07030186 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
C�NTR�.�T�R INFQRM�TIDN
PERMIT NO.
BUILDING ADDRESS:
1 99 85 PRICE AV TBD _ TO BE DETERMINED 07030 18 6
PERMrr ISSUE DATE
"NER'S NAME:
GEORGE MONK 03/22/2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
p Q LICENSED CONTRACTOR'S DECLARATION Job Description
ul P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000).f Division 3 of the Business and Prot ions Codde,and my license is INSTALL 50 YR. ELK OVER EXISTING COMP
<a in full force and eff et�f
i n z License Cl s 3 Lic.f1 FOUR BRC THERS ROOFING CO
M Date —�7 Contractor
ui ARCHITECTS DECLARATION
j a a I understand my plans shall be used as public records
)yU
U.y Licensed Professional
< OWNER-BUILDER DECLARATION
3 a 1 hereby affirm that I am exempt from the Contractor's License Law for the
e
in o following mason.(Section 7031.5,Business and Professions Code:Any city or county
< which requires a permit to construct,alter,improve,demolish,or repair any structure
y prior err its issuance,also requires the applicant for such permit to rile a signed statement �q,Ft.Floor Area Valuation
-Z< that he is licensed pursuant to the provisions oC the Contractor's License Law(Chapter 9 $2900
t=- (commencing with Section 7000)of Division 3 of the Business and Professions Codc)or
i that he is exempt therefrom and the basis
for the alleged exemption Any violation of OCCU Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 36905041 . (1N Number Occupancy YP
not more than five hundred dollars(SSW).
0 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 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.).
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 U-
cease 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.
0 I am exempt under Sec. B&P C for this reason
•ner Date
WORKER'S COMPENSATION DECLARATION-
-I hereby affirm under penalty of perjury one of the fallowing declarations:
0 1 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,far the performance of the
work for which this permit is issued.
0 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 Worker's Com on auranee e u and Policy
'number
�arc:
,,,� 2
Cartier. Policy No.:��_
CERTIFICATE OF EX PTION 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
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z C) CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
LY,> the work for which this permit is issued(See.3097.Civ.C.)
L>a Q Lenders Name
Le dersAddress
I certify that 1 have read this application and state that the above information is
U O correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction.and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
a (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 v�
O" APPLICANT UNDERSTA DS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE R ATION
Re-roofs
Signature of Applicant/Contractor Date Type of F.00f
HAZARDOUS MATERIALS DISCLOSURE YP
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
de,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
OYas �e If a roof s 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?
0 Yes
1 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
docs not currently have a tenant that it is my responsibility to notify the occupant of the Date
requirements .h f must b et prior to issuance of a Certificate O -ancy. Signature of Applicant
C> All roof coverings to be Class"B"or better
Date
Owner or authortrcd agent
CITY OF CUPERTINO
3 ITEMS OF 3 PERMI'' RECEIPT OPERATOR: christya
COPY # 3
Sec: Twp: Rng: Sub: Bl:;: Lot:
APN 36905041. 00
DATE ISSUED. . . . . . . : 03 /22/2007
RECEIPT #. . . . . . . . . : BS )00000758
REFERENCE ID # . . . : 07 )30186
SITE ADDRESS 19 )85 PRICE AV
SUBDIVISION . . . . . . .
CITY CU PERT INO
IMPACT AREA
OWNER GEDRGE MONK
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : TBD - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . :
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- ------------- ---------- ---------- --------
BPERMFEE VALUATION 2, 900. 00 83 . 16 0 .00 83 . 16 0. 00
BSEISMICRE VALUATION .2, 900. 00 0.50 0. 00 0. 50 0 . 00
BUSLIC FLAT RATE 1. 00 107 . 00 0 . 00 107 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 190. 66 0 . 00 190. 66 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 190.66 1320
---------------
TOTAL RECEIPT 190. 66
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIZ RECEIPT OPERATOR: christya
COPY # 3
Sec: Twp: Rng: Sub: Blk.: Lot:
APN 36505041. 00
DATE ISSUED. . . . . . . : 03/22/2007
RECEIPT #. . . . . . . . . : BS( 00000758
REFERENCE ID # . . . : 07(30186
SITE ADDRESS . . . . . : 195'85 PRICE AV
SUBDIVISION: . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER GEORGE MONK
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : TB]) - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TB]) - TO BE DETERMINED
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . :
TELEPHONE
FEE ID UNIT QUANTITY kMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- --------
BPERMFEE VALUATION 2, 900. 00 83 . 16 0. 00 83 .16 0. 00
BSEISMICRE VALUATION 2, 900. 00 0. 50 0 .00 0. 50 0. 00
BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 . 00 0 .00
- --------- ---------- ---------- ----------
TOTAL PERMIT 190. 66 0. 00 190. 66 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 190.66 1320
---------------
TOTAL RECEIPT 190.66
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 apprc val.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,aplywood nail Inspection is required.
6. Any roofing which is applied without f rst obtaining aninspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be perfc rmed.
7. NOTE: If you call for a plywood nail inspection and the lob is not ready,
you will be charged a re-inspection fee :)f$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: `� r
Roofing Company Name: F<) d
G �
Applicant's Signature: �,'t�� /� Date: 3 d 7
Greg Casteel
Building Official
Revised 11/2/04