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06100189 CITY OF CUPERTINO �t BUILDING DIVISION GTRACTQR PERMIT RMTI�N� ` BUILDING ADDRESS: PLATINUM ROOFING INC PERMIT NO-06100189 10261 BUBB RD OWNER'S NAME: PERMTr ISSUE DATE GEORGE QUINN 2943 DAYLIGHT WAY 10/26/2006 JNE: SANITARY NO. CONTROL NO. (408) 280-5028 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH (r� 0 0 (� 1 O p LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing 2 Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is >>y in fu 11foreeandcftm2 3G REROOF- TEAR OFF EXISTING AND INSTALL NEW j ? License CI s Lic.# I'm Date contractor ELK 30 YR 1/2" PLYWOOD, CLASS A ARCHITECTS DECLA ATION ,a U 1 understand my plans shall be used as public records O in Licensed Professional y OWNER-BUILDER DECLARATION a I hereby affirm that 1 am exempt from the Contractor's License Law for the 00 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 Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valu 1blffi)19 7 =0 that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area I–$ (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 any applicant for a permit subjects the applicant to a civil penalty of �yN Number Occupancy Type not more than five hundred dollars($500). 3 /20008 . 00 ❑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 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 exempt under Sec. B&P C for this reason OwnerDate WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: L]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)Compensation Insurance _carrier and Policy 7=6 m ran Carriers �� lt�ua,� .Polk.....:, f 6/C/ CERTIFICATE F EXEMPrlON 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,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 ,J O forthwith comply with such provisions or this permit shall be deemed revoked. z 2 CONSTRUCTION LENDING AGENCY Er tom. I hereby affirm that there is a construction lending agency for the performance of G!, > the work for which this permit is issued(See.3097,Civ.C.) w Q Lender's Name Z Lender's Address U 0 1 certify that I have read this application and state that the above information is LL.r— correct.I agree to comply with all city and county ordinances and state laws relating to C building construction,and hereby authorize representatives of this city to enter upon the U above-mentioned property for inspection purposes. a (We)agree to save,indemnify and keep harmless the City of Cupertino against t� liabilities,judgments,costs and expenses which may in any way accrue against said City U 2 in consequence of the gran. g of this permit. Date e lir P' APPLICANT UND R A S AND WILL COMPLY WITH ALL NON-POINT Issued by: I'd SOURCE REGUL O 2&_` k' Re-roofs Signature ofApplic tractor Date ARDOUS MATERIALS DISCLOSURE Type of Roof Will the appHe t or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Cede,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 Area Air Quality Management all new materials for inspection. District? 1 ❑Yes C3 No J r I have read the hazardous materials requirements under Chapter 6.95 of the Califor- niaHealth&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building 4 l/+ does not currently have a tenant,that it is my responsibility to notify the occupant of the requi5nta whish must be n nor to issuance a Certificate of Occupancy. S ignatur Applicant ate All roof coverings to be Class"B"or better Owner authorized agent Dace CITY OF CUPERTINO 2m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35720008 . 00 DATE ISSUED. . . . . . . : 10/26/2006 RECEIPT # . . . . . . . • • : 36576 REFERENCE ID # . . . : 06100189 SITE ADDRESS . . . . . : 10261 BUBB RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GEORGE QUINN ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : PLATINUM ROOFING CONTRACTOR . . . . . . . : ERIC MITCHELL LIC # 22805 COMPANY . . . . . . . . . . : PLATINUM ROOFING INC ADDRESS . . . . . . . . . . : 2943 DAYLIGHT WAY CITY/STATE/ZIP . . . : SAN JOSE, CA 95111 TELEPHONE . . . . . . . . : (408) 280-5028 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - - - - -- - - - - - - - ---- - - ---- - --------- ---------- ---------- - ----- ----- - --- ------ BPERMFEE VALUATION 26, 000 . 00 332 . 64 0 . 00 332 . 64 0 . 00 BSEISMICOM VALUATION 26, 000 . 00 5 . 46 0 . 00 5 . 46 0 . 00 ---- ------ -------- -- --- ----- -- --- --- -- -- TOTAL PERMIT 338 . 10 0 . 00 338 . 10 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER - - - - - - -- - - - ---- - - - - ------- - -- ----- ----- - ------- CHECK 338 . 10 17209 TOTAL RECEIPT 338 . 10 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 UwDo � --� CITY OF CUPERTINO CCG - REIZOOF CUPEkTINO PERMIT APPLICATION FORM APN# Date: Q� 2 �• �� Building Address: Owner's Name: Phone#: `13 �� 2 Contractor: ! j License#: Contact:/ HCl Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑/Wood Shakes ❑ Wood Shakes 0 Wood Shingles 14 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: ❑ Joh Description: le 66 yr Residential ❑ Commercial Fire Zone: Yes ❑ No Confirmed with Planning Deft. if there are any restrictions: LJ Cost of Project: Tc of Construction: Occupancygroup: S ` k3 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