07030045 CITY OF CUPERTII�10 �TpR I1 `QRM�T �N
BUILDING DIVISION PERMIT
k.Mw— PERMIT NO.
BUILDING ADDRESS: CASTI LLO ' S ROOFING 07030045
11696 PALM SPRING CT
PERMIT ISSUE DATE
OWNER'S NAME:
ICHIKAWA SHINPEI AND ANNA C 1703 CA"HAY SANITARY NO. CONTROL NO.
-LONE:
(408) 25:.-3565
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
(� Lr
p C LICENSED CONTRACTOR'S DECLARATION Job Description
v I hereby affirm that I am licensed under provisions of Chapter 9(commencing
;z� witihSection7t300)ofDivision3oftheBusinessandPro�k=QnnScode,andmylicenseis TEAR-OF: EXISTING ROOF, INSTALL 50 YR. ELK COMP
>>y t lull force and ef(ec 2 c/r / HINGLE ROOF
? License Class ✓ LM
p Date Contractor
t to ARCHITECTS DECLARATION
j aa
< I understand my plans shall be used as public records
)ulU
r U.H Licensed Professional
O< OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law Cor the
(no 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 swcturc
a—y prior to its issuance.also requires the applicant for such permit to rile a signed statement S Ft.Floor Area Valuation
-?< that he is licensed pursuant to the provision of the Contractor's License Law(Chapter 9 q $6500
i I--O (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
a 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). 366541
13
0 1,as owner of the property,or my employees with wages as their sole compensation, Required Inspections
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 We.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-
rty who
reon,and.
who c contracts for such projects with a c ntraclLaw does not apply to an owner of obuilds
r(s)I censedn
pursu it to the Contractor's
License Law.
0 1 am exempt under Sec B&P C for this reason
Owner Date -_--
WORKER'S COMPENSATION DECLARATION
/I hereby alum under penalty of perjury one of the following declarations:
0 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 tabor Code,for the performance of the
wo 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.
M Workers Cyo��ny nation In�sura)n ca er and Policy number re: q
Carer. (r^ y ^' 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
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
o
Z CONSTRUCTION LENDING AGENCY
(~�CA I hereby affirm that there is a construction lending agency for the performance of
p�> the work for which this permit is issued(See.3097,Civ.C.)
W Q Lender's Name
p+ Lender's Address
U 0 1 certify that I have read this application and state that the above information is
o— correct.I agree to comply with all city and county ordinances and state laws relating to
rJ- Ubuilding construction,and hereby authorize representatives of this city to enter upon the ti
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
U z in consequence of the granting of this permit. Date j
�SR
ICANT U ERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued l,y:
t!`RE Re-roof Sz
ur of App r t/Contractor Date Type of Roof
HAZARDOUS MATERIALS DISCLOSURE yP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munr'pal Code.Chapter 9.12,and the Health and Safety
All foo s shall be inspected prior to any roofing material being installed.
Code,Section 25532(a)?
0Yes A'"° 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 contami7N.
defined by the Bay Arca Air Quality Management all new materials for inspection.
District? r
0 Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Cali
nia Health&Safety Code,Section 25505,25533 and 25534.I understand that if the builds
docs not cu ntly tenant,that itis my responsibility to notify the occupant of the Date
req c issuance of a Certificate olOccupattcr lgnatl re ppl ieant
All roof coverings to be Class"B"or better
Owner or a thorized agent Date
CITY OF CUPERTINO 0_40RjC O5
RE�20OF
CUPERTINO PERMIT APPLICATION FORM
APN# �(Pu 13 1
Date: `1
Building Address: ` ` ^� r nil C n
Owner's Name: I tL (Q I" J Phone#: S.
S £,-�Yl�1 Q i �Vv C� �b�� 2 Jr ( " �.�(n�
Co act r: IX r License#: Y L C, L�jco
A STf i L-A_0`3 'V'1 "1
Contact: oe_ C �ilo Cupertino Business License#:
�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
V- Asphalt Shingles - Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ 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 Ct. ertino's Tear Off Policy:
Job Description:
Residential% Commercial .❑ .
Fire Zone: Yes El Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of ConstrL ction: Occupancy group: `
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
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 agrE e 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 bu.lding 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.-irst obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be perf armed.
7. NOTE: .1f 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.
Homeowner's Name: RM) kaw rj
1
ob Site Address:
Roofing Company Name:
Applicant s Signature:
Date/_7 1
Greg Casteel
Building Official
Revi:.ed 11/2/04
CITY OF --UPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN . . . . . . . . : 36654113 . 00
DATE ISSUED. . . . . . . : 03/07/2007
RECEIPT # . . . . . . . • . : BSC00000626
REFERENCE ID # . . . : 07C30045
SITE ADDRESS . . . . . : 11( 96 PALM SPRING CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER ICHIKAWA SHINPEI AND ANNA C
ADDRESS
CITY/STATE/ZIP CUPERTINO CA, 95014-5142
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : JOSE CASTILLO LIC # 25850
COMPANY . . . . . . . . . . : CASTILLO' S ROOFING
ADDRESS : 1703 CATHAY DR.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95122
TELEPHONE . . . . . . . . : (4 )8) 251-3565
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
___ ------------- ----------
---------- ----------
BENERGY PERMIT FEE 1 . 00 34 . 86 0 . 00 34 . 86 0 . 00
BPERMFEE VALUATION 6, 500 . 00 137 . 16 0 . 00 137 .16 0 . 00
BSEISMICRE VALUATION 6, 500 . 00 0 .70 0 .00 ------0_70 ------0_00
---------- ----------
TOTAL PERMIT 172 .72 0 .00 172 .72 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -
CHECK 172 .72 14372
---------------
TOTAL RECEIPT 172 .72
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: —
ERMU# v 7 O 3 v05G�
OWNER'S NAME: PHONE# c;:95-1-3 6
GENERAL CONTRACTOR: FAX# 5 — 3 5-41.5
I am not usingan subcontractor C 3 ` 7 7
y Si;;nature Date
Please check applicable subcontractors com )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
Owner/Contractor Signature Date