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07060256loo_ :UU :z tnz ' EZ W Baa >yU ry N .O �p0 L O V y e� LR CITY OF CUPERI I. BUILDING DIVISION BUILD1UTRESS: WEYMOL OWNER'S NAME: CHI SHEN NE: ARCHITECT/ENGINEER: PERMIT PERMIT NO. DR TBD — TO BE DETERMINED 07060256 PERMIT ISSUE DATE 06/27/2007 SANITARY NO, CONTROL NO. I hereby affirm Ihat I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and lice is in full force andl force and effect cry fl/! License Class CC Lia N Date Comraetor H CTS DECLA ATION I understand my plans shall he used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason. (Section 703 1.5, Business and Professions Code: Any city or county which requires a permit to construct. alter, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement 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 (5500). Q 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 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.). 0 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 themon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. B & P C for this reason C]I am exempt under Sec. OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L] I have and will maintain a certificatc 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. 0 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 Workeesnloghtice carrier and Polity numy0er aJre�: � Carrier: Policy No.: —� CERTIFICATE OF EXEMPTION FROM WORKERS' 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 O forthwith comply with such provisions or this permit shall be deemed revoked. Z t—+ w> f�. Q aZ UO 0U UZ BUILDING PERMIT INFO BLDG EO PLUMB Job Description TEAR DOV\N EXISTING ROOF. 1/2" PLYWOOD, 30 LB. EXTURE, 40 YRS FIBERGLASS SHINGLES. US LIC PD 6/27/07, A. RICKY ROOFING PD BY PABLO �S Ft. Floor Area 3621000 (�tNum CONSTRUCTION LENDING AGENCY 1 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 above-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 consequence of the granting of this permit. APP LI VNDER WH ALL NON- NDS AND WILL C MPLY PINT SOUR RE Signatu of Ap fl UCon for Dam 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)? ❑ yes kfuL o Will the applicant orc building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District? 0 Yes Nu 1 have read the hazardous materials requirements under Chapter 6.95 of Ute Califor- Vnouffe CedC, Sections 25505, 25533 and 255 derstand that tribe building have a tenant, that it is my nsihifitytono' � the occupant of the must be auto issu of a Certificate cupancy. ed agent Date Issued by Re -roofs Type of Roof $10000 Type Required Inspections All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new rlaterials for inspection. Signature: of Applicant Date All roof coverings to be Class "B" or better 2 ITEMS OF 2 CITY OF �UPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN 36210007.00 DATE ISSUED.......: 06/27/2007 RECEIPT #.........: BS000001831 REFERENCE ID # ...: 07C60256 SITE ADDRESS .....: 1249 WEYMOUTH DR SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER CHI. SHEN ADDRESS ........... CITY/STATE/ZIP ...: CUPERTINO CA, OPERATOR: patg COPY # : 1 95014-4915 RECEIVED FROM ....: PABLO SANCHEZ CONTRACTOR TBI) - TO BE DETERMINED LIC # 00096 COMPANY TBI) - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP TELEPHONE ........ FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---------- THIS REC ---- NEW BAL ----------------------- BPERMFEE VALUATION ---------- 10,000.00 ---------- 169.56 0.00 169.56 0.00 BSEISMICRE VALUATION 10,000.00 1.00 0.00 -1_00 -- -- ------0_00 170.56 0.00 170.56 0.00 TOTAL PERMIT METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---- CASH 170.56 CASH FOR PERMIT --------------- TOTAL RECEIPT 170.56 70(to oZ CITY OF CUPERTINO i RE [GOOF CUPERTINO PERMIT APPLICATION FORM APN # 2 /„ a©� %� v O Bldg Permit Fees Date: / 1 - fj_07 Building Addres Energy BUILDING BSEISMICRE Owner's me: BUILDING Phone #: / Seismic Commercial BUILDING BPLANCHK Contractor: BUILDING License #- Business License BUILDING Contact: I Cupertino Business License #: EX Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof V ❑ ,Asphalt Shingles Asphalt Shingles V' Wood Shakes ❑ Wood Shakes F2 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: Kwr Job obw.,) ag b alai• rUv�Opl �-•�l ��LZ�, !F y✓S {'�h Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Det. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: III Q . 0�0 Qty. if A licable Fee ID Fee Description Fee Group FF 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 applie 4 without first obtaining all inspection and written approval from the buildin„ 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 an- 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 ma-:erial down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re -inspection fee of $176.18. The re -inspection fee must be paid before another inspection car 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. e, W/ 5� Homeowner's Name: ` job Site Address: _ q 4-1 i ./ • -, I O� � 1 � %Z- &U T— Roofing Company Name: ( AV R- Applicant's Signature: Date: 4� 67 Greg Casteel Building Official Revised 11/2/04