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07060062
CITY OF C1 ERTINO BUILD1NGbIVIS10N PERMIT PERMIT NO. BUILEJNfJ,f2ESl�,RINITY SPRING CT LOS GATOS ROOFING 07060062 l PERMIT ISSUE DATE OWNER'S NAME: 06/08/2007 SWENSON JOHN F AND BETH M P O BOX 1726 SANITARY NO. CONTROL NO. ,NE: (408) 298-9399 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH p 0O LICENSED CONTRACTOR'S DECLARATION Job Description W I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REMOVE EXISTING WOOD SHAKES & INSTALL ASPHALT Z UW with Section 7000)of Division 3 of the Business and Professions Code,and my license is n in full force afit p SHINGLE: . �z [rcertsc C1 �•� p Date Conlracwr ARCHITECTS DECLARATION i a< I understand my plans shall be used as public records >qU u.y Licensed Professional o a OWNER-BUILDER DECLARATION 3 a I hereby affirm that 1 am exempt from the Contractor's Uccnse Law for the no following reason.(Section 7031.5,Business and Professions Calc:Any city or county W which requires a permit to construct,alter,improve,demolish,or repair any structure 1;m m prior to its issuance,also requires the applicant for such permit to tilt a signed statement `,q,Ft.Floor Area Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $3900 2 F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or r3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy T Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3665303 f> Number P Y yPe not more than five hundred dollars($500). ❑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 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 or 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 u. cense Law does not apply to an owner of property who builds or improves thereon•and who contracts for such projects with a contractors)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 1 hereby affirm under penalty of perjury one of the following declarations: 2I have and will maintain a Certificate of Consent to self-insure for Workees Compen- ion,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 3 of the Labor Code,for the performance of the work for which this permit is issued. My War s Co pensati Insuranyp carrier and Policy number arc: Carrier. 4-—Policy No.: ©� CERTIR ATE O —EMPTION FROM WORKE S 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'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 R CONSTRUCTION LENDING AGENCY (� tom+ 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.) [Ll ALender's Name az Lender's Address V 0 1 certify that 1 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 U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection Purfwses. >" a f Cupertino against (We)agree to save,indemnify and keep harmless the City o hFa liabilities,judgments,costs and expenses which may in any way accrue against said City6_C�6 fJ 2 in consequence of g ting of this permit. Dale APPLICANT U ANDS AND WILL COMPLY WITH AL NON POINT Issued b): SOURCE RE S. Re-roofs Signature ppliantlContractor are Type Of I:OOf HAZARDOUS MATERIALS DISCLOSUR yP Will the applicant or future building occupant store or handle harardous material as defined by the Cope no 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. 0YO3 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 r laterials for inspection. District? \— ❑Yes l�No I have rc the hazard<ws materials requirements under Chapter 6.95 of the Califor- nia Health&S ty Code,Sections 25505,25533 and 25534.1 understand that Tthe building docs not curmntl ave a tenant,that it is my responsibility to notify the occupant of the r Date rcquirc w h must be met prior to issuance of a Ccrtificatc o��F_ S ignatun s of Applicant All roof coverings to be Class 'B or better Owner of authori-rcd agent CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36653038. 00 DATE ISSUED. . . . . . . : 06/08/2007 RECEIPT #. . . . . . . . . : BS000001591 REFERENCE ID # 07060062 SITE ADDRESS 11742 TRINITY SPRING CT SUBDIVISION CITY CUFERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : SWENSON JOHN F AND BETH M ADDRESS CITY/STATE/ZIP . . . : CUFERTINO CA, 95014-5146 RECEIVED FROM . . . . : LOE GATOS ROOFING CONTRACTOR . . . . . . . : RADDY BROWN LIC # 23481 COMPANY . . . . . . . . . . : LOE- GATOS ROOFING ADDRESS : P C' BOX 1726 CITY/STATE/ZIP . . . : LOE; GATOS, CA 95031 TELEPHONE . . . . . . . . : (4( 8) 298-9399 FEE ID UNIT QUANTITY ILMOUNT PD-TO-DT THIS REC NEW BAL __ __ _ ---------- ----------- ______ ---------- --- BPERMFEE VALUATION 3, 900. 00 104 .76 0. 00 104 .76 0. 00 BSEISMICRE VALUATION 3, 900. 00 0.50 0. 00 0_50 ------0_00 ----- TOTAL PERMIT 105 .26 0. 00 105 .26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- CHECK 105 .26 #1908 - ------------- TOTAL RECEIPT 105 .26 CITY OF CUPERTINO 0-70(n 00(0 2 R;EROOF CUPEkTiNO PERMIT APPLICATION FORM APN# � /� ��, 2 �i 0 Date: Building Address: n Owner's Name: Phone#-. iwen lob' Contractor: 1,.0p Phone #: d License#: .V-S rrazhs IV-a , - 9229 Y07 Contact: — Phone#: Cupertino Business License#: Type of 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) 3C) FC-L Number of existing coverings 13 Provide I.C.B.O.Report# ❑ To be Removed Provide Mfgr.Installation Specs. S si I Have Read, Understand and Will Comply With :�u ertino's Tear Off Policy: Job Descri ti n:__ke Residential Commercial [� Fire Zone: Yes ❑ No Confirmed with Planning Deft. if. there are any restrictions: Lf Cost of Projects/_ Type o Conssructi Occupancy group:Q f , 0 D Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy 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 Fax: (408)777-3333 CITY OF Telephone: (408)777-3228 C U PE �INO 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 building inspector. A final inspection and approval shall be obtained from the wilding 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 City, 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 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. 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 cn the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: A4cG S"(,)-n So _- ._:__--4-ob_site-adaress:_ Roofing Company Name: O A plicant's Signature: Date: U Greg teel Building Official Re-,ised 1/30/03 Printer'on Recycled Paper POLICYHOLDER COPY NO STATE P.O. BOX 420807, SAN FRAN':ISCO,CA 84142-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-00-2007 GROUP, 000295 POLICY NUMBER 0002279-2007 CERTIFICATE IR 191 CERTIFICATE EXPIRES:09-01-2009 02-01-2007/03-01-1009 EVIDENCE OF INSURANCE NO This Is to certify that we haus Issued a valid Workers' Compensation Insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated This policy is not subject to cancellstion by the Fund except Wion30 days advance written notice to the employer. We will also give you 30 days advance notice should this policlf be cancelled prior to its normal expiration This certificate of Insurance is not an Insurance policy and doer not Intend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of Insurance may be Issued or to which it in" pertain, the insurance afforded by the policy described herein is subject to all the turns. exclusions, and conditions, of such policy. ZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE Cars: $1,000,000 PER OCCURRENCE. ENDORSEMENT 12065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-01-2005 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. 00 CITY OF C U P E RT I N O BUSINESS LICENSE CUPEkTINO FINANCE DEPARTMENT • CUPERTINO,CALIFORNIA TAX CERTIFICATE WINE] • • • 911 kRTill -• a o] BUS. LOCATION: 888 FAULSTICH CT 23481 OWNERSHIP RANDY BROWN 04/30/2008 LOS GATOS ROOFING DOING BUSINESS AS EXPIRATION DATE P 0 BOX 1726 LOS GATO S CA 95031 Tr.„o LICENSE MUST BE POSTED INA CONSPICUOUS PLACE ON THE PREMISES OR VEHICLE DIRECTOR OF ADMINISTRATIVE SERVICES O � �� Jn M IUD I Q M Community Development 10300 Torre Avenue f Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Buildixn De artment JOB ADDRESS: PERMIT # ( 0c) (OA ll,7 X12 Arm�Ay -S r1- s 0�d C� W OWNER'S NAME: swensvn PHONE # GENERAL CONTRACTOR: ` 6- ©5 FAX# I am not using any subcontractors: Signature Date Please check-applicable subcontractors and comf Plete the following information: SUBCONTRACTOR BUSIrJESS 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