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09070137 CITY OF CUPERTINO �e BUILDING DIVIFION PERMIT � ll. � �a� BUILDING ADDRESS: PERMIT NO. 10126 ] W OWNER'S NAME: PERMIT ISSUE DATE ON SA A CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH RE—ROOF TEAR OFF EXISTINGag D D D D uoc LICENSED CONTRACTOR'S DECLARATION ROOF AVD OSB SHEATHI)�Description U p I hereby affirm that I am licensed under provisions of Chapter 9(commencing Z W with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full fora and a tt.3 72 j�ZJ Lieenc (G.. Lie.N 3�, Dale Contrador ARCHITECT'S DEC RATION -r I understand my plans shall be used as public records me A. U O y Licensed Professional n N OWNER-BUILDER DECLARATION I 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 9 which requires a permit to construct.alter,improve,demolish,or repair any structure y Zr prior to its issuance,also requires the applicant for such permit to file a signed statement _< that he is licensed pursuant to the provisions of the Contractor's License Taw(Chapter 9 )Cl.Ft. Floor Area Valuation yt- (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 APN Number Occupancy Type not more than five hundred dollars(5500). ❑I,as owner of the pmperty,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 9 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 Taw. ❑1 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: ❑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 37 a Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number Carrier-. d!kdW Policy No.:-71A0 2 4S1y ERTIFICATE OF EXEMPTION 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,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 Workces Compensation provisions of the Labor Code,you must ,J O forthwith comply with such provisions or this permit shall be deemed revoked. Z" CONSTRUCTION LENDING AGENCY Fr uN+ 1 hereby affirm that there is a construction lending agency for the performance of tyithe work for which this permit is issued(Sec.3097,Civ.C.) 0 Lender's Name 04 0 z Lendees Address U C) 1 certify that I have read this application and state that the above information is Lt. corect.I agree to comply with all city and county ordinances and state laws relating to 0 V building construction,and hereby authorize representatives of this city to enter upon the Uabove-mentioned property for inspection purposes CL (We)agree to save,indemnify and keep harmless the City of Cupertino against 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 a'- APPLICANT UNDERST NDS AND WILL COMPLY WITH A L NON-POINT Issued by: / SOUR REGULAT70 Re-roofs of li t/Con tortate HAZARDOUS MATERIALS DISCLO RE 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 Cede,Section 25532(a)? All roofs,hall be inspected prior to any roofing material being installed. C]Yes Will the applicant or future building occupant use equipment or devices which If a roof i; 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 if spection. District? ❑Yes }!lo I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 505.25533 and 25534.1 understand that if the building does not c nEly have a tenant at it is my responsibility to notify the occupant of the requircm which must be me to of a Certificate of Occupancy. -S nature ) pl iea Date 0-.7.,authore ag Dae All roof coverings to be Class"�¢"or better CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35914045 . 00 DATE ISSUED. . . . . . . : 07/20/2009 RECEIPT 4. . . . . . . . . : BS000008217 REFERENCE ID # . . . : 09070137 SITE ADDRESS . . . . . : 10326 BONNY DR SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : LIPAAN PETER H AND CORINNE S ADDRESS . . . . . . . . . . : 10326 BONNY DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2908 RECEIVED FROM . . . . : SHADOWFAX ROOFING CONTRACTOR . . . . . . . : JERRY SHAFFER LIC # 27342 COMPANY . . . . . . . . . . : SHADOWFAX ROOFING ADDRESS . . . . . . . . . . : 1366 SANTA FE DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95118 TELEPHONE . . . . . . . . : (408) 265-2490 FEE ID UNIT QUANTITY AKOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 13, 500. 00 1.00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 13, 500. 00 1 .40 0 . 00 1 .40 0 . 00 1REROOFRES SQ FEET 28 . 00 364 .00 0 . 00 364 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 366 .40 0 . 00 366 .40 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 366 .40 MASTER CARD --------------- TOTAL RECEIPT 366 .40 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO RFROOF CUPEkTINO PERMIT APPLICATION APN # 51" /LI 6 ��✓UU Date: Building Address: ® 3z � Owner's Name: A��A A/' �1r1�� Phone #: HOA: Yes ❑ No If yes, provide leiter from HOA Contractor: Phone #: Q� �6.S-o►4�(� �5wwvzom-3i� ltexo I Fax #: Cupertino Business License #: Contractor License #: � Z Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles �4, Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: 0 Residen is!)Q Commercial Green Building:' ase complete relevant portion of the Confirmed with Planning Dept. if Gree ng Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet ind ex. Valuation: r� I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: a4 Si nature Revised 02/05/09 CITY OF CUPERTINO REF:OOF CITY OF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1 REROOFCOM Re-roof Commercial B 1 COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B �G 1REROOFRES Re-roof Re;;idential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissio:i Fee 1BSEISMICRE Seismic ReAdential B IREROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business Li;ense B V 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 agi ee 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 buildir g 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 Citi,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 nai.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/ 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: Job Site Address: Roofing Company Name: Applicant's Signature: Date: 777 O j� Greg Casteel Building Official Revised 07/30/08 Community Development 10300 Torre Avenue 7 Cupertino CA 95014 Telephone(408)777-3228 CITY OF �UPEI�TINO Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT# OWNER'S NAME: 1 ` PHONE # f6S V GENERAL CONTRACTOR: FAX # c I am not using any subcontractors: �Zd ° i;na a ate 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 ?0 16 Owner/ tractor ignature Ddte