06100112 CITY OF CUPERTINO �dlTktACTC)R IN }R # TI�N:
`SUILDINO DIVISION PERMIT
BUILDING ADDRESS: BRUCE MOYER PERMIT NO. 06100112
6003 BOLLIN PERMIT ISSUE DATE
OWNER'S NAME:
BRUCE MOYER
SANITARY NO, CONTROL NO.
NE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
ce 0 O LICENSED CONTRACTOR'S DECLARATION Job Description
UP: I 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
1'g I.- in full force and effect. EXISTING ROOF OVER SINGLE-FAMILY DWELLING
;4Z License Class Lic.#
;;"q Date Contractor
ARCHITECT'S DECLARATION
J,< I understand my plans shall be used as public records
1yV
'
U.y Licensed Professional
y OWNER-BUILDER DECLARATION
> I hereby affirm that I am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
%m 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 Valuation
Ft.Floor Area
-?< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq
I (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
R F 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 of1: 00 Occupancy Type
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 Required Inspections
and Professions Code:The Conuactor'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
sale.).
el.as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Conuictoes 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 exem under Sec. B&P C for this reason
Owner �"'C9 Date
WORKER'S COMPENSATION D Z! RATION
I hereby affirm under penalty of perjury one of the following declarations:
�J I have and will maintain a certificate of Consent to self-insure for Workces 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:
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 perso in any mann�ip tq�eIutlLect to the Workers'Compensation
Laws of Califo D
Applicant a
NOTICE TO APPLICANT:If,after making this o ption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
HFir I hereby affirm that there is a construction lending agency for the performance of
p!> the work for which this permit is issued(Sec.3097,Civ.C.)
Lt7 Q Lender's Name
p+ Lender's Address
Pz
1 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
0 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
U Z in consequence of the granting of this permit. Date
APPL ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
s4i��w
SO E REGULATIONS:
Re-roofs
sig ore o pplicant/Contractor Dare T Of Roof
HAZARDOUS MATERIALS DISCLOSURE Type
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(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes 3-140—
If a roof is installed without first obtaining an inspection,I agree to remove
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 all new materials for inspection.
District?
❑Yes Nu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.I understand that if the building
does not urently have a tenant,that it' my responsibility to notify the occupant of the
requi nts which must be met prior iss ancc oC a Certificate of OO/cc�cyy� Signature of Applicant Date
`;: l f - All roof coverings to be Class"B or better
Owner or authorized agent Date
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 approval.
2) In-progress inspection approval.
3) Final inspection approval. a
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 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: `_ Q_V-,
c—
Roofing Company Name: / �^
Applicant's Signature: 4:�::Ilme: "
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
3m 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 37538001 . 00
DATE ISSUED. . . . . . . : 10/16/2006
RECEIPT # . . . . . . . . . : 36442
REFERENCE ID # . . . : 06100112
SITE ADDRESS . . . . . : 6003 BOLLINGER RD
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BRUCE MOYER
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4629
RECEIVED FROM . . . . : BRUCE MOYER
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : BRUCE MOYER
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4629
TELEPHONE
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - --- - - - - - - - --- - - ------ --- ------- --- - --- --- ------- - -- ------- --- --------- -
BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00
BSEISMICRE VALUATION 5 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---- ------ ---------- ---------- ----------
TOTAL PERMIT 116 . 06 0 . 00 116 . 06 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - - - ---- - - ---- - - - ----- - ----- --- - --------------
CHECK 116 . 06 2332
TOTAL RECEIPT 116 . 06
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:3r75 -- 3 ? -od /0-1
Building Addr ess: � t�
Owner' ame: I S Phone#: f _
Contractor: , « License#:
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ' SI-►9.q ❑ Wood Shingles 1 ��
❑ Other(Specify) ��.�/` ( � ❑ Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O. Report#
tr--To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Descrip 'on: l�
r SX ice-. r�aSs u-'Lv '6� �. i c `
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning D�t. if
there are any restrictions:
Cost of Project: Type of Construction: Occupanc�j gr p:
Joh wig '`
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