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09050041 CITY OF CUPERTINO BUILDING DIVISION PERMIT + �1 ' �► ► `TT �t � � � * BUILDING ADDRESS: PERMIT NO. 11784 RIDGE CREEK CT CAST-IL , q OWNER'S NAME: PERMrr ISSUE DATE -•,O9T AND SHIZUKA 4:703 02kTHAY E)R SAi�tAgNt.2 e 8 9 CONTROL NO. 408) 231-3565 ARCHPTECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a O p LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z m with Section 7000)of Division 3 of the Business and Professions Code,and my license is '.4y in full fortxandeIfec� 2� RE-RF 'P/0 EXTNG WDSHKS, INSTL #30LB FLT :INSTL j n? License Class Lic.K ✓ `�X' -o Date o1- contractor GAF/ELK GRND CANYN CMP CLS A 21SQ ul ARCHITECTS DECLARAA& -r I understand my plans shall he used as public records �yU O y Licensed Professional n rn OWNER-BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the p o following reason.(Section 7031.5,Business and Professions Code:Any city or county e$�Z 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 G shat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation yH (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $9500 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 more than rive hundred dollars(s500). 36604032 . 00 ❑1,as owner of the property.or my employees with wages as their sole compensation, will do the work,and the structumisnot intended oroffered for sale(Sec.7044,Business Required Inspections and Professions Code:The Conuacweii License Law does not apply to an owner of q P property who builds or improves thereon,and who does such wort 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 Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 'have and will maintain a Certificate of Consent to self-insure for Worker's Campen- .on,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 squired by Section 3700 of the Labor Code,for the performan ce of the work for which this permit is issued. My Workers Compensation Ica 'er and Policy number are: Cartier. S e nsurance PolicyNo.: 11-611102Y-19- CERTIFICATE 9311020-9CERTIFICATE OF E) MON FROM WORKERS' COMPENSATION INSURANCE (ibis section need not be completed if the permit is formic hundred dollars($100) or less) I certify that in the performance of the work for which this permit is issued,)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 Oforthwith comply with such provisions or this permit shall be deemed revoked. Z""' CONSTRUCTION LENDING AGENCY [�CA 4 I hereby affirm that there is a construction lending agency for the performance of �.c > the work for which this permit is issued(Sec.3097,Civ.C.) WGL Q Lenders Namc ]Z Lenders Address U O 1 certify that I have read this application and state that the above information is LL r-c corccL 1 agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorise representatives of this city to enter upon the W above-mentioned property for inspection purposes fy (We)agree to save,indemnify and kap harmless the City of Cupertino against y rA 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 r"'r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b SOURCE RgGULATIO �--J 5�,- -- / U Re-roof: Signature)if Applicam/Conuactor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof 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 `I.j'rvo 'ng occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove Will the applicant or future bei it hazardous air contaminants u fined by the Bay Area Air Quality Management all new materials for inspection. .trier? ❑Yes ❑No 1 have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&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 requirem wh' -lust be met pri r to issuance of a Certificate of Occup cy. Signature of Applicant Date ow r or authorized agent Dare All roof coverings to be Class'n or better 0 Uva I CITY OFCUPERTINO , RI`ROOF CUPEkTiNO PERMIT APPLICATION APN #� U �, 1 (� Date- (P ate: Building Address: `�f Owner's Name: �� Z� ��A (� �,5 , Phone#: HOA: Yes ❑ No ❑ If Yes, provide letter from HOA q q&. I ( t Contractor: Phone #: 3,5C�,5- C asff l (d S � �� , Fax #: Cupertino Business License #: Contractor License #: q,X `454�7 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles ul"Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings _ ❑ Provide I.C.C.E.S. Report# V To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: T �Q D-V -7eX 6 ( 66C � GcI�S. 41,'•' 7kl 3C�1.1 gromd cGn yon Con-z? Ca Residential Commercial Green Building: Please complete relevant pc rtion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the :application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: 01 rvy-).co I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signatthe Revised 02/05/09 CITY OF CUPERTINO REROOF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissic n Fee 1BSEISMICO Seismic Cc,mmercial B 2 ( IREROOFRES Re-roof Residential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Coni missic n Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissicn Fee 1BSEISMICRE 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 a;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 app lied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the wilding 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 ap]:)roval. 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 f�!e of$176.18. The re-inspection fee must be paid before another inspection c in 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 cn the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: 1 12,2 kl9 Job Site Address: K _ _-l' _£' �- Roofing Company Name: S Applicant's Signature: Date: S 1 0 Greg Casteel Building Official Revised 07/30/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ''UPEkTINO Building Department JOB ADDRESS:_ PERMIT # OWNER'S NAME: SI i i k W ' -w s.,p-e- PHONE # A5(-3,5-&S GENERAL CONTRACTOR: C «o` er FAX# 2- I I am not using any subcontra -Lk S gnature Date Please check applicable subcontractors and com Tete 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