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07060181 CITE'OF CUPERTINO BUILDING DIVISION PERMIT PERMIT NO. BUIL( rc���EsLINDY LA LOS GATC)S ROOFING 07060181 b PERMIT ISSUE DATE OWNER'S NAME: KEVIN YEN P 0 BOX 1726 06/21/2007 SANITARY NO. CONTROL NO. SNE: (408) 298-9399 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 100 ICENSED CON TRACTOR'S DECLARATION Job Description V): [hereby affirm that I am licensed under provisions of Chapter 9(commencing ?z with Section 70M)of Division 3 of the Business and Professions Code,and my license is REMOVE EXISTING C EMWOOD ROOF. INSTALL 7 16" OSB <s in full force and Ctect� � z License I s 1�3�I Lic.# �d• AND ROOFERS SELECT FELT. INSTALL LANDMARK f Date Contractor ARCHITECTS DECLARATION PREMIUM 1 understand my plans shall be used as public records o SHINGLE.. . n,ti Licensed Professional C) OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the pO 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 o y Prior to its issuance,also requires the applicant for such permit to rile a signed statement Valuation _ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 )q.Ft. Floor Area $8364 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or L - 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 offf Number Occupancy Type not more than five hundred dollars(5500). 3 5 6 2 2 011) Ctl7 ❑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 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.). ❑I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Coatractoes 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 Contractoes License Law. ❑1 am exempt under Sec. B&P C for this mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: n I have and will maintain a Certificate of Consent to self-insure 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 Warker'g ompausatiophnsurancf carrier and olicy number 1tMI Cartier: S Poli No.: dwt 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY (-r CA I hereby affirm that there is a construction lending agency for the performance of p�> the work for which this permit is issued(Sec.3097,Civ.C.) ALender's Name z Lender's Address U C) I certify that I have read this application and state that the above information is h-' correct.1 agree to comply with all city and county ordinances and state laws relating to C U building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against r�r rA liabilities,judgments,toss and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date CJ 4"U ►4 APPLI A UNDERSTAND AND WILL COMPLY WITH ALL NON-POINT Issued by: s4c��&�. SOUR GULATIONS 1f 0 IRe-roofs Signa re fAppdicant/Contractorse Type of Roof 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)7 All roofs ;hall be inspected prior to any roofing material being installed. ❑Yes 04ro Will the applicant or future building occupant use equipment or devices which If a roof i;installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑Yes gnu 1 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 docs n rrcntly ha�Lhatesponsibility o notify the oaupant of the cc of a Certificate of Oc Signature of Applicant Date 0-:� All roof coverings to be Class"B"or better wnWor authorized agent Dace CITY OF ]UPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . 35622016. 00 DATE ISSUED. . . . . . . : 06/21/2007 RECEIPT #. . . . . . . . . . BS000001735 REFERENCE ID # . . . : 07060181 SITE ADDRESS . . . . . : 21661 LINDY LA SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER KEVIN YEN ADDRESS CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4807 RECEIVED FROM . . . . : LOS GATOS ROOFING CONTRACTOR . . . . . . . : RAEDY BROWN LIC # 23481 COMPANY . . . . . . . . . . : LOS GATOS ROOFING ADDRESS P C BOX 1726 CITY/STATE/ZIP . . . : LOS GATOS, CA 95031 TELEPHONE (4C8) 298-9399 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- --------- BPERMFEE VALUATION 8, 364. 00 158.76 0. 00 158 .76 0. 00 BSEISMICRE VALUATION 8, 364.00 0.90 0. 00 0.90 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 159 .66 0. 00 159 .66 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 159 . 66 #1916 --------------- TOTAL RECEIPT 159 . 66 CITE' OF CUPERTINO t EROOF CITY OF CUPERTINO PERMIT APPLICATION FORM APN# �5� — Z � — ��� Date: v Building Address: n- Ow n r"s Narpe: Phone##: s 7e-(, Contractor: Phone #: © License#: -s 21t- 939 ROO -207 Contact: _�- Phone#: Cupertino Business *cense#: Sam 358 Type cf Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt ShinglesAsphalt Shingles ElWood Shakes ' ❑ Wood Shakes ❑ Wood Shingles El Wood Shingles Other(Specify) W UO )K Other(Specify) 6S S Number of existing coverings ❑ Provide I.C.B.O.Re ort# To be Removed Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With -u ertino's Tear Off Policy: 3 b D sc�riptipx*: "�vt-Q_ �-��v��e ./�'-�� ' j�� 4S' Residential Commercial [ Fire Zone: Yes ❑ No Confirmed with Planning Deft. if there are any restrictions: LLff Cost of Projlt: Type o Constructi Occupanc�grro3up: , Qty. if �. 31 Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISWP - - SEismic Fee.Res - _ -B-IM- - 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 CITY�F Fax: (408)777-3333 CUPEl�Tll�O Building; Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must a;ree to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be app:-ied without first obtaining all inspection and written approval from the build ng: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 E ny roofing installation. 4. To receive a final sign off from the C-ty,the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed,a plywood nz il.inspection is required. 6. Any roofing which is applied withot:t first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. IMPORTANT: 1. Flat roofs must have a minimum of lii"per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be o 1 the job site at the time on inspection. I understand and will comply with the abo-;7e stated policy on re-roofing. Homeowner's Name: �ob.Site-Addr_ess:__ 0� 1. i�� L n _ _----- _._. _.-----_._ _ _.----- _----- _ ___ T__=..��- �.. _. . Roofing Company Name: A plicant's Signature: �` Date: d J Greg teel Building Official Revised 1/30/03 Printed�n Recycled Paper Community Development r` 10300 Torre Avenue x A Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Buildi:n De artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE #47ff-5 )Z6 GENERAL CONTRACTOR FAX # I am not using any subcontractors: ! v� Signature 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 b-) _ 1 La O er/Contractor Signature Date