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07060199 CITY OF CUPERTINO BUILDING DIVISION PERMIT 'rGTflR PERMIT NO. BUILDING ADDRESS: ANSON GLORIA A 07060199 22442 WALNUT CL PERMTT ISSUE DATE OWNER'S NAME: ANSON GLORIA A 6 22 SANITARY NO.. 7 CONTROL NO. )NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB IAECH 3 3wz0 LICENSED CONTRACTOR'S DECLARATION Job Description W— 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing ?Z� withScclion70()0)ofDivision3ofthcBusincssandPrafcssiunsCode,andmyliccnscis RE—ROOF DUPLEX, TEAR OFF EXISITING ASPHALT sly Lifull force ceneClassdcffect. Licit SHINGLES AND INSTALL NEW ASPHALT SHINGLES License Class `p Date Contractor ARCHITECTS DECLARATION j a< I understand my plans shall be used as public records )yU u.y Licensed Professional y OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law far the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county <m ff which requires a permit to construct.alter,improve,demolish,or repair any structure Q-401 prior it)its issuance.also requires the applicant for such permit to file a signed statement ,Ft.Floor Area Valuation Z a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q $7000 il-- (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 Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). 3570303 -3 . ❑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.70M4,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.). CalI,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sed.7044,Business and Professions Code:)The Contractor's Li- cerise Law docs not apply to an owner of property who builds or improves,hereon,and. who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. ❑I am exempt under Sec. B&P C for this reason Owner � �� `^�" Dare L 0 WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: ❑I hsve and will maintain a Certificate of Consent to self-insure for workees 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 Code,for the performance of the work for which this permit is issued. My Workees Compensation Insurance carrier and Policy number are: 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 manrjcrr so Itcnto come subject to the Workers'Compensation Laws of 1 for a.Date - a ApplicantTla NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must O forthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY [~- I 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.) W A Lender's Name az Lender's Address U 0 1 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 rJ U building construction,and hereby authorize representatives of this city to enter upon the a 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 j U Z in consequence of the granting of this permit. Date ►- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b'�: SOURCE REGULATIONS. LIzzkl Re-roofs 91 Signature of ApplicanUContractor Date HAZARDOUS MATERIALS DISCLOSURE Type of:Zoof 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)? pfNo All roof: shall be inspected prior to any roofing material being installed. ❑Yes 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 materials for inspection. District? ❑Yes fgNo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Codc,Sections 75505.25533 and 25534.I understand that if the building does not currently have a tenant,that it is my responsibility to notify the Occupant of the Date requireme�is which must be met prior to issuance of a Certificate of 0ccpancy. S lgnatul�of Applicant 1 L;l'10-4 All roof coverings to be Class"B"or better Owner or authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 35703035 . 00 DATE ISSUED. . . . . . . : 06/22/2007 RECEIPT #. . . . . . . . . BSC00001754 REFERENCE ID # . . . : 07C60199 SITE ADDRESS 22942 WALNUT CL SUBDIVISION CITY CUPERTINO IMPACT AREA . . . . . . OWNER ANSON GLORIA A ADDRESS CITY/STATE/ZIP CUPERTINO CA, 95014-2742 RECEIVED FROM DOTI ISAMU TOKUNAGA CONTRACTOR LIC # *OWNER* COMPANY ANSON GLORIA A ADDRESS CITY/STATE/ZIP CUPERTINO CA, 95014-2742 TELEPHONE . . . . . . . . : FEE ID UNIT QUANTITY kMOUNTPD-TO-DT THIS REC NEW BAL ---------- - --------- ------ BPERMFEE VALUATION 7, 000 .00 137 .16 0 .00 137 .16 0 .00 BSEISMICRE VALUATION 7, 000 .00 0 . 70 0 .000_ ----70 -0 .00 - - - TOTAL PERMIT 137 . 86 0 . 00 137 . 86 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 137 .86 772 --------------- TOTAL RECEIPT 137 .86 VOICE ID DESCRIPTION VOICE ID DESCRIPTION - -------- ---------------------------- ------- ---------------------------- 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS CITY OF CUPERTINO E AC F PE T NO PERMIT APPLICATION FORM APN# Date: Bui lingAddress: a. ��{�2 WaC�w1- (?�rtl� SO�t►%� , Cu-- ► {,'� q57} Iy Owner's Name: Phone#: cc Av Contractor: License#: C ntact: Cupertino Business License #: 60S`4 3 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof p Asphalt Shingles )� Asphalt Shingles 40 r�J� ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings j ❑ Provide I.C.B.O.Report# Q To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: ❑k Job Description: Vl We&- ye, { � . I�,6hL,,("C-• , p a '� . � ww. 40 ,� iil f< . 1 l"�✓.fib/la{�� 3`6 5��-+�`v�, f��f-cetT �,N f 2, Residential Commercial ❑ Fire Zone: Yes ❑ No M Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupan` oup: 400o 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 f 6176/L4 A i_i 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 buildinp 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 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 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 f irst obtaining an inspection, will require the removal of all new material 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 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: Job Site Address: a `-�3g `�`l�- 5. t•U a,J�tti�l Ci rcd . Roofing Company Name: Applicant's Signature: Date: Lb�D 0 Greg Casteel Building Official Revised 11/2/04 OWNER-BUILDF R VERIFICATION 1. (Check one) I or my immediate family I parent, spouse or child) will perform: A. All the work authorized by this permit B. — A portion of the work C. — None of the work If B or C is checked,c)mplete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. — A portion of the work (complete section below) Contractor Address/City Phone # State License # Type of work to be performed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be performed ................................................................................... I declare under penalty of perjury that the a'3,ove is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owner's Signature: L Date: '`i`– Job Address: G(C-' so-L4Permit# Any changes to the information provided ori this form shall be submitted to the City of Cupertino Build Department. Community Development 10300 Torre Avenue . Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF '"WERTINO B1, ildin De artment JOB ADDRESS: PERMIT # �060� Y �aq 3g �a-U 4 2 6 OWNER'S NAME: f a k r� ci c� ra ti PHONE# 0 zsk- 2�►�� GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Sig nature Date Please check applicable subcontractors and complete the followin 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 E-------- Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Date Owner/Contractor Signature