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07030059�cc :ULU F :z ;t"rnu tea >yU U. �pr0ry� u^w CITY OF CUPEXHINU BUILDiNC, DIVISION PERMIT 10321, 10327,10329 CASA DE ANZA HOA 5NE: ARC HITECI'/ENGINEER: LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect / (' License Class . 2 5-3? C 33 Lic. S (� 17 Lo Date t27 Contractor ARCHITECT'S DECLA I understand my plans shall be used as pub[ - Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason. (Section 7031.5, 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 Contractors 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 ($500). 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.). rl 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 contractor(s) licensed pursuant to the Contractor's License Law. I 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: Q I have and will maintain a Certificate of Consent to self -insure for Workees Compen- sationas provided for by Section 3700 of the Labor Code, for the performance of the wor�fori h this permit is issued. 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. Ivry Worker's Compensation Insurance carrier and Policy number are: f Cartier./} �•r••,riyat`S/Cc. Policy No.:%1WC-ILl 1O� 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 Workcrs' 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 � CONSTRUC71ON LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of (Y > the work for which this permit is issued (Sec. 3097, Civ. C.) W A Lender's Name Lender's Address U C) I certify that 1 have read this application and state that the above information is Cry 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 W above-mentioned property for inspection purposes. C>~ (We) agree to save, indemnify and keep harmless the City of Cupertino against Cn liabilities, judgments, costs and expenses which may in any way accrue against said City V 2 in consequence of the granting of this ' . " APPLICANT UNDERS E.}rND�VILL COMPL WITH ALL NON -POINT SOURCE REGU Sig _ of Appli ontractor Dare H ALS DISCLOSURE I a licant or futu ilding Occupant store or handle hazardous material as defined by the up ipal Code. Chapter 9.12, and the Health and Safety Code, Section 25532(a)? f El Yes 0<0 Will the applicant or future building occupant use equipment or devices which -mil hazardous air contaminants as dcfrned by the Bay Area Air Quality Management District? — J/ Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Code, Sectio 4. I understand that if the building docs not currently enant my rcsponsibilt a notify the occupant of the rcquircm mch mu3tkeriiet p Issuance of a Ce mcate of Occupancy. or aulhon .cz d agent �� Date ... .. _ ..... PERMIT NO. DRAEGER CONSTRUCTION INC 07030059 PERMIT! ISSUE DATE 605 CONMERCIAL ST ni/09/20Q7 SANITARY NO. CONTROL NO. (408)536-0420 BUILDING PERMIT INFO BLDG ELECT PLUMB Job Description REROOF-REMOVE (E) & APPLY CLASS A COMP SHINGLES & CLASS P BUR ON PERIMETER -32 SQUARES. (10319,10321,10327,10329 BLDG B) Sq. Ft. Floor Area 326520C 3 `°'�1NNumber Issued b_,: Re -roofs Type of Goof Valuation $40000 Occupancy Type Required Inspections Date 3-00-0-1 All roof: 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 materials for ins SignatW- Icant Date All roof coverings to be Class "B" or better k CITY OF CUPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Buildin De artment JOB ADDRESS: 4-)6PERMIT # O� -/off,)-7- iD3� -r7,�� OWNER'S NAME: �✓Z PHONE # Z j d iDC' GENERAL CONTRACTOR:�/j/�G G- �� n s�r�� 1 FAX # I am not using any subcontracto �,�',.sf •nature Date Please check applicable subcon tors an nese uie 1V11VWUL.UUU.L11LGL"WLL. SUBCONTRACTOR ESS 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 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 building 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 First obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be perf armed. s 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: O Lam- Job Site Address: 2 C) 3 I q — 16 3 ?- ) _ ) O 3,)- % — / P 3 a—i m E7,1-� j Roofing Company Name: Applicant's Signal Greg Casteel Building Official &tke > R— ( cam i rc,c4i o :) Date: 2' �r C� -7 Revised 11/2/04 CITY OF CUPERTINO REROOF CUPEItTiNO PERMIT APPLICATION FORM ��0� 7 APN # Bldg Permit Fees Date: —7— />— C Building Address: ? VS Own e 's Name: BSEISMICRE Phone #: 1V0',5 --,-_)C 1D BUILDING BSEISMICOM Seismic Commercial Contractor: j � C� CT BPLANCHK License #: Contact: BUSLIC Cupertino Business License #: Type of hoof Covering: Proposed: t' Proposed: Existin Roof ❑ Asphalt Shingles Ll Built -Up roof 1d' Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report # �o be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Ct pertino's Tear Off Policy: Job Description: J Residential Commercial ❑ + ee o fS 4 13uiL ons tic �.•-�� Fire Zone: Yes ❑ No Confirmed with Planning Dept. if 3�_ 5i