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07090125 CITE'OF CUPERTINO BUILDING DIVISION PERMIT >+�d� R��CTC'1R IEMATIl�� PERMIT NO. BUIL131I;(G,p 9'tINDA VISTA DR SHELTON ROOFING 07090125 OWNER'S NAME: PERMIT ISSUE DATE AOKI, ED 1988 LEGHORN ST 09/19/2007 YNE: (650) 96'.-7699 SANITARY NO, CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH p 0O LICENSED CONTRACTOR'S DECLARATION Job Description V I hereby affirm that I am licensed under provisions of Chapter 9(commencing ;Z� with Section 7000)of Division 3 of the Business and Professions Code,and my lice=is TEAR OFF SHAKE ROOF, INSTALL PLYWOOD, #30 FELT, a y in full force and effort "4 6( 0 4 )vn Z License Class C� Lie. NEW GUT�.'ERS, FIRE FREE SLATE F a Date 11I Contractor ARCHITECTS DECLA ATION i a a I understand my plans shall be used as public records >dU wo y Licensed Professional y OWNER-BUILDER DECLARATION } 1 hereby affirm that 1 am exempt from the Contractor's License Law for the jp 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 y prior in its issuance,also requires the applicant for such permit to file a signed statement e=< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 )q.Ft. Floor Area $27104 Valuation at $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L 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 ofp�Number Occupancy Type not more than five hundred dollars(5500). 3 5 616 01 r E ?w ' ❑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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors 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 die Contractors License Law. ❑1 am exempt under Sec B&P C for this mason Owner Date 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 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. ❑I 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 ompeenTnsardInsurance carrier and Policy number arc: / Cartier. 'J /z�/'��l 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,)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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY [~i r�r 1 hereby affirm that there is a construction lending agency for the performance of . (Y.> the work for which this permit is issued(See.3097,Civ.C.) Rw.Q Lender's Name a z Lender's Address U 0 1 certify that I have read this application and state that the above information is �- COMM I agree to comply with all city and county ordinances and state laws relating to G^U building construction,and hereby authorize representatives of this city to enter upon the CL, above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against Hc.4) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. r'+ APPLI NT UNDE Date ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU EGULATI 9- Re-roofs Re-roofs Si m of App on or Date T of R sof �1J HAZARDOUS MATERIALS DISCLOSURE ype 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 Cale,Section 25532(a)? ...,,,ttt All roofs:;hall be inspected prior to any roofing material being installed. ❑Yes JNo / If a roof i:;installed without first obtaining an inspection,I agree to remove Will the applicant or forum building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m 3terials or 1 SpeCilOn. District? ❑Yes 4No •7 Ihave read the hazardousmaterials requiremcntsundcrChapier6.95oftheCalifor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a to t.that ft is my responsibility to notify the occupant of the require is which must riot to issuance of a Ccrtifrca of Occupancy. ature Of Ap nt Date _G All roof coverings to be Class"B"or better aulhori z cn Dam - - CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN . . . . . . . . . 35E16014 . 00 DATE ISSUED. . . . . . . : 09/19/2007 RECEIPT #. . . . . . . . . : BSC00002688 REFERENCE ID # 07C90125 SITE ADDRESS . . . . . : 11166 LINDA VISTA DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . AOP.I, ED ADDRESS . . . . . . . . . . : 11166 LINDA VISTA DR CITY/STATE/ZIP . . . : CUPERTINO, CA RECEIVED FROM . . . . : SHE,LTON ROOFING CO CONTRACTOR . . . . . . . : WRF.Y, RICHARD LIC # 20755 COMPANY . . . . . . . . . . : SHELTON ROOFING ADDRESS . . . . . . . . . . : 19E8 LEGHORN ST CITY/STATE/ZIP . . . : MOLNTAIN VIEW, CA 94043 TELEPHONE . . . . . . . . : (6E0) 961-7699 FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 27, 104. 00 349 .92 0. 00 349 .92 0. 00 BSEISMICRE VALUATION 27, 104 . 00 2 .80 0. 00 2 . 80 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 352 .72 0. 00 352 .72 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 352 .72 #18006 --------------- TOTAL RECEIPT 352 .72 �7c�� � ias w. CITY OF C'UPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN# Date: Building Address: ,k` Owner's Name: �� Phone 40 ( ZS_,3 6 6z C, Contractor: L (� License#: Z61 Q Contact Cupertino Business License #: C 6M 90 7 �2 -7s� Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles X Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles f ❑ 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 Wi!A Cu ertino's Tear Off Policy: Job Description: !�C)VF Ske,-kt Too 17; S ilk �4)l. truck 6,, do "r56is Residential PSI Commercial ❑ Fire Zone: Yes ❑ No K Confirmed with Planning Dept. if there are any restrictions: U Cost of Pro'ect: Type of o .tion: Occupancy gr : G "c' " — 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 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:Ming 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 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 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 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: Eck Job Site Address: � 6 Roofing Company Name: S . �WV(, Applicant's Signature: Date: [-t Greg Casteel Building Official Revis(d 11/2/04 Community Development 10300 Torre Avenue Ali Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ';UPEkTIN0 Building Department JOB�1�99SS� , I lS PERMIT#r1 0 '? a NE # 6_50- t Z- OWI/ I R'S NAME: V G PHONE # 0- G GENERAL CONTRACTOR: e- FAX # !?61 0S8t; I am not using any subcontractors: Si,nature Date Please check applicable subcontractors and com-Aete 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 er ntractor Signature Date