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06100173CITY OF CUFE3K11NV BUILDING DIVISION PERMIT BUILDING ADDRESS: 22687 VOSS AV OWNER'S NAME. VP SHENOY )NE: ARCHr'ECr/ENGINEER: Z LICENSED CONTRACTOR'S DECLARATION VC I hereby aCGrm that I am licensed under provisions of Chapter 9 (commencing U m with Section 7000) of Division 3 of the Business and Professions Code, and y license is v� ll Cd fy t c.zLicense Class p Date Contractor t m E(TS DECLARA 10 a < 1 understand my plans shall he used as public records yU iO y Licensed Professional < OWNER -BUILDER DECLARATION ly.m > 1 hereby affirm that 1 am exempt from the Contractor's License Law for the :0 O following reason. (Section 7031.5, Business and Professions Cod c: Any city or county e which requires a permit to construct, alter, improve, demolish, or repair any structure t Z � prior to - issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section t= 7000) of Division 3 of the Business and Professions Code) or e. 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 of 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 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. 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. B & P C for this reason ❑ 1 am exempt under Sea Date Owner WORKER'S COMPENSATIOI-- _ATION I hereby affirm under penalty of perjury one of the following declarations: R A CONSTRUCTION PERMIT N°. 06100173 PERMIT ISSUE DATE 559 CAMPBELL TECH PARKWAY 10/23/200-) SANITARY NO. CONTROL NO. (4 0 8) 3 6 9- 992 1 BUILDING PERMITINFO BLDG ELPLUMB MECH C� Job Description REROOF- COMP SHINGLES & TEAR OFF OSB CLASS A X25 SQUARES Valuation Sq. K. Floor Area $8995 AP N Number Occupancy Type Required Inspections ❑ 1 hsve and will maintain a Certificate of Consent to self-insum 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 Workers 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.: C R IFiCA OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (chis section need not he completed if the permit is for one hundred dollars (S 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 Z forthwith comply with such provisions or this permit shall be deemed revoked. Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) W Q Lender's Name IL Lcndees Address V I certify that I have read this application and state that the above information is fL F correct. I agree to comply with all city and county ordinances and state laws relating to O U building construction, and hereby authorize representatives of this city to enter upon the above-mcntioncd 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. APPLICANT UNDER ND WILL COMPLY WITH ALL NON -POINT SOURCE REGU (O 1 0 Signatu A cant/Contractor Date HAZARDOUS MATERIALS DISCLOSURE ill 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)? ` ` ❑Yes /fib Will the applicant or future building occupant use equipment or devices which emit hazardous air contaminants as defined by the Bay Arca Air Quality Management District? ❑ Yes voc 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health & SafctyCode, Sections 25505, 25533 and 25534.1 understand that if the building docs not currently have nant, that it is my responsibility to notify the occupant of the requirementswhi jn pt prior w issuan a Certificate of Occupancy. Date Issued by: _.' Re -roofs Type of Roof Date d 2_7 -,%� All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. nature of Applicant Date All roof coverings to be Class "B" or better CITY OF 7UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: � L,/_ �y� ��,,� �� / PERMIT # OWNER'S NAME: PHONE # 3 1 - GENERAL CONTRACTOR: FAX # I am not using any subcontractors: ignature Date PIPacP rhPrk annlicable subcontractors /d complete the following information: er/Contractor Signature Date 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 er/Contractor Signature Date CITY OF CUPERTINO ,m 1 of 1 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34215048.00 DATE ISSUED.......: 10/23/2006 RECEIPT #.........: 36539 REFERENCE ID # ...: 06100173 SITE ADDRESS .....: 22687 VOSS AV SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ....... OWNER VP SHENOY ADDRESS .......... CITY/STATE/ZIP OPERATOR: amyw COPY # : 2 RECEIVED FROM RACONSTRUCTIONRON LIC # 21382 CONTRACTOR ...... COMPANY ..........: R A CONSTRUCTION ADDRESS 559 CAMPBELL TECH PARKWAY CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (408)369-9921 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT ---------- THIS REC- -- NEW -BAL- ---------- BPERMFEE VALUATION BSEISMICRE VALUATION BUSLIC FLAT RATE ---------- 9,000.00 9,000.00 1.00 ---------- 158.76 0.90 105.00 0.00 0.00 0.00 158.76 0.90 105.00 0.0 0.00 ------0_00 TOTAL PERMIT 264.66 0.00 264.66 0.00 METHOD OF PAYMENT AMOUNT NUMBER _------------ --------------- CHECK 264.66 14458 TOTAL RECEIPT 264.66 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: Job Site Address: Roofing Company Name: / `—/--/ { Applicant's Signature: Date: Z42 -- Z, Greg Casteel Building Official Revised 11/2/04 coloclqs -,, CITY OF CUPERTINO (� REROOF CUPEkTINO PERMIT APPLICATION FORM APN #�_ �' ._-. of -i8 Bldg Permit Fees Date: 22:7% Building Address: Energy Owner's Name: BSEISMICRE Phone #:,311` Contractor: BSEISMICOM License #: BUILDING BPLANCHK Plan Check Fee Contact: BUSLIC Cupertino Business License #: _,.-,Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles X Asphalt Shingles 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 Cupertino's Tear Off Policy: ❑ Job Description: /ear Residential >Z Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Det. if there are any restrictions: lJ Cost of Project:Type of Construction: L Occupancy group: Qty. if Annlicable 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