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07050094?00 ,m U u' i<a h viz )WU )yV W y :o 000 <�� _zr eFp'� U CITY OF CUPERTINO BUILVING DIVISION PERMIT BUILDING ADDRESS: 864 KIM ST OWNER'S NAME: WILLIAM RINEY _ NE: ARCHITECTIENGINEER: 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 effect. License Class Lic. M Date Contractor ARCHITECTS DECLARATION 1 understand my plans shall be used as public records 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 file 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 (5500). ❑ 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 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 sae.). Vas owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U. cense Law does not apply to an owner of property who builds or improves thereon, and. who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law. ❑ I am exem r undo C. B & PC for this n /. Owner ate -SECLARATION I hereby affiunder penalty of perjury one of the following declarations: ❑ I have and will maintain a Certificate of Consent to self -insure for Workefs Compen- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 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 Compensation Insurance carrier and Policy number are: 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 f the work for whit this permit is issued, 1 shall not employ any person in any m r so as to become t w the Workers' Compensation Laws of California. oft Applicant NOTICE TO APPLICANT: If, r making*ts—Ccrtiricaft Exemption, you should become subject to the Wor s Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Sec. 3097, Civ. Q Lender's Name Lender's Address 1 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 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 g g of this permit. APPLICANT UNDE ANDS AND WILL MPLY WITH ALL NON -POINT SOURCE RFQUL NS. r _ / _ _ HA7,ADOUS MATERIALS DISCLOSURE - Will the applicyfor future building occupant store or handle hazardous material as defined by the Cu vino Municipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(a)? ❑ Yes gift 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 Wo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Hcalth & Safety Code, Sc c ' is 25505, 25533 and 255 .1 understand that if the building does not currently have ant. that it is my respo dity pp notify the occu ant f the rcyuircmcnt vhich be met prigF w�aSuan ` f a Certificate of Occu�rar _ 1 _ PERMIT NO. TBD - PO BE DETERMINED 07050094 PERMIT ISSUE DATE SANITARY NO. CONTROL NO. REPLACE EXISTING ROOF WITH I BLDG COMPOSITION CLASS AJob Description Issued by Re -roofs 5q. Ft. Floor Area Required Inspections BUILDING PERMIT INFO Valuation 'type Type of Roof All roofs ;hall be inspected prior to any roofing material being installed. If a roof i; installed without first obtaining an inspection, I agree to remove all new materials for inspection. 0.0 Signature of Applic 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 ........: 35S19036.00 DATE ISSUED.......: 05/11/2007 RECEIPT #......... BSC00001286 REFERENCE ID # ...: 07C50094 SITE ADDRESS .....: 864 KIM ST SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER WILLIAM RINEY ADDRESS ..........: CITY/STATE/ZIP ...: CUPERTINO CA, OPERATOR: bethe COPY # : 1 95014-4323 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 I.MOUNT PD -TO -DT ---------- THIS REC ---------- NEW BAL ---------- ----------------------- BPERMFEE VALUATION ---------- 14,100.00 ---------- 223.56 0.00 223.56 0.00 BSEISMICRE VALUATION 14,100.00 1.50 0.00 1.50 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 332.06 ---------- 0.00 332.06 0.00 METHOD OF PAYMENT AMOUNT REFERENCE -------------------- NUMBER ----------------- --------------- CREDIT CARD 332.06 AMEX --------------- TOTAL RECEIPT 332.06 May 10, 2007 To Whom It May Concern: I authorize Sabrija Kucevic to pull and s ign in my name for the necessary permits for re -roofing my house at 864 Kim Street, Cupertino, CA 95014. Home Owner Wanda Riney CITY OF C_UPERTINO RE ROOF 71TCUPEkTINO PERMIT APPLICATION FORM 0 70,WN APN # ,)/ I- l 9- t 7�_ Bldg Permit Fees Date: os Building Address: Address: e/•/P7 67 - Energy Owner's Name: WA ./ 12/Ne y BSEISMICRE Phone #:'log S((16 g126 ,. / Contractor: 5 W 7_9W_,?i IDA/ BSEISMICOM License #: 993195 Contact: � � � BPLANCHK Cuperti o Busine5sLicense #: i I L , �'I,iir t Type of Roof Covering: Existing: Proposed: Business License ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles 0< Asphalt Shingles X Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings pNr ❑ Provide I.C.B.O. Report # kTo be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu)ertino's Tear Off Policy: Job Description: � �2 4S t3 3Q �: t, � . t-1 Y 0 CC-L P'Vf 2� Residential X Commercial ❑ Fire Zone: Yes ❑ No [} Confirmed with Planning Dept. if there are any restrictions: U Cost of Project:/ Type of C cation: � (./00. Occupanc grou 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 P.