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07060107 777777 is ib: CITE'OF CUPERTINO BUILDING DIVISION PERMIT CE? I +fRMATIfJN PERMIT NO. BUfLIr6aj1l�QEsSB..LANEY CT JIM KR7.USE ROOFING 07060107 j PERMIT ISSUE DATE OWNER'S NAME: SCOTT 2310 DANA AVE 06/13/2007 SANITARY NO. CONTROL NO. zNE: ARCHITECT/ENGINEER: BUILDING PERMIT INFO REMOVE WOOD SHAKES & REPLACE BLDG ELECT PLUMB MECH D D D D p p LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z W with Sccdon 7000)of Division 3 of the Business and Professions Code,and my license is 0. in full force and effc = 3Jr o 4 rn License Clas Lic. :r p Date Contractor ARCHITECTS DECLARATION ,a< t understand my plans shall he used as puhlic records >A.0 U.F Licensed Professional OWNER-BUILDER DECLARATION } 1 hereby affirm that 1 am exempt from the Contractor's License Law for the pOe� following reason.(Section 7031.5,Business and Professions Code:Any city or county !i 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 .Ft.Floor Area Valuation ; 2 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3 q t F- (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 arty applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type not more than five hundred dollars($500). ❑1,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 docs 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.). ❑1,as owner of the property,am exclusively contracting with licensed conuacwrs 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. C]I 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 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. 1have and will maintain Workers Compensation Insurance,as required by Section 5700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: 3 Carrier. �1R Ce �u N� Policy No.:?? i7— ) CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Chis 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,l shall rex employ any person in any manger so to c e subject to the Workers'Compensation Laws of Calif,,Date ( �! ` Applicant (� NOTICE TO APPLICANT:If,afulYmakintLltis Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the Labra Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY Fr rA I hereby affirm that there is a construction lending agency for the performance of fYi> the work for which this permit is issued(Sec.3097,Civ.C.) Wc�.A Lenders Name .`7 Z Lender's Address U 0 1 certify that I have read this application and state that the above information is U. i correct.1 agree to comply with all city and county ordinances and state laws relating to Vbuilding 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 Le) 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: SOUR GULATIONS. d3 I v 7 Re-roofs Signature of pplicant/ ntractor Dam T Of Roof ARDOUS MATERIA ISCLOSURE Type Will pylic Int or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safely Code,Section 25532(a)? r, All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes Ipo Will a roof i.;installed without first obtaining an inspection,I agree to remove ll 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 [�Io I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 75534.1 understand that if the building ` does not currently have a tenant,that it is my responsibility to notify the occupant of the require n which must be met prior to issuance of a Certificate of Oc panty. Signature of Applicant Date �—/T"`� All roof coverings to be Class'B"or better Owner or authorized 2-11) Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN 361,32015 . 00 DATE ISSUED. . . . . . . : 06/13/2007 RECEIPT #. . . . . . . . . : BS000001645 REFERENCE ID # . . . : 07060107 SITE ADDRESS . . . . . : 10;;13 BLANEY CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . . SCOTT ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3123 RECEIVED FROM . . . . : EDWARD A GREGORY CONTRACTOR . . . . . . . : KRI�USE, JIM LIC # 21415 COMPANY JIM KRAUSE ROOFING ADDRESS . . . . . . . . . . : 23:_0 DIANA AVE CITY/STATE/ZIP . . . : MORGAN HILL,. CA 95037 TELEPHONE . . . . . . . . : (408) 779-0704 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BENERGY PERMIT FEE 1. 00 34.86 0. 00 34 .86 0. 00 BPERMFEE VALUATION 11, 700. 00 191 .16 0. 00 191.16 0. 00 BSEISMICRE VALUATION 11, 700. 00 1 .20 0. 00 1.20 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 227 .22 0. 00 227 .22 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 227 .22 MC --------------- TOTAL RECEIPT 227 .22 0-70(o CC CITY OF CUPERTINO RF R OOF CUPEkTINO PERMIT APPLICATION FORM APN43(og3 ;),d �. UC� Dater ` /3 0 7 Building Address: Z0313 Owner's ame: Phone#: C_ yoa'- z 3- 7P z 3 Contractor: License#: `lam r G U.S-e. ATO`�i wc, — � i.�Z ,C—S Contact: Cupertino Business License #: y,19-6 62 l North Bay PPeRMt ervice Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles K Asphalt Shingles X Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings I ❑ Provide I.C.B.O.Report# XTo be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: )a Job Description: -r/0 �K.I4/11 �`'� �� S' 4l/ /)oti s `� a.,1 7/�b OSCs' 3 Jlb e 1f r Z- �d vtior k G-o cr sir: le-5' SSS 14 3S 59=s', Residential P< Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dyt. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: 7G9`J 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 r Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 clip kTINO Building Department JOB ADDRESS: Aq -�/�-� 1--s /1:7 C �-- PST# 01 o f c-7 OWNER'S NAME: PHONE# Ok- Z s 3 Z Sz 3 GENERAL CONTRACTOR Ji v b'`— 0 FAX# I am not using any subcontracto -(]� Signature V late Please check applicable subcontractors and compleie 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 �C Roofing ra Septic Tank Sheet Metal Sheet Rock ••, Tile /3- 0 Owner/ConlYaci8oignature Date