07090132 CITY OF CUPERTINO
BUILDING DIVISION PERMIT � o,�Tfl
BUILDIN6.RLY�IirESsROCK SPRING LOS GATOS ROOFING PER 07090132
OWNER''SlN�AMGE: PERMrr ISSUE DATE
ROB WHEELER P 0 BOX 1726 09/20/2007
SANITARY NO. CONTROL NO.
ME:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: RMV EXT SHAKE RF; INSTL TYPH BLDG ELECT PLUMB MECH
p z0 LICENSED CONTRACTOR'S DECLARATION T�r ryT_ry _ Job.Descrlptlon
W 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
U E with Section 7000)of Division 3 of the Business and Professions Code.and my lie
h=y in full force and effect.
h vM z License Lic.8
F DateIve
Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
)4U
oh Licensed Professional
n OWNER-BUILDER DECLARATION
'> 1 hereby affirm that 1 am exempt from the Contractors License Law for the
jcl o following reason.(Section 703 1.5,Business and Professions Code:Any city or county
e 0! which requires a permit to construct,alter,improve,demolish,or repair any structure
?Z} prior to its issuance,also requires the applicant for such permit to file a signed statement rea Valuation
x a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor A
e.t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
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 APN Number Occupancy Type
not more than five hundred dollars(5500).
❑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.).
❑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 Sea B&P C for this reason
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 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 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 4qpmpensaLio,p4asuraff carrier and Policy number are: �Q
Cartier. Policy No.:ln; ao
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
1 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
,J. O forthwith comply with such provisions or this permit shall be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
F~.t rA 1 hereby affirm that there is a construction lending agency for the performance of
(�r7 the work for which this permit is issued(See.3097,Civ.Q
QLender's Name
Z Lender's Address
U O 1 certify that I 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
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
4r (We)agree to save,indemnify and keep harmless the City of Cupertino against
Hc/i liabilities,judgments,costs and expenses which may in anyway accrue against said City
U 2 in consequence of the granting of this permit.
►'+ APPLI NT UNDFRST NDS AND WILL COMPLY WITH ALL NON-POINT Issued by Date 5
SO REGULATI J\ D
Re-roofs
Sign ore oCApplirara '�
HAZARDOUS
T of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant stoic or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and die Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes 0
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
emit havArdous air contaminants as defined by the Bay Arca Air Quality Management all new rr aterials for inspection.
District?
C]Yes u
7
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
Q
does not ently have a tenant.that it is my responsibility to notify the occupant of dhc
rcquis which must b_ t prior to issuable of a Certificate of Occ antsy. Signat e of Applicant Date
All roof coverings to be Class"Br'or better
Owncr uthorircd agent 62W
CITY OF CUPERTINO
REROOF
CUPEkTiNO PERMIT APPLICATION FORM
APN# 3 j_ � 0 v Date: �9 /f G;7
Building Address: //52 / 4e S,,,117tf al—
Owner's Name- Phone
n�
e,�X f G
Contractor: 1 Phone#: O License#:
r A,
t'�
- oo2o
Contact: _�— Phorr;#: Cupertino Business Lice n e#:
Sa�� 3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles j
❑ Other(Specify) Other(Specify)_ , 7 M3U f-1 L
Number of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed 1n� i� ❑ Provide Mfgr.Installation Specs.
J
/fool e/ass
I Have Read, Understand and Will Comply With Cu ertino's Tear Qff Policy:
Job Descriptio
Residential Commercial []
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: (5
Cost of Pr ject•L5
Type o Con.,1ructi • Occu ancy group: ,
on clu 3 6,
L_ Qf)ak
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE _ _Seismiclee.Res BUII.DING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
i
CITY OF CUPERTINO
2 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN . . . . . . . . . 36651035 . 00
DATE ISSUED. . . . . . . : 09/20/2007
RECEIPT #. . . . . . . . . : BSC00002701
REFERENCE ID # . . . : 07C90132
SITE ADDRESS . . . . . : 11529 ROCK SPRING
SUBDIVISION . . . . . . :
CITY CUE ERTINO
IMPACT AREA . . . . . .
OWNER ROE WHEELER
ADDRESS 11E29 ROCK SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : LOE GATOS ROOFING
CONTRACTOR . . . . . . . : RADDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : L0: GATOS ROOFING
ADDRESS P C BOX 1726
CITY/STATE/ZIP . . . : LO: GATOS, CA 95031
TELEPHONE . . . . . . . . : (4C8) 298-9399
FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
BPERMFEE VALUATION 4, 536. 00 115 .56 0. 00 115 .56 0. 00
BSEISMICRE VALUATION 4, 536. 00 0.50 0. 00 0 .50 0. 00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 116 .06 0. 00 116 .06 0. 00
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEf�TINO
Building Department
Subject: Re-roofing policy for th E! 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 buildinginspector. 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 Tiny 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 n iil 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.
IMPORTANT:
1. Flat roofs must have a minimum of?'4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be c n the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
-__Job_Site Address:
Roofing Company Name:
O
Applicant's Signature: 7� 2,eDate: 07
Greg teel
Building Official
Revised 1/30/03
Printec on Recycled Paper
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEI�TINO
Buildin De artment
JOB ADDRESS: /�S 9 P,,� P�i��q C, PERMIT# �� Z
OWNER'S NAME: G /e e PHONE # �`D I I-6 7 2
GENERAL CONTRACTOR FAX# &);r y3 -
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete 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
'
)- 4elo
lyz
bwner/ Signature Date