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09030052 CITY OF CUPERTINO BUILDING DIVISION PERMIT ` ' PERMIT NO. BUILDING ADDRESS: 7552 SHADOWHILL LN LOS _2A ROO PERMIT ISSUE DATE OWNER'S NAME: SA CONTROL NO. SNE: BUILDING PERMIT INFO ARCHrrECTIENGINEER: BLDG ELECT PLUMB MECH RE—RF :SMV 2 EXT LYRS OF CMP D D O C7 upZ LICENSED CONTRACTOR'SDECLARATIO14 INSTL _.MFRS SELCT Job Description VI hereby affirm that I am licensed under provisions of Chapter 9(commencing 0 with Section 7000)of Division 3 of the Business and Professions Code.and my license is n H in full force and Cee o?0 7 z License ClLie Date Contractor I-o ARCHITECTS DECLARATION i i� 1 understand my plans shall be used as public records �,U Gy Licensed Professional rn OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the in O following reason.(Section 7031.5,Business and Professions Code:Any city or county K Pi which requires a permit to construct,alter,improve,demolish,or repair any structure rn prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 S(1 F-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or J11 .. 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 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 Required Inspections and Professions Code:The Contractor's License Law does 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 L- eone 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 Owner Date WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: have and will maintain a Certificate of Conscnt to self-insure for Worker's Compen- "tion,as provided for by Section 3700 of the Labor Code.for the performance of the work for which this permit is issued. ,kSave and will maintain Worker's Compensation Insurance,as required by Section 3f the Labor Code,for the performance of the work for which this permit is issued. Morkees tom on Itis ance carrier and Policy number arc: Cartier. 1 Policy No.:6 3 q 000o CERMCATE OF EXEMPTION FRO ORKERS' 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.I shall not employ any person in any manner so as to become subject to the Workers'Contpensadon 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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z Z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of p!.7 the work for which this permit is issued(Sec.3097,Civ.C.) W Q L.endces Name =Z Lender's Address U 0 I certify that I have read this application and state that the above information is LL cormcL I agree to comply with all city and county ordinances and state laws relating to V building convection,and hereby authorize representatives of this city to enter upon the 0 W above-mentioned property for inspection purposes. iL (We)agree to save,indemnify and keep harmless the City of Cupertino against DHy to) 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 ►-t APPLICANT UNDER AND WILL COMPLY WITH ALL NON-POINT Issued b is SOURCE REGULATIO 3bRe-roofs — Signature of ApplicAlCoraractor I cite HAZARDOUS MATERIALS DISCLOSURE Type of Zoof 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 roof.,;shall be inspected prior to any roofing material being installed. Yes �t' If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future building occupant use equipment or devices which L hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. strict? ❑Yesadtehaz Nu 1 have mate rials requirements under Chapter 6.95 of the Califor- nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that if the building does not currently a tenant,that it is my responsibility to notify the occupant of the requirements w be met prior to issuance of a Certificateof Occup ry. Signatur�of Applicant Date 'r 9All roof coverings to be Class';W'or better Owner or authorized agent ato CITY OF CUPERTINO RE ROOF CUPEkT1NO PERMIT APPLICATION APN # Date: Building Address: , Owner's me: Phone #: Contractor: d Phone #: Fax M Cupertino Business License M Contractor License M 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) -p� Other (Specify)30 Number of existing coverings ❑ Provide I.C.B.O. Report# ❑ To be Removed 11� Provide Mfgr. Installation Specs. S Z `. Job Des 'ptio/A-L _ � �%�,��✓�.� �h�v Y G�� bff sidential Commercial El Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicablej,nclude in plan set & the sheet ind,:x. Valuation: S � I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 6/16/08 CITY OF CIUPERTINO REROOF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee D'eseription Fee Permit Type Squares Group 1REROOFCOM Re-roof Corrmercial B 1COMMLROOF 1BSEISMICO Seismic Corunercial B 2� 1REROOFRES ' Re-roof Res-dential B 1SFDWLR00F 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B Revised 6/16/08 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 al-ree to comply with 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 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 pe:-formed. 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/ "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 wi a aboi a stated policy on re-roofing. Homeowner's Name: Job Site Address: �7�55 2 0 Roofing Company Name: S Applicant's Signature: '1 D te: /� r / Greg Casteel Building Official Revised 07/30/08 Community Development x 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 CUPERTINO Buildi-n- g Department JOS ADDRESS: PERMIT OWNER'S NAME: :Y �yy� PHONE % GENERAL CONTRACTOR: i . FAX r r lam not using any subcontractors: Sio nature at Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME I BUSINESS LICE SE Cabinets C'-7 Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamer4tal Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal (--Sheet Rock Tile Owner/Con actor Signature ate