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07050063 CITY OF CUPERTINO /( BUILDING DIVIrSTON PERMIT �+ ^' �� BUILDJ�,rMHESURDENVI EW LA TBD TO BE DETERMINED P07050063 OWNER'S NAME: PERMIT ISSUE DATE KAWASHIMA RICHARD K AND BELLA 05/08/2007 JNE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH i p p LICENSED CONTRACTOR'S DECLARATION Job Description LU p 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and Professions Code.and my license is REROO F, 23 SQUARES, ADDING 2ND LAYER, ASPHALT y in full force and effect. i ? License Class Lic.r 4 ROOF I in Date Contractor/t ARCHITECTS DECLARAMN 7 C It I understand my plans shall be used as public records )yU U.In Licensed Professional 0, OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the COO 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 y prior to its issuance.also requires the applicant for such permit to file a signed statement t, < that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 sq.Ft.Floor Area Valuation r II-C (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $10000 y 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 a Number Occupancy Type not more than five hundred dollars(5500). 3261909 :'17 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 Ins ections and Professions Code:The Contractors License Law does not apply to an owner of p 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 sal&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 riot build or improve for purpose of sale.). MI,as owner of the property,am exclusively contracting with licensed contractors to c tinct 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 2 / Date �7 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following 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,for 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 Workers Compensation insurance carrier and Policy number arc: Carrier. Policy No.: 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 man nceagas2��ubject to the Workcrs'Compensauon Laws of Califomi. a fJ Applicant NOTICE TO APPLICANT:If,alter making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must Qforthwith comply with such provisions or this permit shall be deemed revoked. Z'~ CONSTRUCTION LENDING AGENCY (�V] I hereby affirm that there is a construction lending agency for the performance of fZ! > the work for which this permit is issued(Sec.3097,Civ,C.) WW Q lender's Name ] Z Lender's Address U Q 1 certify that I have read this application and state that the above information is V.►' correct.I agree to comply with all city and county ordinances and state laws relating to 0 U building construction,and hereby authorize representatives of this city to enter upon the aabove-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against 0F4 to liabilities,judgments,costs and expenses which may in any way accrue against said City V Z in consequence of the granting of this permit. Date "E 7 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: �- d- SOURC REGUy�TIONS. �t/�---- �7 Re-roofs Si ature o Applicant/Contractor Type of R sof r HAZARDOUS MATERIALS DISCLOSURE Will Use 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 Cede,Section 25532(a)? All roofs,hall be inspected prior to any roofing material being installed. 0 Yes t(]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 Arca Air Quality Management all new m.iterials for inspection. District? 0 Yes 4eyNo I have aced the hazardous materials requirements nd55 4.1 r Chapterunderstand the if the Califor- nia Hcalth&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building does not currently have a tenant.that it is.my responsibility,,to notify the occupant of the rcyuircm� tfmust]c mel prior ssuance of a Certicate o!Occu Signature ppl icant Date Ownera innrizcd agents—' _ All roof coverings to be Class"B"or better or INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIT INVOICE OPERATOR: christya Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 32619094. 00 INVOICE DATE. . . . . . : 0508/2007 REFERENCE ID # . . . : 07050063 SITE ADDRESS . . . . . : 21868 GARDENVIEW LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : KMIASHIMA RICHARD K AND BELLA ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1132 CONTRACTOR . . . . . . . : TBI) - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBI) - TO BE DETERMINED ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : TELEPHONE . . . . . . . . FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ----------------- ---------- ---------- ---------- BLDG PERMIT FEES PRINTING PERMIT 169 . 56 0.00 169 . 56 SEISMIC FEE RES PRINTING PERMIT 1. 00 0.00 1. 00 ---------- ---------- ---------- 170.56 0. 00 170. 56 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: christya COPY # 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN . . . . . . . . . 32E19094 . 00 DATE ISSUED. . . . . . . : 05/08/2007 RECEIPT #. . . . . . . . . : BSC00001244 REFERENCE ID # . . . : 07C50063 SITE ADDRESS . . . . . : 21E68 GARDENVIEW LA SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : KAV'ASHIMA RICHARD K AND BELLA ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1132 RECEIVED FROM . . . . : REC'EIPT INTERFACE CONTRACTOR . . . . . . . : TBI► - TO BE DETERMINED LIC # 00096 COMPANY . . . . . . . . . . : TBI) - TO BE DETERMINED ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY 114OUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- --•-------- ---------- ---------- ---------- BPERMFEE VALUATION 10, 000. 00 169. 56 0. 00 169 .56 0. 00 BSEISMICRE VALUATION 10, 000. 00 1. 00 0. 00 1. 00 0.00 ----------- ---------- ---------- ---------- TOTAL PERMIT 170. 56 0 . 00 170.56 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 170.56 MASTERCARD --------------- TOTAL RECEIPT 170.56 CITY OF CXPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN# Date: C Building Address: D Owner's Na Phone#: rt�J 1(-°k- 2- Z- Contractor: License#: W k) Contact: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles pa, Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu)ertino's Tear Off Policy: Job Description: 2351s. ikd-d,,, Residefitial ] Commercial 0 Fire Zone: Yes ❑ No P1 Confirmed with Planning Dept. if there are any restrictions: U Cost of Project: Type of onstruc,tion: Occupancy group: / 0 ovo re- Qty. if Applicable Fee ID Fee Description Fee Group 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 0 . 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 agre;to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be appliec!.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 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 inspection 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-3,e 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 hated policy on re-roofing. Homeowner's Name: 2,t Ef A Wtlkj�=1/►'!�' Job Site Address: S `6 (D ������ ✓f L�'L-� L- N Roofing Company Name: Applicant's Signature: — Date: 2 T Greg Casteel Building Official Revised 11/2/04 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent,spouse or child) will perform A. � All the work authorized by this permit B. — A portion of the wo:-k C. — None of the work If B or C is checked,complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. — A portion of the wc:-k (complete section below) —[—Contractor Address/City Phone # State License # Type f work to 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer(see reverse side). A Certificate of Insurance covering workers' corn p enation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City . Phone Number Type of work to be performed ...............................................................................,....................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information(reverse side). Property Owner's Signature: . L �� Date: Job Address: 6-71i2-0r�01 C-") Permit# Any changes to the information provided on 1 his form shall be submitted to the City of Cupertino Build Department. Community Development ' 10300 Torre Avenue 4 Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Building Department JOB ADDRESS: o / PERMIT # �Z— 6 � 8 OWNER'S NAME: PHONE # 2--S-Z -os-A, GENERAL CONTRACTOR FAX # I am not using any subcontractors: -�-- Signature Date Please check applicable subcontractors and co m ►lete the following 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/Contractor Signature Date