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EUILDING DIVISION PERMIT
ANG ADDRESS:
10397 TONITA WY
OWNER'S NAME:
FINSTAD VERA M AND HAROLD F
JNE:
ARCHITECT/ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Codccmy license is
in full force and cf t 0
License Class _7 LM• x
Date C~� Con
ARCHITECTS D
I understand my plans shall he used as pub cords
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
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 structure
prior to its issuance, also requires the applicant for such permit to rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's License law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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
not more than five hundred dollars ($500).
❑ I, 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
and Professions Cade: 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.).
[11, 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 Sec . B & P C for this reason
Owner Date _
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self -insure for worker's Compen-
ation, 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
1700 of the Labor Code, for the performance of the work for which this permit/is/issued.
My Work/�C�o�m r insurance carter and Policy number are*
arrier.Fi7Y/eK Uk�f�2��7 PoI'tcyNo.
CERTIFICATE OF EXEMPTION FROM WOR CERS'
COMPENSATION INSURANCE
(This section need not he completed if the permit is foronc 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
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
Lenders Address
I 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 construction, and hereby authorize representatives of this city to enter upon the
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
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOME REGUL IONS.
St aturc of Applican ntractor Date
HAZARDOUS MATERIALS DISCLOSURE
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)?
❑ Yes
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
District?
❑ Yes —E.�tw
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
dces�a tenant. that it is my re ponsiCeti to notify the occupant of the
requ' cn whi must ri uancc of a Certificate of Occupancy.
Owncr or authorized agent Date
TBD — To BE DETERMINED
TEAR OF]' EXISTING AND
Issued by:
Re -roofs
Type of Roof
1. Ft. Floor Area
umber
PERMIT NO.
07030283
PERMIT ISSUE DATE
nA/27/2nn7
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB
"Required Inspections
Type
All roofs .,hall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature A Applicant Date
All roof coverings to be Class "B" or better
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35914007.00
DATE ISSUED.......: 03/27/2007
RECEIPT #......... BS000000797
REFERENCE ID # ..-: 07030283
SITE ADDRESS .....: 10397 TONITA WY
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: bethe
COPY # : 1
OWNER ............: FINSTAD VERA M AND HAROLD F
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-2931
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
----------
8,500.00
--------------------
158.76
0.00
----------
158.76
0.00
BSEISMICRE VALUATION
8,500.00
0.90
0.00
0.90
0.00
BUSLIC FLAT RATE
1.00
107.00
0.00
107.00
----------
0.00
----------
TOTAL PERMIT
---------- ----------
266.66
0.00
266.66
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
NUMBER
----------------- ---------------
CHECK
266.66
--------------------
31409
---------------
TOTAL RECEIPT
266.66
CITY OF CUPERTINO
0, REROOF
CUPEkTINO PERMIT APPLICATION FORM
07 0.3 0 &�3
APN # j 5q y l j L— 0o 7
Elldg Permit Fees
Date: 3 O
Building Address: ___---
lane
1---nergy
? a
BSEISMICRE
Owner's Name:
Vda Fin.1 4ad
BUILDING
Phone #:
r + 1,96-7
Contractor: nustioxe. Tme
BUILDING
License #: 41 O 175
BUILDING
BUSLIC
Contact:
BUILDING
Cupertino Business License #:
3A d rl M6 P1
"dL��
Type of Roof Covering:;'
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
Ir Asphalt Shingles
Ur" Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings
❑ Other (Specify)
e Provide I.C.B.O. Report #
q-' To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ►ertino's Tear Off Policy:
Job Description: rr
T.ct
D t 0 e
Residential Commercial ❑
it
Fire Zone: Yes ❑ No
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: OC Type of Construction: Occupanc grS p:
F566 0
!M oT�J —
Qty. if
Annlicable
Fee ID
Fee Description
Fee Group
BPERMFEE
Elldg Permit Fees
BUILDING
BENERGY
1---nergy
BUILDING
BSEISMICRE
,3eismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
flan 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
I. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re -i oofing.
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 approval.
2) In -progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail lspection is required.
6. Any roofing which is applied without fist obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be perfo:•med.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re -inspection fee c f $176.18. The re -inspection fee must
be paid before another inspection can he scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " :ger 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 :Mated policy ou re -roofing.
Homeowner's Name: 42\�— S
Job Site Address:'�-
Roofing Comp a
ZV1 AZO
Applicant's Si ature: Date: ..3 ��ti
Greg Casteel
Building Official
Revised 11/2/04
CITY OF
71UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: PERIVIIT #
3e —� QwA , �� c� V 0703002
OWNER'S NAME:Q -V-\ PHONE # 2K --mil
GENERAL CONTRACTOR: tc-z (� C FAX # - Z
I am not using any subcontrac ors:
Signature Date
Please check annlicable subcontractors and comr lete the following information
Owner/Contractor Signature
Date
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