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07060271BUILDiNGr DIVI IION' PERMIT BUILDYr6�ES SCOIGNE DR OWNER'S 2iNAME: JOHN REINERT NE: ARCHITECT/ENGINEER: p 0O LICENSED CONTRACTOR'S DECLARATION U E I hereby affirm that I am licensed under provisions of Chapter 9 (commencing Z with Section 7000) of Division 3 of the Business and Professions Code, and my license is t y in full force and of t z License Cla-ss/ Lam• 8 E ppato / Contractor a Y' ARCHiTECI S DECLARAPON I z e 1 understand my plans shall be used as public records .,u U. y Licensed Professional 'C, �1 �1 OWNER -BUILDER DECLARATION t t a � 1 hereby affirm that 1 am exempt from the Contractor's License Law for the i o o following reason. (Section 7031.5, Business and Professions Code: Any city or county 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 a 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001 ❑ 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 and Professions Code: The Contractor's 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 We. 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 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: 1] 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. ❑ 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 Workers Co pensadon Insurance c Trier and Policy number are: Carrier: Policy No.;39 CERTIFICATE OF (EMPION FROM 0 KERS' COMPENSATION INSURANCE (This 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. I shall not employ any person in any manner so as to become subject to the Workers' Competsation 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the ahovc-mentioned 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 in consequen% granting of this permit. APPLICA-Wr U>IDERSTANDS AND WILL COMPLY WITH ALL NON -POINT HAZARDOUS MATERIALS DISCLOSURE 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), [:3 Yes No Will the applicant or. uture building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District, ❑ yes 1 have the h 7 dons materials requirements under Chapter 6.95 of the Califor- nia H Saf Code, Sections 25505, 25533 and 25534.1 understand that if the building d not cu tly have a tenant, that it is my responsibility to notify the occupant of dam' remuirem s which mustdfnet oriouetssuance of a CcniLcetetJfOccunancy. Date PERMIT NO. KEITH ROOFING CO INC 07060271 PERMIT ISSUE DATE 920 LINCOLN AVE 06/29/2007 SANITARY NO. CONTROL NO. (408)295--8616 BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Job Description TEAR OFF & REROOF USING TAR & CAPSHEET ROOF, CLASS A 28. c. Ft. Floor Area 37528010 qftl Number $11200 Required Inspections Issued by: 71i=„�i/f� Re -roofs Type of Roc f Valuation Occupancy 'lype Date 6 — All roofs sh ill be inspected prior to any roofing material being installed. If a roof is i istalled without first obtaining an inspection, I agree to remove all new 5Pl!'als for inspection. of Applicant Date All roof coverings to be Class "B” or better CITY.OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 375:M10.00 DATE ISSUED........ 06/:29/2007 RECEIPT #.......... BSO)0001853 REFERENCE ID # ...: 07050271 SITE ADDRESS .....: 10531 4SCOIGNE DR SUBDIVISION ...... CITY CUP: SRT INO IMPACT AREA ...... OWNER ............: JOH]1 REINERT ADDRESS ..........: 10531 GQSCOIGNE DR CITY/STATE/ZIP ...: CUP:ERTINO, CA 95014 RECEIVED FROM ....: ROG:�',R BRIGHT CONTRACTOR .......: BRIGHT, ROGER LIC # 21477 COMPANY ..........: KEITH ROOFING CO INC ADDRESS ..........: 920 LINCOLN AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95126 TELEPHONE ........: (403)295-8616 FEE ID UNIT QUANTITY AvIOUNT PD -TO -DT THIS REC NEW BAL ----------------------- BPERMFEE VALUATION ---------- 11,200.00 ---------- 191.16 ---------- 0.00 ---------- 191.16 ---------- 0.00 BSEISMICRE VALUATION 11,200.00 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 -------------------- VISA --------------- TOTAL RECEIPT 192.36 07o(,�'0,27/ CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN # ?q6 ? 010 , B dg Permit Fees Date: BENERGY Energy BUILDING Building Address: r BUILDING BSEISMICOM Owner's Na -- Phone #-- :77-'(�� BUILDING BUSLIC Contractor: 4 BUILDING ,' Cc License # Contact: Cupertino Business License #: Type of Roof Covering: Exist g• Built -Up Roof Propoedi:It-Up roof �Aus Ll Asphalt Shingles halt Shinglesles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ,-rtino's Tear Off Policy: Job Description: rLAS 1 Residentia Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: ❑ Cost of Project: Type of Construction: Occu ancy group: ii - Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE B dg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK F Ian Check Fee BUILDING BUSLIC I'lusiness License BUILDING