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07090122 CITY OF CUPERTINO BUILDING DIVISION PERMIT H i Q IIYF+E IZ VIA►`I`I(JN' BUILf�ITV 2PERMIT NO. {\9D�IESkEST ESTATES DR BENA DAVID C 07090122 OWNER'S lN5AME: PERMIT ISSUE DATE BENA DAVID C 10880 W ESTATES 09/19/2007 SANITARY NO. CONTROL NO. ,NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 o LICENSED CONTRACTOR'S DECLARATION Job Description U PI hereby affirm that I am licensed under provisions of Chapter 9(commencing ;ZuUI with Section 70M)of Division 3 o die Business and Professions Cade.and my license is RE—ROOF WITH COMPOSITION SHINGLE 1/2" PLYWOOD, y in full force and effect. t ? License Class Lic.# 3011 : :—a Date Contractor ARCHITECTS DECLARATION FELT & 22 SQ i C< 1 understand my plans shall be used as public records >aU U. y Licensed Professional H OWNER-BUILDER DECLARATION Y 1 hereby affirm that I am exempt from the Contractor's License Law for the pO following reason.(Section 7031.5,Business and Professions Code:Any city or county <��z which requires a permit to construct,alter.improve,demolish,or repair any structure z y prior to its issuance,also requires the applicant Cor such permit to file a signed statement a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Floor Area $4200 0 Valuation e r (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 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36922024 . Number Occupancy Type not more than five hundred dollars($500) ❑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 oroffered 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 dbitstruct the project(Sec.7044.Business and Professions Cade:)The Conuactoes 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. ❑I am t under Sec. B&P C for this reason Owner Date WORKER S CO PENSATiON 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 Workces 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 Workces 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: Cartier: 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 shat(not employ any person in any t nCr so as to !n1vubject tolhe o�ket Cprr�cnsation Laws of California.Date 1\ $4 1 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 (~i C/) I 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.) nW+A Lender's Name Z Lender's Address U 0 1 certify that 1 have read this application and state that the above information is Lt " correct.I agree to comply with all city and county ordinances and state laws relating to rJ U building construction.and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against fn 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 UNDIj<STANDS AND W L COMPLY WITH ALL NON-POINT Issued by SOURCEREGULA Re-roofs Signature of Applicam/C forDatelT 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 (a No 1' 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 emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes G No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505.25533 and 25534.1 understand that if due building does not ctifrently have a ten t,that it is my responsibility to notify the occupant of the rcyuircments! 'ch must be t p to issuance of a Certificate of Oc�arucy. /� Signature of Applicant Date 1 //r//e-1/� , All roof coverings to be Class„B„or better Owner or authorized agent oto (- f /-pts CITE' OF ���TPETI�O CUPEkTINO PERMIT APPLICATION FORM APN# � r_� � n r, n q ,Q Date: Building Address: � - v ''� — �/V • Phone #:Owner'sN ne: Contractor: License Contact: Cupertino Business License #: Type of R)of Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles —Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Nmber of existing coverings , ❑ Provide LC.B.O. Report# To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand nd Will Comply With Cupertino's Tear Off Policy: Job Description: , r L 01 Residential Commercial ❑ 'L2 a P Fire Zone: Yes ❑ No r4 Confirmed with Planning Dept. if there are any restrictions: ❑ Cost f roject: Type of Ccaistruction: Occupancy gr �vk Qty. if �— !`/ Applicable Fee ID Fee Description F Group BPERMFEE Bldg Permit Fees BUILDING BENERGY energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK - ]an 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. Prwr to pt'171�11 ISSUCIM"(' you must agree_ tc> compl) o", r11 19 U}3C `>t�:;nciard�; and manufacturers specifications on re-1 oofing. 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 appro-al. 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 fist 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 cf$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 LC.B.O. report is required to be on tl.e job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: v t A Job Site Address: Roofing Company Name -----_ Applicant's � 's Si ature: Date: PP 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 . . . . . . . . . 36922024 . 00 DATE ISSUED. . . . . . . : 09,119/2007 RECEIPT #. . . . . . . . . : BS0]00002685 REFERENCE ID # . . . : 07090122 SITE ADDRESS . . . . . : 10380 WEST ESTATES DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER BE14A DAVID C ADDRESS . . . . . . . . . . . 10;380 W ESTATES CITY/STATE/ZIP . . . : CU:?ERTINO, CA, 95020-6321 RECEIVED FROM . . . . : DA`IID CHARLES BENA CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : BE]4A DAVID C ADDRESS . . . . . . . . . . . 10:380 W ESTATES CITY/STATE/ZIP . . . : CUPERTINO, CA, 95020-6321 TELEPHONE . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- - --------- ---------- ---------- ---------- BPERMFEE VALUATION 4, 200. 00 115 .56 0. 00 115 .56 0. 00 BSEISMICRE VALUATION 4, 200. 00 0.50 0. 00 0.50 0. 00 - --------- ---------- ---------- ---------- TOTAL PERMIT 116 . 06 0. 00 116 . 06 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 116 . 06 #275 --------------- TOTAL RECEIPT 116. 06 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. 2the work author ized by this permit B. — A portion of the wo-k C. _ None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. — All of the work B. _ A portion of the wcrk (complete section below) Contractor Address/City Phone # State License # Type of work to be performed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understanc.that I may be an employer (see reverse side). A Certificate of Insurance covering workers' con ipensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be erf ormed .......................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information ( verse side Date: Property Owner's Signature: Job Address: V m r Permit# An changes to the infor n o e oilhis r`m shall be submitted to the Ci of Cupertino Build Department. Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 '"UPEI�TINO Building Department JOB ADDRESS: L PERMIT# ( 0116 W , L Ta 1 0-? 0 ��fZZ OWNER'S NAME: PHONE # o - GENERAL CONTRACTOR: � FAX # I am not using any subcontractors: r'13)0-7 Signature Date Please check applicable subcontractors and co m lete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing 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 - l 9/u �l Owner/Contractor Signature Date