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07030090 CITY OF CUPERTINO 'Cda TOR Il Ff'r. $UILDING DIVISION PERMIT PERMIT NO. BUILDING ADDRESS: 07030090 IT 22639 STEVENS CREEK BLVD WOODS ROOFING PERMISSUE DATE OWNER'S NAME: BALL DAVID F AND ROSA O 2179 STONE AVENUE STE 22 03/131/2007 SANITARY NO. CONTROL NO. ZONE: (831) 637-5576 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH i p O LICENSED CONTRACTOR'S DECLARATION Job Description VF= I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z U, with Section 70(X))of Division 3 of the Business and Professions Code,,and my license is REROOF—T/0 (E) WOOD SHAKES, INSTALL NEW 3 0 LB a a in full force and err l z License Lic.K 3 Z FELT, t- pad Contractor ARCHITECTS DECLARATION GERARL LW, 4 5 SQUARES i e I understand my plans shall be used as public records )WU U.y Licensed Professional 0, OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county ,0,ff which requires a permit to construct,alter,improve,demolish,or repair any structure u-y prior uh its issuance,also rcyuires the applicant for such permit to file a signed statement $q.Ft.Floor Area Valuation -Z< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $32000 F (commenring with Section 7000)of Division 3 of Business and Professions Code)or i that he is exempt therefrom and the basis for the alleged exemption.Any violation of A �l Number Occupancy Type Section 703 LS by any applicant for a permit subjects the applicant to a civil penalty of 3 4 212( 3 8 not more than five hundred dollars($500). ❑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.). ❑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 See .B&P C for this reason _ - - Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: -_- LJ I have and will maintain a Certificate of Consent toself-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work 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. My Worker's c''ompensauo nsurance carrier and Policy number arc: Cartier: 45 ��"� Policy No' � �VrC�f7��6 , CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he 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 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of > the work for which this permit is issued(See.3097,Civ.C.) W Q Lender's Name =Z Lender's Address U Q1 certify that I have read this application and state that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. i (We)agree to save,indemnify and keep harmless the City of Cupertino against tE,t liabilities,judgments,costs and expenses which may in anyway accrue against said City U Z in consequence of the granting of this permit. Date APPLIC NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOU GULATIO . Re-roofs signature of Applicant/Contractor Dare Type t)f Roof 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 Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes If a rcof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment ordevices which all rte N materials for inspection. emit hazardous air contaminants as defined by the Bay Area Air QualityManagement District? ❑Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafetyCodc,Sections 25505,25533 and 25534.1 understand thatif the building docs not currently have a tenant.that it is my responsibility to notify the occupant of the Date rcq which be met prior to issuance of a Ccrdficate of Occupancy. Slgna.ure of Applicant 0,7 All roof coverings to be Class "B"or better Owner or authorize ager Date CITY OF CUPERTINO 2 ITEMS OF 6 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 34212038. 00 DATE ISSUED. . . . . . . : 03/13/2007 RECEIPT #. . . . . . . . . BS00)000677 REFERENCE ID # . . . : 0703 )090 SITE ADDRESS 2263) STEVENS CREEK BLVD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : BALL DAVID F AND ROSA O ADDRESS CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5625 RECEIVED FROM . . . . : RECEIPT INTERFACE CONTRACTOR . . . . . . . : WOOD, LAWRENCE E LIC # 20810 COMPANY . . . . . . . . . . : WOODS ROOFING ADDRESS . . . . . . . . . . : 2179 STONE AVENUE STE 22 CITY/STATE/ZIP . . . : SAN JOSE, CA 95125 TELEPHONE . . . . . . . . : (831) 637-5576 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- --- ------- -- BPERMFEE VALUATION 32, 000.00 384.48 0 .00 384 .48 0.00 BSEISMICRE VALUATION 32, 000 .00 -- ---3_20 ------0_00- -----3_20 ------0_00 TOTAL PERMIT 387.68 0 .00 387.68 0.00 CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN# I / _ Date: � 1/� 5 —/ 3 Building Address: j/ Owner's Name: � Phone#: 41 Contractor. to u,) j S --)�oo �<;�� License. #: Contact: ,. Cupertino Business License #. J tj4-1 Type of R&A Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof � L3 Asphalt Shingles Asphalt Shingles l �S(� f- (�tl�,,� f 'p. Wood Shakes ❑ Wood Shakes �// L ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) / Other(Specify) Number of existing coverings ❑ Provide LC.B.O.Report# Jy To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cup,,rtino's Tear Off Policy: Job Descrition. lc7J a - R sidential Commercial ❑ -� Fire Zone: Yes ❑ No ffT' Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project�J� Type of Con�clion: Occupancy group: 77 2 Qty. if Fee Grou Applicable Fee ID Fee Description P BPERIMIFBE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM ;Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC 3usiness 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 building i Zspector. 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 performed. - 7. NOTE: If you call for a plywood nail impection 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 :;tated policy on re-roofing. Homeowner's Name: V► job Site Address: 2- ' (i' 4-1 Roofing Company Name: t) S Applicant's Signature: Date:` _ Greg Casteel Building Official Revised 11/2/04 Community Development St�k , 10300 Torre Avenue ` Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEIQTINO Buildir% De artment JOB ADDRESS: / PERMIT # �6 t e , k 7b 3csv To OWNER'S NAME: ,,E'd -� ll PHONE # xo 8-- Z 3 _S GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Sig lature Date Please check applicable subcontractors and co m l ete the followin 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/Contrac or Si ture Date