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09070090 CIT','OF CUPERTINO BUILDIN6'.IVISION PERMIT BUILDING ADDRESS: PERMIT NO. 10345 FARALLONE DR M C ROO=FING 09070090 ^WNER'S NAME: PERMIT ISSUE DATE vagi-IND �Q��aTZ„ �pJ ,rtONE: SXl4rdA8.2CONTROL NO. (408) 723-3436 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a O p LICENSED CONTRACTOR'S DECLARATION Job Description m C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing Z(5 with Section 7000)of Division 3 of the Business and Professions Code.and my license is ;a y in run force and ecL RE—ROOF TEAR OFF SHAKES, INSTALL 7/16 INSTALL Llcenao C7as Lie.# Date ARCHITECTS RA m< I understand my plans shall be used as public rcc TECH S H L ELD WITH 3 0 LB 50 —PRESIDENTIAL SHAKE woyLicensed Professional COMPOSITION SHINGLES. CLASS A 22 SQUARES yOWNER-BUILDER DECLARATION I hereby alTirm that 1 am exempt from the Contractor's License Law for the C in O following reason.(Section 703 1.5,Business and Professions Code:Any city or county <m 9 which requires a permit to construct.alter.improve,demolish,or repair any structure y Z y prior to its issuance,also requires the applicant for such permit to file a signed statement F_C that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area Valuation yh$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 8 9 O 0 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). 36931013 . 00 ❑I,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 Conuactoes 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.). ❑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- ccnse Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractors)licensed pursuant to the Contractor's License Law. ❑1 am exempt under Sec. B&P C for this reason ^wnerDate 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 fo ich this permit is issued. have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worlu:Z ore natio asursnc carrier and Policy number arc: Carrier Policy No.: CERTIFICATE OF CEMP ION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for ane hundred dollars($100) or less) I certify that in the performance of the work for which this permit is issued.1 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 provision or this permit shall be deemed revoked. Z~ CONSTRUCTION LENDING AGENCY F~-r I hereby affirm that there is a construction lending agency for the performance of . (1! the work for which this permit is issued(Sec.3097,Civ.C.) W 0 L.endces Name Z Lender's Address U 0 I certify that 1 have read this application and state that the above information is VJ ►' cor ecL 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 W above-mentioned property for inspection purposes LL (We)agree to save,indemnify and keep harmless the City of Cupertino against c�rl liabilities,judgments,costs and expenses which may in any way acme against said City U Z in consequence of the granting of this permit. Date �. APPLICANT UND TAND AND MPLY WITH ALL NON-POINT Issued by: SOURCE G ONS. 1 r /Vd Re-roofs Signature oficant/Con Date HAZARDOUS MATERIALS DISCLOSURE Type of R)of 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,hall be inspected prior to any roofing material being installed. ❑Yes ONO 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 m.iterials for inspection. District? ❑Yes ONO I have mad the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safcty Codc,Section 25505,25533 and 25534.1 understand that if the building docs not currently have a anL that tt is bili to 0 f Utc occupant of the requircmcnts w 'h m met prior of a a f Occupancy. Signature � pl leant Date r morin gent Date All roof coverings to be Class'A:I'or better Community Development as 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: i PHONE # L GENERAL CONTRACTOR: C FAX # �Zl - I am not using any subcontractors: D Si;nature 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 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 36931015 . 00 DATE ISSUED. . . . . . . : 07/08/2009 RECEIPT #. . . . . . . . . : BS000008157 REFERENCE ID # . . . 09070090 SITE ADDRESS . . . . . : 10345 FARALLONE DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER YAEUHO MIYAKAWA ADDRESS . . . . . . . . . . : 10345 FARALLONE DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : MIGUEL CASTILLO CONTRACTOR . . . . . . . : MICUEL CASTILLO LIC # 24741 COMPANY M C ROOFING ADDRESS 14E00 MCVAY AVE CITY/STATE/ZIP . . . : SAr JOSE, CA 95127 TELEPHONE . . . . . . . . : (4C8) 729-3436 FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 900. 00 1 . 00 0 . 00 1. 00 0 . 00 1BSEISMICR VALUATION 8, 900 . 00 0 . 90 0 .00 0. 90 0 .00 1REROOFRES SQ FEET 22 . 00 286 . 00 0 .00 286. 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 287 .90 0 . 00 287. 90 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 287 . 90 visa --------------- TOTAL RECEIPT 287. 90 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 CUPEkTINO PERMIT APPLICATION DSD loft APN # 3 U/5 do Date: 7 lk-lc,:�! 9 Building dress: I [C) r ) e Owner's Name: + ,� Phone #: ,t�i�f�.-0__3 CZ�' HOA: Yes ❑ No [R-'If es, provide leiter from HOA Contractor: Phone #: C Fax #: -_393 -7 Cupertino Business License Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles ,- 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: T C v, �. }-} ,�)�t S i N �4 j/� T-r L 1-N /\\ C\ � �►1 3d �- � �C� YCS � r 1 S�� Kr Residential �" - Commercial Green Building: Please complete relevant pot tion 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: C-0 I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: 01 Signaturr/ Revised 02/05/09 a0l CITY OF ('UPERTINO REROOF CITY Of CUPEkTiNO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1 BCBSC Cal Bldg S tandards B ALL PERMIT TYPES Commissicn Fee 1 BSEISMICO Seismic Cc mmercial B 1 REROOFRES Re-roof Re 3idential B 1SFDWLROOF / 1 BCBSC Cal Bldg Si andards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Re3idential B 1 REROOFMRES Re-roof W lti-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1 BSEISMICRE Seismic Residential B 1 BUSLIC Business Li tense B