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07060142 CITY OF CUPERTINO BUILDING SIVISION PEPMIT C}RM TI©1�1•. PERMIT NO. BUILDING ADDRESS: 10207 COLD HARBOR AV ELLIOTT ROOFING 07060142 PERMIT ISSUE DATE OWNER'S NAME: SUROVIK GEORGE A AND SYLVIA P OBOX X066 1 7 SANITARY NO. CONTROL NO. JE: (831) 42: -0675 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH (� (� (_ (� W Z LICENSED CONTRACTOR'S DECLARATION Job Description 0 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing u UZ 8 with Section 7000)of Division 3 of the Business and Professions Code,and my license is REMOVE :,X I ST I NG ROOF AND REPLACE WITH GALAT I C '4 H in full fore and effect. v�Z License Class Lic.# Dam Contractor 't A CHITECTS DEC TION i C a 1 understand my plans shall be used as public records �yU U.ti Licensed Professional i r OWNER-BUILDER DECLARATION < 1 hereby affirm that 1 am exempt from the Contractor's License Law for the { oo following reason.(Section 703 1.5,Business and Professions Code:Any city or county m Pi which requires a permit to construct,alter.improve,demolish,or repair any structure 1'y prior to its issuance,also requires the applicant for such permit to rile a signed statement ; ,Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Cl $3800 F (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or ? that he is exempt therefrom and the basis for the alleged exemption.Any violation of ,�1 Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36909022 . V 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 arc 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 Contractor'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 commctor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Seo. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: tJ I have and will maintain a Certificate of Consent to self-insurc 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 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 Worker's Compensation Insurance carrier and Policy number ate• Cartier. ? /I �C� QG Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is foronc hundred dollars($100) or less.) 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY rA I hereby affirm that there is a construction lending agency for the performance of (1!✓ the work for which this permit is issued(Sec.3097,Civ.C.) LL)Q Lender's Name z Lcndees Address I certify that 1 have read this application and state that the above information is O correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding conswction•and hereby authorize representatives of this city to enter upon the (Il above-mentioned property for inspc ' n purposes. a (Wc)agree to save,ind .t( d keep harmless the City of Cupertino against liabilities,judgments,Zin e rases which may in any way accrue against said City U z in consequence aC the this permit. Date APPLICANT UNDDS WILL COMPLY WITH ALL NON-POINT Issued b�': SOURCE REGU S. r Re-roofs Signature of icandCo actor Dam T of Roof HAZARDOUS MATERIALS DI LOSURE Type W' the applicant or future building occupant store or handle hazardous material as defin d by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? }}} All roof: shall be inspected or to any roofing material being installed. El Yes yICLNo If a roof is installed wi "� t 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 i naterials f5yif�spection. District? j ❑Yes a � 1 have read the hazardous materials requirements undcrChapter 6.95 of the califor- — nia Health&Safct ,Sections 25505.25533 and 25534.1 understand that if the building doeAauthori- ve a tenant,that is my respo ility to notify the occupant of the Date reqmust m r m issuance a Certificate of Occupancy. �ign C Of Ap ICa t All roof coverings to be Class"B" or better Ow a nt arc CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 36909022 .00 DATE ISSUED. . . . . . . : 06/18/2007 RECEIPT #. . . . . . . . . . BSC00001678 REFERENCE ID # 07C60142 SITE ADDRESS 1007 COLD HARBOR AV SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SUROVIK GEORGE A AND SYLVIA ADDRESS . CITY/STATE/ZIP . . . : CU13ERTINO CA, 95014-3326 RECEIVED FROM JIM ELLIOTT CONTRACTOR . . . . . . . : JIM ELLIOTT LIC # 25914 COMPANY EL',IOTT ROOFING ADDRESS P )BOX 7066 CITY/STATE/ZIP SANTA CRUZ, CA 95060 TELEPHONE (831) 423-0675 FEE ID UNIT QUANTITY .%MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- BPERMFEE VALUATION 3, 800. 00 104.76 0.00 104 .76 0. 00 BSEISMICRE VALUATION 3, 800. 00 0.50 0. 00 0_ ------ 50 0_00 ----- TOTAL PERMIT 105 .26 0. 00 105 .26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---------- CHECK 105 .26 #9575 --------------- TOTAL RECEIPT 105 .26 0-70( 0 [ LfZ_ CITY OF CXPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN# 3 (p-IO9D �` 0 D l Building Address: )wner's N m CC Phone#: cJiJ Contra tor: License#: Contact: Cupertino Business License Type of Roof Covering: Existing: Proposed: ':�k Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood ShakesL3Wood Shakes LlWood Shingles D� S G �� `f o � ❑ Wood Shingles ❑ Other(Specify) 4e�J�e. !�5X'z��li--1 ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# 9� To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cupertino's Tear Off Policy: ❑ Job Description: Residential Commercial No.B Confirmed with Planning Dept. if Fire Zone: Yes ❑ there are any restrictions: i Cost of Project: Type of Construction: Occupancy group: Qty. if Fee Group Applicable Fee ID Fee Description p 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 L90 0 6_� �2 ��— 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 agre 2 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 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 apprcval. 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 Arial down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail nispection 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: Z t/ Job Site Address: -10-20- `Z K Roofing Company Name: a rl �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 7UPEkTINO Buildin De artment JOB ADDRESS: R PERMIT# © -70 G l� "L G� '/n.c�I PHONE # GENERAL CONTRACTOR: C_ # I am not using any subcontractors: — Sil;nature Date Please check applicable subco tractors 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 i Lathing --� Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile owner/Contractor Signature Date