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07030356CITY OF CUPERTINO BUILDING DIVISION PERMIT e� BUILDING ADDRESS: ONUAMP, S E ARCHITECT/ENGINEER: LICENSED CONTRACIVK'S UbULAKAI tun I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and eIT L License Class Lic. k pate _ Contractor ARCHITECT'S DECLARA ION 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that I 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 file a signed statement that be 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 Code: The Contractor's License Law docs 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.). ❑ I, 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 conlractor(s) licensed pursuant to the Contractor's License Law. ❑ 1 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: i have and will maintain a Certificate of Consent to self-insum 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 Workers Compensation Insurance, as required by Section 3700 of the Labor Cotte, for the performance of the work for which this permit is issued. My Wo_rkkeeess Compensation Insurance carrier and Policy number arc: Carrier: Policy No.: Z 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 Workcr's Compensation provisions of the Labor Code, you must Z forthwith comply with such provisions or this permit shall be deemed revoked. 0 �-t Q Z H V W a Z CONSTRUCriON LENDING AGENCY 1 hereby affirm that there is a consttuctinn 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 anyway accrue against said City in consequence of the granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOU I;t~r; UR ]l6 AT1O fS. Signet\\a�tioof��pplicant/onuactor r� )Dante 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 �No Will the applicant or future building occupant use equipment or devices which hazardous air contaminants as defined by the Bay Area Air Quality Management .hstrict? E3 Yes XNo 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & Safety Codc, Sections 25505, 25533 and 25534. I understand that if the building does not currently have a tenant, that it is my responsibility to notify the occupant of the requircmenis y#uch must b(met prior to psuance of a Ccrtificatc.a4cupa cy..t r Owner or authorized aecm Date REPL7,CE WITH 30 YEARJob Description Issued I Re -roof Sq. Ft. Floor Area Number I Occupancy Type Required Inspections Type of Roof All roo 's shall 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 of Applicant All roof coverings to be Class "B" or better Date 04 2 ITEMS OF 2 CITY CF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Elk: Lot: APN ........: 37526019.00 DATE ISSUED.......: C3/30/2007 RECEIPT #.........: ES000000830 REFERENCE ID # ...: C7030356 SITE ADDRESS .....: 18631 STARRETT CT SUBDIVISION ...... CITY .............. CUPERTINO IMPACT AREA ...... OWNER ............: JAMP, SUE ADDRESS ..........: 18631 STARRETT CT CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM CONTRACTOR ... COMPANY ...... ADDRESS ...... CITY/STATE/ZIP TELEPHONE .... OPERATOR: bethe COPY # : 1 EECEIPT INTERFACE NARTINEZ, JAVIER LIC # 21207 TAINTER ROOFING INC 151 WYANDOTTE DR SAN JOSE, CA 95123 4083638052 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- BPERMFEE VALUATION ---------- 4,930.00 -------------------- 115.56 0.00 115.56 0.00 BSEISMICRE VALUATION 4,930.00 0.50 0.00 0.50 0.00 ---------- TOTAL PERMIT ---------- ---------- 116.06 0.00 ---------- 116.06 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- --------------- CREDIT CARD 116.0E MASTERCARD --------------- TOTAL RECEIPT 116.06 OITYOF CUPEkTINO CITY OF CUPERTINO RE,ROOF PERMIT APPLICATION FORM C 70303& APN # ----- Bldg Permit Fees Date: BENERGY Energy Building Address: BSEISMICRE Seismic Fee Res BUILDING Owner's Name: Seismic Commercial Phone #: _ ` - BPLANCHK Plan Check Fee BUILDING Contractor: Phone if: Business License License #: Contact: Ic Phone # : Cupertino Business License #: Type of Roof Covering: g: osed: p Proposed: ❑ Built -Up Roof ❑ Asphalt Shingles ❑ Built -Up roof je Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles Other (Specify) TIN Q _ E✓l, ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings To be Removed j CCC (:�jZ I�L ❑ Provide I.C.B.O. Report # ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: Residential i' Commercial ❑ .S Fire Zone: Yes ❑ No F1 Confirmed with Planning Dent. if Ei there are any restrictions: Cost of Project: Type of Construction: Occupancy groin ___ Qty. if rMPURS-1-27, RPa Tlacr.rintinn Fee Group Applicaulu 1 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