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07060220 CITY OF CUPERTINO BUILDING DIVISION PERMIT IMATI� * BUILDING ADDRESS: PERMIT NO. 7556 BOLLINGER RD WOODS ROOFING 07060220 OWNER'S NAME: PERMIT ISSUE DATE GAMBLE PAUL N AND MARJORIE A 1020 HICKORY CT 06/25/2007 NE: SANITARY NO. CONTROL NO. (831) 631-5576 ARCHMCT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH IW O p LICENSED CONTRACTOR'S DECLARATION Job Description U p I hereby affirm that I am licensed under provisions of Chapter 9(commencing ?z w with Section 7000)of Division 3 of the Business and Professions Code.and my license is TEAR OFF' 2 ROOFS, INSTALL RESIDENTIAL 50 YDS. 30# t H inlull force and effect Imo/ 3;z%1—) -3 PAPER. ? License CJaSs J ( Li•x F Date Contractor +�/*.1 ARCHITECTS DECLARATION 22-1 94.< 1 understand my plans shall be used as public records >yU H Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the C a Oy following reason.(Section 7031.5,Business and Professions Code:Any city or county $Ii which requires a permit to conswct,alter,improve,demolish,or repair any suudure prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft. Floor Area Valuation 2 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q t– (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $11695 y 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 Number Occupancy Type not more than five hundred dollars(5500). 3592400: 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 twiner of 9 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.). Q 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Conuacor's 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 Contractor's License Law. 0 I am exempt under Sec B&P C for this mason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: J I have and will maintain a Certificate of Consent to self-insum 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 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 Compensation Insurance carrier and Policy number are: Carrier: �1-�" IyA PolityNo.��I�IG CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is Cortin hundred dollars($100) or less.) I certify that in the performance of the work for which this permit is issued,1 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 [- tz I hereby affirm that there is a construction lending agency for the performance of (yr the work for which this permit is issued(Sec.3097,Civ.C.) W� Q Lender's Name z Lender's Address U C) I certify that I have read Ws application and state that the above information is L>+t 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 (3l above-mentioned property for inspection purposes. Q. (We)agree to save,indemnify and keep harmless the City of Cupertino against V) liabilitiesJudgmem s,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -� S RCE R ATIONS. G as­ra7 Re-roofs Signature of Applicant/Comractor Dao HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 shall be inspected prior to any roofing material being installed. L]Yes jgu 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 hazardous air contaminants as defined by the Bay Arca Air Quality Management all new maerials for inspection. District? ❑Yes P No I 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 does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements whiustbcmetpriortor m mraccnifi nrOceapanty. Signature of Applicant Date �tQ= � �- pn5 All roof coverings to be Class"B"or better Owner or authorized agent Dao CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B1}:: Lot: APN 355,24002 . 00 DATE ISSUED. . . . . . . : 06/ 25/2007 RECEIPT #. . . . . . . . . : BS(100001783 REFERENCE ID # 07060220 SITE ADDRESS . . . . . : 75_,6 BOLLINGER RD SUBDIVISION . . . . . . : CITY CUPERTINO IMPACT AREA . . . . . . . OWNER GAMBLE PAUL N AND MARJORIE A ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4333 RECEIVED FROM . . . . : LAWRENCE E WOOD CONTRACTOR . . . . . . . : WOOD, LAWRENCE E LIC # 20810 COMPANY WOODS ROOFING ADDRESS 10,:0 HICKORY CT CITY/STATE/ZIP . . . : HOI,LISTER, CA 95023 TELEPHONE (8;;1) 637-5576 FEE ID UNIT QUANTITY 2MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 11, 695. 00 191.16 0. 00 191.16 0. 00 BSEISMICRE VALUATION 11, 695. 00 1.20 0. 00 1.20 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 192 .36 0. 00 192 .36 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 192 .36 AMEX --------------- TOTAL RECEIPT 192 .36 0-70 (o a 2 Z O CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN# Date: r Building Address: ;;;Pl S're �o���i✓6 c 41D Owner' Name: Phone#: 6,47t /3 KGs'' a s - G 3� --- ©`�'- Contrctor: License#: 2m�t') S ��l ir✓ �,v 3,;2 3 Contact* Cupertino Business License#:/ Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 2, Asphalt Shingles 119 Wood Shakes ❑ Wood Shakes .9 Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# /4— To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu)ertino's Tear Off Policy: Job,Description: 5b Y-4 C=, ice o? /f�ac_>!^ 5 /fit 5 %o') L Residential 4 Commercial ❑ Fire Zone: Yes ❑ No 9 Confirmed with Planning Det. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy grou . 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 buildinp 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 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 mat?rial 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 the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: ed v/_ l4-^ 6 i- V- job Site Address: 7 5 5 g,41.r"` &-rA,. R D Roofing Company Name: CtJa'� rs ��'c r /c Applicant's Signature: Date: Greg Casteel Building Official Revised 11/2/04 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 ';UPEkTIN0 Building Department JOB AD RES PERMIT # -755 C ey' 0 02 2--c OWNER'S NAME: ,¢ v L PHONE # yo -6,9'c GENERAL CONTRACTOR: lvo�o 's �l'��=,n FAX # I am not using any subcontractors: Si;nature 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 Owner/Contractor Signature Date