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06100026 CITY OF CUPERTINO ?IZM BUILDING DIVISION PERMIT CONTINTT�N: BUILDING ADDRESS: A ROOFING PERMIT NO.0 61 0 0 0 2 6 10539 FARALLONE DR PERMIT ISSUE DATE OWNER'S NAME: FOOT KENNETH 5700 SHADOWBROOK WAY 10/04/2006 )NE: SANITARY NO. CONTROL NO. (408) 390-7016 BUILDING PERMIT INFO ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH !00 LICENSED CONTRACTOR'S DECLARATION Job Description m I hereby affirm that I am licensed under provisions of Chapter 9(commencing i� with Section 7000)of Division 3 of the Business and Professions Code,and my license is RE ROO F- TEAR OFF PLYWOOD ASPHALT SHINGLES, U., in full force and a fee Lic# r r r �? License Class 35 SQUARES CLASS A Date Contractor r LU a ARCHITECT'S DECLARATION Cd I understand my plans shall be used as public records )yU Cin Licensed Professional 0� OWNER-BUILDER DECLARATION < 1 hereby affirm that I am exempt from the Contractors License Law for the LOO following reason.(Section 7031.5,Business and Professions Code:Any city or county c which requires a permit to construct,alter,improve,demolish,or repair any structure i Z y prior it)its issuance,also requires the applicant for such permit to role a signed statement Valu 116 0 0 0 < that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area r II— (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or 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 APN NM!r 0 0 Occupancy Type not more than five hundred dollars(5500). 3 b "3 y9 NM 3 0 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 Contractors 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.U. 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. Q 1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby alum under penalty of perjury one of the following declarations: I]I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. 011 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 Workers Compensation Ins^ranee ca cr and Policy number are: Cartier: T�ti r: F� 00V Policy No.: b CERTIFICATE OF EXEMPTION FROM WO COMPENSATION INSURANCE (Ibis 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 Workcrs'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 Z forthwith comply with such provisions or this permit shall be deemed revoked. rZ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of (x^✓ the work for which this permit is issued(Sec.3097.Civ.C.) W ALender's Name 0Z Lcndees Address U 0 1 certify that T have read this application and state that the above information is II. correct.1 agree to comply with all city and county ordinances and state laws relating to 0U building construction,and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. ;_W (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 Applicant/Contracior Dare Type Of Roof HAZARDOUS MATERIALS DISCLOSURE 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 <o 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? ❑Yes '@fN. 1 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 (> does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements whh �"''st be met prior to issuance of a Certificate of Occupancy. Signature of Appl ieant Date ✓^4'' 1©q'06 All roof coverings to be Class"B or better Owner or authorized agent Date Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 C(TY OF Fax(408)777-3333 ':MkTINO Building Department JOB ADDRESS: 101539 Fgr6110()e r-- PERMIT #0-0 ( OWNER'S NAME: j- PHONE # 9' GENERAL CONTRACTOR: A V j C& OFT' FAX # not using any subcontractors:?& Signature Date 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: KC w 1-0c) t Job Site Address: 105 3'1 rc,( I o•. t C c� n S 0 L Roofing Company Name: A V,wf I�vt,�, ,►� c, Applicant's Signature: Date: Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36939033 . 00 DATE ISSUED. . . . . . . : 10/04/2006 RECEIPT # . . . . . . . . . : 36310 REFERENCE ID # . . . : 06100026 SITE ADDRESS . . . . . : 10539 FARALLONE DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : FOOT KENNETH ADDRESS . . . . . . . . . CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : A VIAT ROOFING CONTRACTOR . . . . . . . : TROY AVIAT LIC # 24838 0. p ROOFING ADDRESS . . . : 570OASHADOWBROOK WAY lOgO v v`'� CITY/STATE/ZIP . . . : FAIR OAKS, CA 95628-3043 C.N ' TELEPHONE . . . . . . . . : (408) 390-7016 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL - --- ------ ------- ----- - ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 16 , 000 . 00 234 , 36 0 . 00 234 . 36 0 . 00 BSEISMICRE VALUATION 16, 000 . 00 1 . 60 0 . 00 1 . 60 0 . 00 BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 340 . 96 0 . 00 340 . 96 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------- ------ ------------ ------ ------------ CHECK 340 . 96 0470 TOTAL RECEIPT 340 . 96 OW OG(f2tf CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN# Date: Building Address: 053e ,I I a 4, ti r Owner's Name: Phone#: Ec>o t- L109 7 62- Contractor: 2Contractor: License#: &2 q5 .2 8 Contact: Cupertino Business License #: -Fro y V, C. 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 ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: is Job Description: 7�!Jb Residential ® Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: If OL)o 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