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BUILDING DIVISION PERMIT
BUILDING ADDRESS:
10525 FARALLONE DR
OWNER'S NAME:
CALVERT M S AND DIANE K
TE.
ARCH1TECr/ENGINEER:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 70(10) of Division 3 o the Business and Pro ici Code. and my license is
n full Corce and eCf J7 a fW�
icensc Class Lam• N
Date
Con uactmr
ARCHfrE(:rS DECLARA
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason. (Section 703 1.5. Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve, demolish, or repair any structure
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
(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 airy applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
0 I, as owner of the property, or my employees with wages az their sole compensation,
will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Conuactoes License Law does 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.).
0 I, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractors Ui
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.
0 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
1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, az 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 Ins ca and Policy ntrfT" yl ' (tr`
Cartier. :SMA's Policy No.: V
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for oac 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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z ' CONSTRUCTION LENDING AGENCY
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.)
W Q Lender's Name
Z Leaders Address
U 0 I certify that I have read this application and state that the above information is
C>~ correct. I agree to comply with all city and county ordinances and state laws relating to
U building construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
&} a (We) agree to save, indemnify and keep harmless the City of Cupertino against
rn liabilities, judgments, costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
►+ APP�RCGUUZATIONS.
DERSTANDS AND WILL COMPLY WITH ALLION-POINT
S
Signa pplicant/Contractor �-C Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
az defined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Code, Section 25532(a)?
0 Yes °
Will the applic or Cuturc building occupant use equipment or devices which
knit hazardous air co taminants az defined by the Bay Area Air Quality Management
District?
0 Ycs
I have read the h rdous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety 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 occupan of the
requirements which must be met prior to issuance of a Certificate o[ Occ
LINDY ROOFING CO INC
5554 H.
(408)285-9990
PERMIT NO.
07060253
PERMIT ISSUE DATE
SANITARY NO, CONTROL NO.
BUILDING PERMIT INFO
ELECT PLUMB
Job Description
REMOVIN3 EXISTING WOOD SHAKE ROOF; INSTALLING
OSB, 30# FELT & 50 YR COMP. 36 SQURS.
;.q. Ft. Floor Area
36939032`:
f
$20000
Required Inspections
Valuation
occupancy
Issued by: Date
Re -roofs
Type of Roof
All roofs shall be inspected prior to any roofing material being installed.
If a roof .s installed without first obtaining an inspection, I agree to remove
all new n)aterials for inspection.
h-7
Wc of Applicant Date
All roof coverings to be Class "B" or better
2 ITEMS OF 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Bl -c: Lot:
APN 36939032.00
DATE ISSUED.......: 06/27/2007
RECEIPT #.......... BS)00001825
REFERENCE ID # ...: 07)60253
SITE ADDRESS .....: 10525 FARALLONE DR
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............: CAIVERT M S AND DIANE K
ADDRESS ...........
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4406
RECEIVED FROM ....: LI\TDY ROOFING CO.
CONTRACTOR .......: RUAFORD, LINDY LIC # 3921
COMPANY ..........: LINDY ROOFING CO INC
ADDRESS ..........: 5554 HARVARD DR
CITY/STATE/ZIP ...: SAN JOSE, CA 95118
TELEPHONE ........: (408)286-9990
FEE ID UNIT
QUANTITY
AMOUNT PD -TO -DT
THIS REC
----------
NEW BAL
-------
-----------------------
BPERMFEE VALUATION
----------
20,000.00
--------------------
277.56
0.00
277.56
0.00
BSEISMICRE VALUATION
20,000.00
2.00
0.00
2.00
----------
0.00
----------
TOTAL PERMIT
---------- ----------
279.56
0.00
279.56
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
--------------------
NUMBER
----------------- ---------------
CHECK
279.56
#3073
---------------
TOTAL RECEIPT
279.56
J7b& 025 3
CITY OF CUPERTINO
RE ROOF
CUPEkTINO PERMIT APPLICATION FORM
APN#34�19.59OCU
Bldg Permit Fees
Date:
c) 6-67
Building Address: / J a S rC,_ 1101
�r
Owner's Name: -, c6cj
BSEISMICRE
Ph rte —7
Contractor. r Phone #:
L
p
(4G &
License #:
Cont4ct: one #:
c
Cupertino Business License #:
Type of Roof
Covering:
Existing:
Proposed:
❑ Built -Up Roof
u Asphalt Shingles
❑ Built -Up roof
X Asphalt Shingles
Wood Shakes
❑ Wood Shakes
O Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings 7
❑ Provide I.C.B.O. Report #
To be Removed
I
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cuj)ertino's
Tear Off Policy:
Job Description: j- E' ,n C C, y . c si ,,:X) ",60C
S 1G r ccs ►- o c, /c-� s f l r • t j 2 ;, �J 5 �3�
# . e ff ci-^J-
2 C./ C, f s
Residential tommercial TD
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions: LI
Cost of Project: Type of Construc,ti=
Occupancy group:
.2 0 Uva ,- v<, .F
i.�--� , 2,A
Qty. if
Annlirahle
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
j City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax. (408) 777-3333
CUPEQ INO
Buildin;; 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.
?. 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 th,? building inspector when the re -roofing
is completed.
3. All roofs shall be inspected prior tc any roofing installation.
4. To receive a filial sign off from the --ity, the following steps are
required:
1) Pre -inspection and/or tear off a �proval.
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 performed.
7. NOTE: If you call for a plywood niil 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 " per foot slope and demonstrate
that there is no ponding.
2. An 1.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the alcove stated policy on re -roofing.
Homeowner's Name:
SGv c k_1I v erg'
Job Site Address:
Roofing Company Name: I fn 1�6C 1r1
Applicant's Signature: Date: (�(Gq'
Greg Casteel
Building Official
Rvvised 11/2/04
Print )d on Recycled PVer
r m�:
CITY OF
'.-.UPEkTIN0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: /Q S'ZS�r�rL,
J ,.
,fir,
PERMIT #
OWNER'S NAME: f o
Cabinets & Millwork
PHONE # O 'J9
GENERAL CONTRACTOR:
.
FAX #
I am not using any subcontractors:�'-
Si gnature Date
Please check atmlicable subcontractors and complete the following information:
Owner/Contractor Signature
Date
SUBCONTRACTOR
BUSI14ESS 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