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09010006 CITY OF CUPERTINO BUILDING DIVISION PERMIT �CfiITRAC? � + } T3N.: BUILDING ADDRESS: PERMIT NO. 1 A PERMIT ISSUE DATE OWNER'S NAME: A A CONTROL NO. „i0 408 298-9399 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH u o p LICENSED CONTRACTOR'S DECLARATION Job Description U p I hereby affirm that I am licensed under provisions of Chapter 9(commencing Rm with Section 7000)of Division 3 of the Business and Professions Code.and my license is =y in full force and effect. 39 07 RE—RF RMV EXT SHK/SHNGL RFNG, INSTL 7/16. OSB RFRS j rn Z License Class LM•M f/ —,M pare r' Contractor SELCT FLT& LNDMRK PLUS SHNGLS BY CERTAINTD 22SQ g ARCHITECT'S DECLARATIO J e6 d I understand my plans shall be used as public records C L SA ryU U.y Licensed Professional A y OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the pO following mason.(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 prior to its issuance.also requires the applicant for such permit to file a signed statement Valuation x that he is licensed pursuant to the provisions of the Contractor's Liu:cnse Law(Chapter 9 Sq.Ft.Floor Area Y.t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 86600 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 APN Number Occupancy Type not mon:than five hundred dollars WWI. 36923041 . 00 ❑1,as owner of the property,or my employees with wages as their sole compensation, will do the work and the structure isnot intended oroffered 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.). ❑I,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 dt P C for this mason 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- .don,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 Workees 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 CompensattiN�on insurance carrier and Policy number r. � (� Carrier. lGUPolicy Nn 63 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100) or Icss.) 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 2CONSTRUCTION LENDING AGENCY HLn I hereby affirm that there is a construction lending agency for the performance of (Y. the work for which this permit is issued(Sec.3097,Civ.C.) W Q Lender's Name z Lcndees Address V 0 I certify that I have read this application and state that the above information is LL correct.I agree to comply with all city and county ordinances and state laws misting to 0 V building construction,and hereby authorize representatives of this city to enter upon the W above-mentioned property for inspection purposes CL (We)agree to save,indemnify and keep harmless the City of Cupertino against o..4 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 UND NDS AND WILL OMPLY WITH��03 OINT Issued by: Date r SOURCE REGU 0 Re-roofs �/ Signature of Applicant/Contractor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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 Cote,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. fi ❑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 it hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? Cl Yes ZN. 1 have mad the hazardous materials requirements under Chapter 6.95that if the Califor- nia C—r� /' �✓ !��Q / ria Health&Safety Code,Sections 25505.25533 and 75534.I understand that if the building does not currently have a tenant,that it is my responsibility to notify the occupant of the requirements whi issuance of a Certificate of Oc an Signature of Applicant Date All roof coverings to be Class" or better Owner or authorized agent Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36923041 . 00 DATE ISSUED. . . . . . . : 01/05/2009 RECEIPT # . . . . . . . . . . BS000006897 REFERENCE ID # . . . : 09010006 SITE ADDRESS . . . . . : 10865 W ESTATES DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PETER PALUZZI ADDRESS . . . . . . . . . . : 10865 W ESTATES DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4537 RECEIVED FROM . . . . : LOS GATOS ROOFING CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481 COMPANY LOS GATOS ROOFING ADDRESS P 0 BOX 1726 CITY/STATE/ZIP . . . : LOS GATOS, CA 95031 TELEPHONE . . . . . . . . : (408) 298-9399 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 6, 600 . 00 0 .70 0 . 00 0 . 70 0 . 00 1REROOFRES SQ FEET 22 . 00 286 . 00 0 . 00 286 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 286 . 70 0 . 00 286 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 286. 70 #2746 --------------- TOTAL RECEIPT 286 .70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION APN# Date: Buildin Address: Owner's Name: Phone#: jw-wln L Contractor: 6 G-'l L' J `1 Fax #: Cupertino Business License #: 3 -/ Contractor 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) `65 Number of existing coverings Z ❑ Provide I.C.B.O. Report# To be Removed Provide Mfgr. Installation Specs. <_-14 55 Jot Description: Reside tial Commercial ❑ Fire Zone: Yes ❑ No ® Confirmed with Planning Dept. if there are any restrictions: ❑ Valuation: Lr� 06 I Have Read, Understand and.Will Comply with Cupertino's Tear-Off Policy: Signa re CITY OF CUPERTINO _ REROOF CITY Of CUPEkTiNO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1RER06FCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 2 1RER00FRES Re-roof Residential B ISFDWLROOF 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF IBSEISMICRE Seismic Residential B 1BUSLIC Business License B 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 tated policy on r oofing. Homeowner's Name: Job Site Address: Roofing Company Name: I / c L 11.5 /i Cc.�`o c C/ Applicant' Gf Applicant's Signature: f�'i .��-'�) �i�'�`u' Z �'� � Date: L Greg Casteel Building Official Revised 11/2/04 ' Community Development 10300 Torre Avenue Cupertino CA 95014 _ Telephone(408) 777-3228 C(TYOF CUPER�TI�10 Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # AS& ��(000 , OWNER'S NAME: _ PHONE ` GENERAL CONTRACTOR: i - fes, FAX r I am not using any subcontractors: Signature D e Please check applicable subcontractors and complete the following-information: SUBCONTRACTOR BUSINESS NAME I 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 112lue Owner/Ctr ctor Signature Date