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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