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07050038 CITY OF CUPERTINO BUILDING DIVISION PERMIT � � ESS: PERMIT NO. BUILDN �8 JWS LOCKWOOD DR TBD TO BE DETERMINED 07050038 PERMIT ISSUE DATE OWNER'S NAME: SZELONG 05/07/2007 NE: SANITARY NO. CONTROL NO. ABUILDING PERMIT INFO RCHITECT/ENGINEER: BLDG ELECT PLUMB MECH L (� 0 i p p LICENSED CONTRACTOR'S DECLARATION Job Description %m I hereby affirm that I am licensed under provisions of Chapter 9(commencing �Z, with Section 700W)of Division 3 of the Business and Professions Code,and myliccnse is REROOF-T/O OLD SHAKE, REPLACE WITH 1/2" SHEETING, t y in full force an fC L i y �yz License lasay Lie.N TL PRESIDENTIAL COMP-36 SQUARES CLASS A-R.M. Fin Date Ole ARCHITECTS DEC YOUNG 1 understand m plans shall be used as public records y P ROOFING PD FOR BUS LIC 5/7/07 . U.F Licensed Professional O� OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's Liccnse Law for the p O following reason.(Section 7031.5,Business and Professions Code:Any city or county $9 which requires a permit to construct,alter,improve,demolish,or repair any structure z} prior w its issuance,also requires the applicant for such permit to file a signed statement _ that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 iq.Ft. Floor Area Valuation e t– (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $13440 i 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 ofNumber Occupancy Type not more than five hundred dollars($500). 3 4 214 0 3 3' ❑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 Required Inspections and Professions Code:The Contractor's License Law does not apply to an owner of q 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 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 Contractofs License Law. ❑I am exempt under Sec .B&P C for this mason 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-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. ❑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 m enation Insurance 'er and Policy number am: Cartier Policy No.: RTIFIC PTION 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,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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY [~i 1 hereby affirm that there is a construction lending agency for the performance of _ a the work for which this permit is issued(See.3097,Civ.C.) W A Lender's Name Z Lender's Address V I certify that 1 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 0 U building construction,and hereby authorize representatives of this city to enter upon the a 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 a+I ^ }Z in consequence of the granting of this permit. Date J ►+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by SOURC GULA IONS.- O Re-roofs Signuttce of Acan H OU ATERIALS DISCLOSURE ate Type of Roof 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 JoNo 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 Area Air Quality Management all new n'aterials for inspection. District? ❑Yes *No 1 have read the hazardous materials requirements underChapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building docs not currently have a tenant that it is my responsibility to notify the occupant of the rcquircmcn hien ust be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date �--a— -,� ' i ? All roof coverings to be Class"B"or better Owner or authorized agent a�— CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Bl1-.: Lot: APN . . . . . . . . : 34: 14033 . 00 DATE ISSUED. . . . . . . : 0507/2007 RECEIPT #. . . . . . . • • : BS000001220 REFERENCE ID # . . . : 07(150038 SITE ADDRESS . . . . . : 103.85 LOCKWOOD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : SZELONG ADDRESS . . . . . . . . . . . CITY/STATE/ZIP . . . : , 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 INOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- ------ ---------- ---------- ---------- BPERMFEE VALUATION 13,440 . 00 212 . 76 0. 00 212 .76 0. 00 BSEISMICRE VALUATION 13,440 .00 1.40 0. 00 1 .40 0. 00 BUSLIC FLAT RATE 1 .00 107.00 0. 00 107 . 00 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 321.16 0 .00 321. 16 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 321 . 16 VISA-ROBERT YOUNG --------------- TOTAL RECEIPT 321.16 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 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 apprcval. 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 f rst obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be perfc,rmed. 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$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: /1/)'V- s2 L d x., Job Site Address: CL wc5e.),2 ��-- Roofing Company Name: •k" rs Oc.q lZ 'c: Applicant's Signature: '� Date: Greg Casteel Building Official Revised 11/2/04 CITY ORFECXPERTINO ROOF CUPEY TINO PERMIT APPLICATION FORM APN# Date: Building Address: Owner's Name: Phone#: /V (- 5 Z_e_ 6 A Contractor: License#: 7.7 d. �'3 k` Contact: Cupertino Business is se #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 9 Asphalt Shingles 45 Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu)ertino's Tear Off Policy: Job Descripti n: `� r eAv b d 5>=t ao �� torr i 1 ' 1 Residential ® Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Det. if there are any restrictions: LJ Co t of Pro ect: Type of Constru4,tion: Occupancy group: i / *94g1) e dP.06 4�7 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE :31dg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING Community Development 10300 Torre Avenue Cupertino CA 95014 ;..st$ Telephone(408)777-3228 CITY Of Fax(408)777-3333 7UPEkTINO Building Department JOB`LDDIt� L G e 61SS: Lc�Ue c3a- PERMIT# OWNER'S NAME: PHONE# 6S--3 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: d 7 ate Please check applicable subcontractors and complete 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 v7 er/Contractor Signature bate