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07030079 CITY OF CUPERTINO BUILDING DIVISION PERMIT M R INFORMATION PERMIT NO. BUILDING ADDRESS: 10214 S PORTAL AV MICHAE"i LUNNEBORG ROOFING 07030079 PERMIT ISSUE DATE OWNER'S NAME: GUTHRIE, JIM 1328 W/ 1ITE OAKS RD 7 SANITARY NO. CONTROL NO. iNE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: TEAR O 7 F WOOD SHAKE, INSTALL BLDG ELECT PLUMB MECH 0 a 0 a i p O LICENSED CONTRACTOR'S DECLARATION Job Description v 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 70110)of Division 3 of the Business and Professions Code,and my license is >>y in full farce and e(f t 7 t72 Y v�Z License C ass p L1c• E p � •/l7 Date n AT _ DEC 7 a< 1 understand my plans shall be used as public records )yV U.l– Licensed Professional < OWNER-BUILDER DECLARATION 'r I hereby affi m that 1 am exempt from the Contractor's License Law for the p o following reason.(Section 7031.5,Business and Professions Cade:Any city or county < ff which requires a permit to construct,alter,improve,demolish,or repair any structure u'rn prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation ?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area r is (commencing with Section 7000)of Division 3 of the Business and Professions Code)or Q 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 APN Number Occupancy Type not more than five hundred dollars(5500). ❑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.7044,Business Required Inspections and Professions Code:The Contractor's License Law dam 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.). ❑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 Sea - --,B-&P C for this reason -. Owner Date _ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]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 Labor Code.for the performance of the work for which this permit is issued. Khave and will maintain Worker's Compensation Insurance,as required by Section of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Polity number are: Carrier �yllsC J�MuA'.� Policy No.; k—"— CERTIFICATE OF EXEMPTION FRO 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,1 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. z. CONSTRUCTION LENDING AGENCY (�ct. 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.) a Q Lender's Name Lender's Address U O 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 building conswction,and hereby authorise representatives of this city to enter upon the a above-mentioned property for inspection purposes. (We)agree to save,indemnity and keep harmless the City of Cupertino against rF-t 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 / APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b) SOUR REGULATIONS. *6 3' 2-47 Re-roofs Si?' a ontractor Dao Type of I:oof AZARDOUS MAT ISCLOSURE Will the applicant or future buil g Occup store or handle hazardous material as defined by the Cupertino Municipa aptcr 9.12,and the Health and Safety Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes No Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new r laterials for inspection. District? ❑Yes No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant,that it is my rc��5t risibility o notify the occupant of the requi nus whic must be p miss dice a Certificate of occupancy. Signature;of Applicant Date A 11 All roof coverings to be Class "B"or better ncr or 91horized agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 r.UPEI�TINO Building Department JOB ADDRESS: PERMIT# 0`70 0-7 ,5P OWNER'S NAME: PHONE# `fes P73 —/oG GENERAL CONTRACTOR: �,�,, ��� > �i°rs FAX# i1d 3&1 //.5--7" I am not using any subcontractors: -- /z--J7 Si;na Date Please check applicable subcontractors and com,:)lete a Ifoll1lowinginformation 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 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: bethe COPY # 1 Sec: Twp: Rng: Sub: Blk . Lot: APN 36509007. 00 DATE ISSUED. . . . . . . : 03/12/2007 RECEIPT #. . . . . . . . . BSC00000667 REFERENCE ID # . . . : 07C30079 SITE ADDRESS 10114 S PORTAL AV SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER GUTHRIE, JIM ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3350 RECEIVED FROM . . . . : REC'EIPT INTERFACE CONTRACTOR . . . . . . . : MICHAEL LUNNEBORG LIC # 25896 COMPANY . . . . . . . . . . : MICHAEL LUNNEBORG ROOFING ADDRESS . . . . . . . . . . : 1328 WHITE OAKS RD CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (8: 1) 278-1837 FEE ID UNIT QUANTITY ENOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- -------- BENERGY PERMIT FEE 1.00 34 .86 0.00 34 .86 0. 00 BPERMFEE VALUATION 15,400 .00 234 .36 0 .00 234 .36 0.00 BSEISMICRE VALUATION 15,400 .00 1.60 0.00 1.60 0.00 - --------- ---------- ---------- ---------- TOTAL PERMIT 270.82 0 .00 270.82 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 270.82 VISA --------------- TOTAL RECEIPT 270 .82 CITY OF (:UPERTINO ' REROOF CUPER`TINO PERMIT APPLICATION FORM p'jp 3pp 7� APN# Date: Building Address: Owner's Name: Phone#: Contractor, License#: Contact: Cupertino Business License #: '25 S-9 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles Wood Shakes ❑ Wood Shakes Ll Shingles ❑ Wood Shingles ❑ Other(Specify) �W Other(Specify) /1g;t&I rc/e Number of existing coverings Ll Provide I.C.B.0.Report#9"L?_(.- 0 To be Removed ❑ Provide Mfgr.Installation Specs. I-HaVe Read,Understand and Will Comply With Cu)ertino's Tear Off Policy- . LJ Job Description: Mt�� le S __*0-0' C)#5,C)#5, G✓�,id f ( f�ecfr R3 NeLc�t �v�� f I 1 _ _ Residential Commercial ❑ Fire Zone: Yes ❑ No ©— Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Construe;tion: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE 3ldg 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 applied without first obtaining all inspection and written approval from the buildin€;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 f irst obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be 7. NOTE: If you call for a plywood nail nispection and the fob 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 he 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: 10Z i- ✓�- Roofing Company Name: G✓-� SP�ti ��/'� -��S7`crJ Applicant's Signature: Date: 3 Y2-%q Greg Casteel Building Official Revised 11/2/04