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06100133 CITY OF CUPERTINO BUILDING DIVISION PERMIT BUILDING ADDRESS: INTEGRITY ROOFING PERMIT No. 0 610 013 3 10221 RnNNY DR PERMIT ISSUE DATE OWNER'S NAME: ELSA KRAMER SANITARY NO. CONTROL NO. NE: (408) 225-9263 ARCHT IECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH o 0p LICENSED CONTRACTOR'S DECLARATION Job Description U I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z with Section 7000)of Division 3 of the Business and rofessions Code,and my license is o in full force and effect -5REROOF- REMOVE EXISTING SHAKES DOWN TO SPACED License Cla�s Lld•# DateI/1`1 Contractor SHEATHING. SUPPLY AND INSTALL ASPHALT SHINGLES ARCHITECT'S DECLARATION 0< I understand my plans shall be used as public record, TO ROOF SURFACE. CLASS A >�U ,a Gy Licensed Professional H OWNER-BUILDER DECLARATION '> I hereby affirm that 1 am exempt from the Contractor's License Law for the 3 p O 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 r Z} priork)its issuance,also requires the applicant for such permit to file a signed statement =0 that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9 Sq.Ft.Floor Area Valuation I—$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $13532 IRE 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 APN Number Occupancy Type not more than five hundred dollars(5500). ❑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 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 docs 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 Seo. 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 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 Compensation sac nee carrier and Polity number are: I Carrier. i Policy No.:I '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 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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z, CONSTRUCTION LENDING AGENCY (�rA --. I hereby affirm that there is a construction lending agency for the performance of pC,> the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lenders Name Lender's Address U Q I certify that 1 have read this application and state that the above information is LL►. correct.1 agree to comply with all city and county ordinances and state laws relating to rJ U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. a (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 r" APPLICANT U ER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: - 4SOURREG OS. Re-roofs of A li an for Da ARDOUS ATERIALS DISCLOSURE Type of Roof Will the applicant or future ilding 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 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 materials for inspection. District? ❑Yes u I have mad 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 cure ve a tenant,that it is my responsibility to notify the occupant of the rcyui mens hick I be m prior to issuance of a Certificate of OceT"k— Signature of Applicant Date 1 {0All roof coverings to be Class"B"or better Ow r or authri Datc CITY OF CUPERTINO 1 in 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35912033 . 00 DATE ISSUED. . . . . . . : 10/18/2006 RECEIPT # . . . . . . . . . 36482 REFERENCE ID # . . . : 06100133 SITE ADDRESS . . . . . : 10221 BONNY DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER ELSA KRAMER ADDRESS . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : INTEGRITY ROOFING CONTRACTOR . . . . . . . : GREGORY E WILCOX LIC # 23816 COMPANY . . . . . . . . . . : INTEGRITY ROOFING ADDRESS . . . . . . . . . . : 1537 CASA DE PONSELLE CITY/STATE/ZIP . . . : SAN JOSE, CA 95118 TELEPHONE . . . . . . . . : (408) 225-9263 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - --- ----- - --- - ---- - - --- -- -------- --- ----- -- ---- ------ ---------- ---------- BPERMFEE VALUATION 14 , 000 . 00 212 . 76 0 . 00 212 . 76 0 . 00 BSEISMICRE VALUATION 14 , 000 . 00 1 . 40 0 . 00 1 .40 0 . 00 --- ----- -- ---- ------ --------- - ---------- TOTAL PERMIT 214 . 16 0 . 00 214 . 16 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - -- - - ---- - - ----- -- - - -------- -- --- ------------- CHECK 214 . 16 9219 TOTAL RECEIPT 214 . 16 w wi Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPERTINO Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # - G GENERAL CONTRACTOR 12-1oAjhlc FAX # I am not using any subcontra ors: L,11 )10(4 �'� �0�) 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 Owner/Contractor Signature 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) 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: r Job Site Address: Roofing Company Name: lvqLUV,4� I W_ P) V-L, Applicant's Signa re: Date: Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO oLO►od ►53 REROOF CUPEKTINO PERMIT APPLICATION FORM APN# 3501-12-0'-a3 Date: 1 1.7 Building Address: 10 :22J t3o 1 i i 1 CI{ C150 Owner's Name: p / Phone#: F 9C� 1001.1110 -C V_ x-106 . �Z, 16(c tip Contractor: 1 �� �1 License#:7j V_ OS S 7 Contact: C1, r , WtFcox _ Cup�i o Business License Type of Roof Covering: �� Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ® Asphalt Shingles ® Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings 1 ❑ Provide I.C.B.O.Report# 0 To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job escription: C-P ttc E C1 4"Aq Residential Nmmercial Fire Zone: Yes ❑ No Confirmed with Planning De t. if there are any restrictions: LJ Cost of Project:�, . Type of Construction: Occupancy group 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 BPLANC14K Plan Check Fee BUILDING BUSLIC Business License BUILDING