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06100027 CITY OF CUPERTINO BUILDING DIVISION PERMITfi� ITRAT�iF }RMT�f�N BUILDING ADDRESS: Z AGEMENT LLCA PERMIT"°. 0 610 0 0 2 7 10299 MILLER AVE # 1 PERMIT ISSUE DATE OWNER'S NAME: ZSF MANAGEMENT LLCA 10/04/2006 SANITARY NO. CONTROL NO. )NE: BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 1 O p LICENSED CONTRACTOR'S DECLARATION Job Description V P I hereby affirm that I am licensed under provisions of Chapter 9(commencing Zw with Section Division3oftheBusiness and Professions Code.and mylicense is REROOF- TEAR OFF EXISTING AND REROOF WITH COMP �< .�V°•1 in full force andndefeffecect. z License Class Lic.# SHINGLES, CLASS A F tau Date Contractor ARCHITECTS DECLARATION a< 1 understand my plans shall be used as public records )yU O H Licensed Professional 0 3 OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the 00 following reason.(Section 7031.5,Business and Professions Code:Any city or county ii which requires a permit to construct,alter,improve,demolish,or repair any structure Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valll dnO 0 0 0 S Ft.Floor Area =Q that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 q Y F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or i 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 ppN N23 . 00 ber Occupancy Type not more than five hundred dollars($500). 3 6 914 V 2 3 . 0 0 ❑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 docs 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.It. 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 Contractor's License Law. ❑I am eze,,.ln t under Sec. Blj..P C f this asan Ow r pate WORKER'S CO ENS TION LARATION rcby affirm under pe of perjury one of the following declars ions: ❑I have and will maintain a Certificate of Consent to self-insure for Workees Compcn- 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 arc: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not becompleted 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 Applicant NOTICE APPLICANT:If.after aking this Cilitificaic of Ey9ptiW,you should become subject to the Worker's Co nation provisions of the Labor Code.you must 0 forthwith comply with such provision or this permit shall be deemed revoked. z . CONSTRUCTION LENDING AGENCY CA 4 1 hereby affirm that there is a construction lending agency for the performance of �i > the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name jz Lender's Address U 0 1 certify that I have read this application and state that the above information is LL 14 correct.I agree to comply with all city and county ordinances and state laws relating to O Ubuilding construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. >.nWi (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 V Z in consequence of the granting of this permit. Date APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SOURCE REGULATIONS. Re-roofs Signature of Applr ntractor Date ARDOUS MA ALS DISCLOSURE 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 No 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 No I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&SafctyCodc,Section 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 rcquiT c s hick must be met pri to issuance of a Cc_rtifocatc of Otcu ancy. Signature ofApplicant icant Date C ) o All roof coverings to be Class "B" or better Owner or authorized a nt I tc CITY OF CUPERTINO 2m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN 36914023 . 00 DATE ISSUED. . . . . . . : 10/04/2006 RECEIPT # . . . . . . . . . : 36313 REFERENCE ID # . . . : 06100027 SITE ADDRESS . . . . . : 10299 MILLER AVE # 1 SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER ZSF MANAGEMENT LLCA ADDRESS . . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : AUDRON FITCH CONTRACTOR . . . . . . . : LIC # *OWNER* COMPANY . . . . . . . . . . : ZSF MANAGEMENT LLCA ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , TELEPHONE . . . . . . . . . FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- - - ---- - - -- ----- ----- - ---------- --------- - ------ ---- ---------- -------- -- BPERMFEE VALUATION 10, 000 . 00 169 . 56 0 . 00 169 . 56 0 . 00 BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 ---------- ---------- ---------- ------- --- TOTAL PERMIT 170 . 56 0 . 00 170 . 56 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - ----- ------ ---- -- ---------- -------- ----- ----- CHECK 170 . 56 2649 TOTAL RECEIPT 170 . 56 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS 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: 1/te_W1 C�.C�''J ' 7� . Z_ Job Site Address: r/S C � c 1��'Awe Roofing Company Name: �fl All Applicant's Signature: .� Me-lfl Date:W4 ; ( Greg Casteel Building Official Revised 11/2/04 dc�� cx�oa� CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORM APN# Date: Z, Zz�,)o Building Address: /b 1i l JYIc!L � � -- �� Ct ,�� It�• ' e eA Owner's Name: Phone#- ; #: '' /21�t�n c`x t yyt Z/CSQ -- V U` S �Z 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 ❑ Wood Shingles ❑ Other(Specify) Other(Specify)ee,n 12cf5j Aeln Number of existing coverings ❑ Provide I.C.B.O. Report# .�O, To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: Job K-65De cription: r �v�. 7 P -- S f U' Re idential Co ercial ❑ -Un 1 t - � �� /d� with Planning Dyt. if Fire Zone: Yes ❑ No ❑ Confirmed g there are any restrictions: 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 BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING