercial ❑ Fire Zone: Yes ❑ No UK Confirmed with Planning Dept. if there are any restrictions: ET Cost of Project: T e of Construction: Occupancy grow co 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 t 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 2 to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be applies.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 approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail:nspection 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 perfcrmed. 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 comply with the above stated policy on re-roofing. Homeowner's Name: �)c h Sc n Job Site Address: /0 g o r r r 1-`"fit V Roofing Company Name: Applicant's Signature: Date: Greg Casteel Building Official Revise 311/2/04