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07060176 CITY OF CUPERTINO BUILDING DIVISION PERMITTo ZoM�T���t•. PERMIT NO. BUILpII`{G,ARf�tE$$,:___DY LA FFF ROOFING SPECIALIST 07060176 �J �j / jj�J PERMIT ISSUE DATE OWNER'S NAME: EASTWOOD DENIS M AND KAY 06/21/2007 SANITARY NO. CONTROL NO. 'NE: (408) 36r- -0553 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 0 0 0 I ce Q LICENSED CONTRACTOR'S DECLARATION Job Description u I hereby affirm that I am licensed under provisions of Chapter 9(commencing =zto with Section 7000)of Division3ofthcBusinessandProfessionsCode,andmylicenseis TEAR OFF EXISTING WOOD SHAKLE AND INSTALL ASPHALT y in full force and effect j=Z License las Lie.# SHINGLES Contractor a ARCHITECTS DEC RATION 2 a 1 understand my plans shall be used as public records )0. u.y Licensed Professional a OWNER-BUILDER DECLARATION aI hereby affirm that I am exempt from the Contractors License Law for the co following reason.(Section 7031.5,Business and Professions Code:Any city or county m which requires a permit to construct,alter,improve,demolish,or repair any structure "rn prior to its issuance,also requires the applicant for such permit to rile a signed statementValuation > .Ft.Floor Area $9000 9000 ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q rt=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3160205:_ :W Number not more than five hundred dollars(5500). ❑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 sae(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.). ❑1,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 con"ctor(s)licensed pursuant to the Contractor's License Law. ❑1 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: ❑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. ❑1 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 Com nsatioinssurance carrier and Policy number36 `O Carrier. V Z la�I Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Crbis section need not be completed if the permit is foronc hundred dollars($I00) 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 ,J Z forthwith comply with such provisions or this permit shall be deemed revoked. Z O CONSTRUCTION LENDING AGENCY E- I hereby affirm that there is a construction lending agency for the performance of GG r7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name aZ Lender's Address U C) 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 0 J building construction.and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against H0. Cn liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Date T ►�+ APPLICANL UNDERSTANDS AND WIA COMPLY WITH ALL NON-POINT Issued b): SOUR ULAT Re-roofs Si aturc o i o r Dare Type of Roof MATERIALS DISCLOSURE yP 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. C3 ...LLLLLL Yes �No Will the applicant or future building occupant use equipment or devices which If a roof�s 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 r laterials for inspection. District? ❑Yes o I have read the hazardous materials requirements underChapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building docs not currently have a tenant,that it is my responsibility to notify the occupant of the require is which nyrsI be met pr. issuance of a Certificate of Occ pan S ignaturc of Applicant Date C/ -� 7 All roof coverings to be Class'B"or better O ref d 116K Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMI`[' RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN 31302051.00 DATE ISSUED. . . . . . . : 06 /21/2007 RECEIPT #. . . . . . . . . : BS)00001724 REFERENCE ID # . . . : 07 )60176 SITE ADDRESS . . . . . : 10387 RANDY LA SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : EA3TWOOD DENIS M AND KAY ADDRESS CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2037 RECEIVED FROM . . . . : RAY GONZALES CONTRACTOR . . . . . . . : FRANK M CAMOLONGA LIC # 28519 COMPANY FFF ROOFING SPECIALIST ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : SAV JOSE, CA 95116 TELEPHONE . . . . . . . . : (408) 365-0553 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- =--------- ---------- ---------- ---------- BPERMFEE VALUATION 9, 000. 00 158.76 0. 00 158.76 0. 00 BSEISMICRE VALUATION 9, 000. 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 ----------------- --------------- -------------------- CREDIT CARD 159 . 66 AMEX --------------- TOTAL RECEIPT 159 . 66 CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM 070&016e7- 4 APN# j 0 51 Date: � C,-9 67 Building Address: aq Owner's Name: �- Phone#: Contractor: License#: S450-0 6 73 Contact: Cupertino Business License#: TyN of P_oof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles A Asphalt Shingles X 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)ertino's Tear Off Policy: Job Description: 72541UAES6 .sem 4v f- 4 !Fbts�i;�c.� 1--1' Residential IP Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Det. if there are any restrictions: LJ Cost of Project: Type of Construction: Occup ncy group: ,X q -� 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 buildin€;inspector. A final inspection and approval shall be obtained from the bu.lding 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 iropection and the job is not ready, you will be charged a re-inspection fee :)f$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: ���tJ.yiG Job Site Address: /D.5''W7 .4 y<!f Roofing Company Name: Applicant's Signature: Date:�/ d 7 Greg Casteel Building Official Revises i 11/2/04 Community Development 10300 Torre Avenue a .::. Cupertino CA 95014 `„ Telephone(408)777-3228 CITY OF Fax(408)777-3333 ""UPEkTINO Building Department JOB ADDRESS: PERMIT # © 70�o 0/44 7(--,�> fI_Ci OWNER'S NAME: PHONE # - / -7 Y GENERAL CONTRACTOR: - FAX# I am not using any subcontractors: Date Please check applicable subcontractors an �Co, �lete the followinginformation: 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 _ % 5��Aoactor Signature Da(e