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07060184 CITE'OF CUPERTINO BUILDING DIVISION PERMIT PERMIT NO. BUILT JV8T"9EVEN SPRINGS DR LOS GATOS ROOFING 07060184 PERMIT WUE DATE OWNER'S NAME: CHA ANNIE P 0 BOX 1726 06/21/2007 SANITARY NO. CONTROL NO. 'NE: (408) 298-9399 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 100 LICENSED CONTRACTOR'S DECLARATION Job Description % I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing U with Section 7000)of Division 3 of the Business and Professions Code,and my license is REMOVE EXISTING SHAKE ROOF. INSTALL ASTM 30 FELT ­0 in full[oreea dell t. �� _ �' AND GAF GRAND CANYON SHINGLES. j ? License CI s Lle• ❑ Datc Contractor t ARCHITECTS DECLARATION Zd a 1 understand my plans shall be used as public records >aU U.y Licensed Professional 7 a OWNER-BUILDER DECLARATION �yJ 1 hereby affirm that 1 am exempt from the Contractors License Law for the pO following reason.(Section 7031.5•Business and Professions Cafe:Any city or county 9 which requires a permit to construct,alter,improve•demolish,or repair any structure u"w prior to its issuance,also requires the applicant for such permit to file a signed statement �' Ft.Floor Area $5028 Valuation -?a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 'q F❑ (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or i r3 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 3665204-/ . Number not more than five hundred dollars(5500). ❑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 Required Inspections and Professions Cade:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himselr 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.). ❑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 conuactor(s)licensed pursuant to the Contractor's LicenseLaw. 01. 1am 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. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the labor Cade,for the performance of the work for which this permit is issued. My Worker's Co apensation surance Farrier and Policy //n•uum�mO�a Carrier:y Policy No.& CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (chis 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,1 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 Cade,you must Oforthwith comply with such provisions or this permit shall be deemed revoked. Z"" CONSTRUCTION LENDING AGENCY (moo rte. 1 hereby affirm that there is a construction lending agency for the performance of [Y> the work for which this permit is issued(See.3097,Civ.C.) W A Lender's Name 2 Lender's Address U C I certify that I have read this application and state that the above information is UL " correct.1 agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. W W (We)agree to save,indemnify and keep harmless the City of Cupertino against ►�-t C*,) liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date --7_ f-,,-7 m-+ APPL UNDERSTANDS'AND WILL COMPLY WITH ALL NON-P INT Issued by SOUR GULATIONS. l /) Re-roofs G/"— Signature .Applicant/Contractor Dao Type of Roof HAZARDOUS 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. ❑Yes 0 If a roof is installed without 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 rr aterials for inspection. District? ❑Yes 0<a I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 2M5,25533 and 25534.1 understand that if the building does notntly have a tenon that it is my responsibility to notify the occupant of the requi which must be m prior o issuan of a Certificate of Oc an . Signature of Applicant Date u ,'� All roof coverings to be Class"B"or better Owner authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36652047 .00 DATE ISSUED. . . . . . . : 06/21/2007 RECEIPT #. . . . . . . . . . BS030001737 REFERENCE ID # . . . : 07050184 SITE ADDRESS . . . . . : 11601 SEVEN SPRINGS DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER CHA ANNIE ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5126 RECEIVED FROM . . . . : LOS GATOS ROOFING CONTRACTOR RANDY 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 5, 028. 00 126 .36 0. 00 126 .36 0. 00 BSEISMICRE VALUATION 5, 028. 00 0. 60 0. 00 0. 60 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 126.96 0. 00 126.96 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 126.96 #1916 --------------- TOTAL RECEIPT 126 .96 Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 " 'r I N Fax: (408)777-3333 L U P E 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 ie-roofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the buildingmuispector. 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 airy roofing installation. 4. To receive a final sign off from the Ciiy, 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 nal inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new m;iterial down to the sheathing, so a proper City inspection can be performed. 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 policyon re-roofing. -� Homeowner's Name: [�'7� �C( i— Roofing Company Name: � ia Applicant's Signature: �� Date: Greg teel Building Official Revi.;ed 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO z t EROOF i CUPERTINO PERMIT APPLICATION FORM 070& 004 APN# .3 6(,--S Z— o q -7 , v " Date: / 3 Q 6 Building Address: llc�v � <SS Owner's Name: f jPhone#: Contractor: Phone #: 0 License#: 2!q1- �0007 Contact: Phone#: Cupertino Business License#: / S �� a3S Type c f Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) Other(Specify)A6 Tit-) 3 O 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 :�u ertino's Tear Off Policy: Job Description: i-nfL Residential Commercial E Fire Zone: Yes ❑ No Confirmed with Planning Dept. if. there are any restrictions: LJ Cost of Projjt: Type o Constructi Occupancy group: I kL'di, Qty. if Applicable Fee ID Fee Description Fee Group / BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING FeeRes=__�4 BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Community Development ` 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C1TY'OF CUPE�TtNO Fax(408)777-3333 Building Department JOB ADDRESS: ` 07e h P r 1,-,5 s )-� PERMIT # OWNER'S NAME: a r PHONE # GENERAL CONTRACTOR ` © FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and co m lete 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 All/ -) _bwner/ Signature Date