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07050132 CITY OF CUPERTINO BUILDING DIVISION PERMIT �NT � T� Z �' '�� ` PERMIT NO. BUILDJN��I J2E% TANTAU AVE WORRELL ROOFING CO. 07050132 OWNER'S NAME:: PERMIT ISSUE DATE RICHARD FREEMAN 1570 PAM LN 05/16/2007 NE: SANITARY NO. CONTROL NO. (650) 494-8166 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 1 p p LICENSED CONTRACTOR'S DECLARATION Job Description U affirm 1 hereby arm that I am licensed under provisions of Chapter 9(commencing .z En with Section 7000)of Division 3 of the Business and Professions Code,and my license is REROOF DETACHED GARAGE-T/O OLD, INSTALL CDX 50 YR I<m in full force and ; z License Class C Lie.# Z ELK-8 SQUARES CLASS A-CONTRACTOR WORRELL ROOFING F W Date ARCHITECTS DECLARATIONa RENEWED BL 5/16/07 . aa 1 understand my plans shall be used as public records 5W e u.y Licensed Professional `-y OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the C p O following reason.(Section 7031.5,Business and Professions Code:Any city or county .�.Pi which requires a permit to construct.alter,improve,demolish,or repair any structure u Z y prior ser its issuance,also requires the applicant for such permit to file a signed statement =o that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $4000 Valuation (commencing with Section 7000)of Division 3 of the Business and Professions Code)or y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of �p Number Occupancy Type not more than five hundred dollars(5500). 37507026 T� ❑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 ectl0llS 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.). ❑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 contractor(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-insure for Workees 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 Compensation Insurance carrier and Policy number are: carri.s4wk gwt o Policy No.:143—y") CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or less.) 1 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 H►�-� I hereby affirm that there is a construction lending agency for the performance of fyi •� the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name 0. Z Lcndees Address U O 1 certify that I have read this application and state that the above information is CL " correct.I agree to comply with all city and county ordinances and state laws relating to C U 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 r V Z in consequcnc a granting of this permit. Date ►+ APPLIC UN RSTAN SAND WILL COMPLY WITH ALL NON-POINT Issued by soU E TI .I S— Re-roofs Signat f Appli t/Contractor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof. Will the applicant or future building occupant store or handle hazardous material as dcfned 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. ❑Ycs ❑No Will the applicant or future building occupant use equipment or devices which If a roof i 3 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 materials for inspection. District? ❑Yes ❑No 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 does not cwmenik have aJanant,that it is myres ibility to notify the occupant of the regui ,ch et rior to issn of a certificate of Occupancy. Signature Of Appl ieant Date :!Z=/'a All roof coverings to be Class"B"or better C_22_14r authorized agent tc CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec: Twp: Rng: Sub: Blh: Lot: APN . . . . . . . . : 37507026 . 00 DATE ISSUED. . . . . . . : 0S/16/2007 RECEIPT #. . . . . . . . . : BS000001342 REFERENCE ID # . . . 07050132 SITE ADDRESS . . . . . : 10189 S TANTAU AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : RIC:HARD FREEMAN ADDRESS CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : WOLRELL ROOFING CONTRACTOR . . . . . . . : FRED WORRELL LIC # 27857 COMPANY . . . . . . . . . . : WOE'RELL ROOFING CO. ADDRESS 1570 PAM LN CITY/STATE/ZIP . . . : SAN JOSE, CA 95120 TELEPHONE . . . . . . . . : (650)494-8166 FEE ID UNIT QUANTITY I,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPERMFEE VALUATION 4, 000 .00 104 . 76 0.00 104 .76 0. 00 BSEISMICRE VALUATION 4, 000 .00 0. 50 0 .00 0 .50 0. 00 BUSLIC FLAT RATE 1 .00 107. 00 0.00 107 . 00 0. 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 212 .26 0 .00 212 .26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 212 .26 9058 --------------- TOTAL RECEIPT 212 .26 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 e to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be applietI without first obtaining all inspection and written approval from the buildin€;inspector. A final inspection and approval shall be obtained from the bu..lding 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 vlspection 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: �.� Job Site Address: _ (� 1 .s Q✓"TA-y Roofing Company Name: ' Applicant's Sign Date: Greg Casteel Building Official Revised 11/2/04 CITY OF ( UPERTINO _ -S-V REROOF CUPERTINO PERMIT APPLICATION FORM Date: APN# 0 �� 0 / J / & Buil 'ng Addy ss: Owner's Name: Phone#: Contractor: License 2Q / ZOO • A-6 Contact: r Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ,9''^Asphalt Shingles $Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report#J/ ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cupertino's Tear Off Policy: ❑ Job Description: I/ Co K /e�oe D / J '(CoU t. Residential e;a-, Commercial ❑ ��0 n ��R C Fire Zone: Yes ❑ No Eq�—_ Confirmed with Planning Dept. if there are any restrictions: U Cost of Project: Type of Construi;tion: Occuqa}cy roup: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE 13ldg 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 Telephone(408)777-3228 CITY OF Fax(408)777-3333 -UPEkTINO Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: x-, PHONf #&z-b Z —p GENERAL CONTRACTOR: ta--vocU '&e4, FAX 7- S I am not using any subcontractors: q, 16-0 777 Signature Date Please check applicable subcontractors and co m Tete 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 / L-1&- O-7 er/Contractor Signature Date