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07090134 7777777 CITY OF CUPERTINO 77777777777777 BUILDING DIV151ON PERMIT PERMIT NO. BUILIaIPJfI,An"TOUNTRY SPRING CT LOS GATOS ROOFING 07090134 OWNER'S NAME: l PERMrr ISSUE DATE BILL PALLEY P 0 BOX 1726 09/20/2007 ,NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO RMV EXTNG SHAKE RF; INSTL BLDG ELECT PLUMB MECH C7 O O O O p LICENSED CONTRACTOR'S DECLARATION ___� ___ __ ._.___._ �lob Description u I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z w with Section 70(10)of Division 3 of the Business and Professions Code,and my license is =y ce in full forand effe 0✓1�, Z > ? License C• Lie.A ;F w Date Contractor I_t]S &W JAVS KLVftftOt ARCHITECTS DECLARATION i a I understand my plans shall be used as public records >yU u y Licensed Professional w a OWNER-BUILDER DECLARATION j a 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county 9 which requires a permit to construct,alter,improve,demolish,or repair any structure ?Z y prior to its issuance,also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation 2 FT (commencing with Section 7(100)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 or APN 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 or offered for sale(Sec.7044,Business ns Required Inspections and Professions Code:The Contractor's License Law docs(tat 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 Contractor's Li- ccase 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. ❑1 am exempt under Sec. 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 Worker's 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 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 Worker's CCoomypensat((p,�r Insu ce carier and Policy number are: Carrier. artier STr"t e 1't�t Policy No.: CERTIFICATE OF EXEMPTION FROM WO CERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss.) 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z' CONSTRUCTION LENDING AGENCY E"►�-� 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.) aQ Lendcrs Name 0 z Lender's Address U Q I certify that I have read this application and state that the above information is r correct_I agree to comply with all city and county ordinances and state laws relating to rJ building construction,and hereby authorize representatives of this city to enter upon the I.Ta above-mcnuuned property for inspection purposes. (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 U Z in consequence of the granting of this permit. Date �—� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SO REGULATIO S. + /,,I 91 a 101_Z Re-roofs -� g tture of Applicant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of R sof 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 1_17No 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 Area Air Quality Management all new materials for inspection. District? ❑Yes EK., I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Sarcty Code,Sections 25505.25533 and 25534.1 understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the j / 1-i D y✓ ��/ require is which must met prior to issyance of a Certiflcate of Oc Sig attire of Appl ieant Date G oer r authorized agent a,� All roof coverings to be Class"B"or better CITY Oh CUPERTINO REROOF CUPEk INO PERMIT APPLICATION FORM APN# S- Date: ,BGG - S� - � za a 7 Building Address: ZZ-5& 3 riti Owner's Name: Phone#: 6111 a F L Contracto : Phone #: License#: .� s 6, C", jo, �-_ ,)3 <y c) Contract,: Phone;#: Cupertino Business License#: 3 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles Wood Shakes 11 Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) T V P e 3C) G S-rtr, Number of existing coverings _ ❑ Provide I.C.B.O.Report# To be Removed` �� ❑ Provide Mfgr.Installation Specs. S 21, 5 5 s / ss I Have Read, Unde tand and Will Comply With C u ertino's Tear Off Policy ❑ Job D scrip on: a, 64"� t� Residential bd Commerci ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: i5 Cost of Pro'ect: Type of Construction: Occupanc group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISIVIICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING CITY OF CUPERTINO 2 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN . . . . . . . . . 36,351050. 00 DATE ISSUED. . . . . . . : 09 /20/2007 RECEIPT #. . . . . . . . . : BS000002701 REFERENCE ID # . . . : 07090134 SITE ADDRESS . . . . . : 11563 COUNTRY SPRING CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . . BILL PALLEY ADDRESS . . . . . . . . . . : 11563 COUNTRY SPRING CT CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5116 RECEIVED FROM . . . . LOS GATOS ROOFING CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481 COMPANY . . . . . . . . . . : LOS GATOS ROOFING ADDRESS . . . . . . . . . . : P 0 BOX 1726 CITY/STATE/ZIP . . . : LO:' GATOS, CA 95031 TELEPHONE . . . . . . . . : (408)298-9399 FEE ID UNIT QUANTITY !MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 5, 226. 00 126 .36 0. 00 126 .36 0. 00 BSEISMICRE VALUATION 5, 226 . 00 0.60 0. 00 0.60 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 126 .96 0. 00 126.96 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 380. 88 #2530 --------------- TOTAL RECEIPT 380. 88 Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 Fax: (408)777-3333 L U P E IST I N O Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must ag-ee to comply with 1997 UBC Standards and manufacturers specifications on ra-roofing. 2. New roof coverings shall not be appli?d without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the b rilding inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to ar y 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 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 per:'ormed. 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: E Job Site Address: 115 . Roofing Company Name: LC S ��L1:�b = 0�� ''� C. A plicant's Signatur 5 ,,4 Date: Z b /6 Greg C4wteel Building Official Revised 1/30/03 Printed or Recycled Paper Community Development ' 10300 Torre Avenue Cupertino CA 95014 ` Telephone(408)777-3228 CITY OF Fax(408)777-3333 rUPEkTINO Building Department JOB ADDRESS: PERMIT# � �� 3 Cf 6-7OWNER'S NAME: PHONE #-c V - J GENERAL CONTRACTOR: Los - , FAX# c el 9_3 I am not using any subcontractors: Si€nature Late Please check applicable subcontractors and com lete the following-information: . 21 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/Contractor Signature atm