12110111CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7407 TIPTOE LN
CONTRACTOR: NEIGHBORS ROOFING
PERMIT NO: 12110111
AND GUTTERS
OWNER'S N.WIE: LAMPRECBT NANCY W ET AL
200 FORD RD STE 236
DATE ISSUED: 111192012
OWNER'S PIIONE: 4085693244
SAN.IOSE, CA 95138
PBONE NO: (408) 472 -3869
❑ • LICENSED CON TRACTOR'S DECLARA'T'ION
r (J ri
BUILDING PERAIIT INFO: BLDG ELECT PLUMB
License Class GT Lic, k S-o c s C�j
r ❑ Cl
DIECII RESIDENTIAL COM p1ERCtAL
� �
Contractor /Ye Yv x z L ate (-Ly -1 2—
1 hereb}'affirm that 1 am licensed under the provisions of Chapter 9
JOB DESCRIPTION: REMOVE EXISTING WOOD SHARE AND INSTALL NEW
(commencing with Section 7000) of Division 3 of the Business &- Professions
OSD AND
UNDERLAYMENT AND INSTALL NEW COMPOSITION ROOFING
Code and that my license is in full force and effect.
•
(3700 SQFT)
hereby offirm under penalty of perjury one of the follmving IN%o deela to lions:
I have and will maintain a certificate of consent to self- insure for Worker's
Compensation; 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 provided for by
Section 3700 of the Labor Code, for the performance of the work for which this
Sq. Ft Fluor Area:
Valuation: $17985
permit is issued.
APPI.IC, \KI' CERTIFICATION
ANN Number: 35928001.00
Occupancy Type:
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city and county ordinances and state Imes relating
to building construction, and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We) agree to save
indemnify and keep harmless the City of Cupertino against liabilities. judgments,
PERMIT EXPIRES IF WORK IS NOT STARTED
costs, and expenses'which may accrue against said City in consequence of the
granting of this permit. Additionally, the applicant undcrstands and will comply
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non -point source regulations per the Cupertino Municipal Code, Section
180 DAYS FROM LAST CALLED INSPECTION.
9.18. -
Signature �4 qe� ate -� 1 !�-
Issued by: i //✓ f�l //% �/7 Date:
❑ OWNER - BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Lax formic of
RE- ROOFS:
the follow i ng two reasons:
All roofs shall be inspected prior to any roofing material being installed. If a roof is
I, as owner of the property, or my employees'with wages as their sole compensation,
installed withottl first obtaining an inspection. I agree to remove all new materials for
will do the w6rk, and the structure is not intended or offered for sale (Sec.7044,
inspection.
Business & Professions Code)
at /�s� Date:
Signure
1, as owner of the property, am exclusively contracting with licensed contractors to
of pplirunt :
��
construct the project (Sec.7044, Business R Professions Code),
hereby affirm under penalty or perjuq• one of the following three
,%Lt. ROOF COVERINGS TO [IF, CLASS "A" OR IIE'1'1'ER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's
IIA %ARDOUS MATERIAI 4 DISCLOSURE
Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
I have read the hazardous materials requirements under Chapter 6.95 of the
1 have and will maintain Worker's Compensation Insurance, as provided for by
California Ilealth &- Safety Code. Sections 25505. 25533. and 25534. 1 will maintain
Section 3700o( the Labor Code, for the performance of the work for which this
unicipal Code, Chapter 9.12 and the Ilealth'
compliance with the Cupertino M &-
Safety Code. Section _553_(x) should I store or handle hazardous material. -
permit is issued.
Additiomdly should I use equipment or devices which emit hazardous air
I certify that in the performance of the work forwbich this permit is issued. I shall
contaminants as defined by the Bay Area Air Qmdity Management District 1 will
not employ any person in any manner sous to become subject to the Worker's
maintain compliance with the Cupertino Municipal Code. Chapter 9.12 and the
Compensation laws ofCalifomia. If, after making this certificate of exemption, I
Health &- Safety Code, Sections 25505, 25533, and 25534.
become subject to the Worker's Compensation provisions of the Labor Code, I must
forthwith comply with such provisions or this permit shall be deemed revoked.
O`' err o auth �ize a' C
�� 13nte:
APPLICANT CERTIFICATION
CONSTRUC`FION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct. I agree to comply with all city.and county ordinances and state laws relating
I hereby affirm that there is a construction lending agency for the performance of work's '
to building construction, and hereby authorize representatives of this city to enter
for which this permit is issued (Sec. 3097, Civ C.)
upon the abode mentioned property for inspection purposes. (We) agree to save
Lender's Name
indemnify and keep harmless the City of Cupertino against l iabilities, judgments,
costs, and expenses'which may accrue against said City in consequence of the
Lender's Address
granting of this permit. Additionally, the applicant understands and will comply
with all non -point source regulations per the Cupertino Municipal Code, Section
ARCIII'1'ECI "S DECLARA'T'ION
9.18.
I understand my plans shall be used ru public records.
Signature Date
Licensed Professional
ADDRESS: 7407 Tiptoe Lane
APN:
♦P.RR AI1'1''f \'PR:
CUPERTINO
RP #:
WALUATION:
Minnr 6uildina Permit I PLAN CHECK TYPE: Re -roof
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
(408) 777 -3228 • FAX (408).777 -3333 • buildinaCGdlcuoerlino.orD
X211 JI) i
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PROJECT ADDRESS
APN9
OWNER NAME y� PHONE
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STREET ADDRESS
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CITY, sTA ZIP FAX
Gv da co- of
CONTACT NAME
PHONE
E-MAIL
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STREET ADDRESS
CITY, STATE, ZIP
FAX
❑ OWNER ❑ OWNER ByyU,,IL��DERRL ❑ OWNERAGENf W CONIRAC 0R ❑ CONrRACrORAGENT ❑ ARCHITECT' ❑ ENGINEER ❑ DEVELOPER ❑ TENANT
CONTRALTO 'AME I�-"J L°ilr� .e Z.
LICENSENUMBER
LICENSE TYPE
BUS. LIC.a
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COMPANY NAA
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FAX
STREET ADDRES
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CITY, STATE, ZIP
SA S85�C¢- gSL38^
FHONE
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ARCHITECT/ENGBJEFR NAME
LICENSE NUMBER
BUS. LIC. a
COMPANY NAME
E -MAIL
FAX
STREET ADDRESS
CITY, STATE, ZIP
PHONE
USE OF R SFD or Duplex ❑ Multi - Fam
ROOF ARRA::
VALUAITION:
Corrunercial
C+
/zOo -S
O
STRUCTURE: ❑
EXISTINGROOFTYPE: ❑BUILT -UP ROOF ❑ASPHALTSHINGLES i4WOODSHAKES ❑WOODSSHTNGLES ❑ OTHER (SPECIFY)
RENIOVE/REPLACE DYES
IF NO.
PLYWOOD 0- ❑
PLYWD ,y050
PITCH:
ROOF
❑ N
/
a AYERS `
TCKNESS' ❑ '.
❑ Cox
' 1 2
CI-ASS A
PROPOSED ROOF TYPE: ❑ BUILT -UP ROOF GIASPHALT SHINGLES ❑ WOOD SHARES ❑ WOOD SHINGLES ❑ OTHER
IMES REPORT a
DFSCR @/VO` TION OF WORK: �/
J
/
l rw�
I ro v
By my signature below, I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to bull ing construction. I authorize representatives of Cupertino to enter the above-identified property for inspection purpose.
Signature ofApplicandAgenC G' Date:
SUPPLEMENTAL INFORMATION REQUIRED
_ OFFICE
USE ONLY
I'ud cueCK rYPE
ROUTING SLIP,
If building is associated with a Home Owners Association, provide letter
OVER- TIIF.0000 -r't;R
I111111)1N6' i N. RF V kw '
_
of approval from 110A.
_ Provide Planning approval to verify if there any restrictions.
!J F_\PRkSS
:6-PLASSI \C PLAN REV_IE:
_ Provide copy of Manufacturer's Installation Specifications.
O STANDARD
❑ F•IRE Derr • '
- 1
Provide signed copy of Cupertino's Tear-Off Policy.
❑ orur.R:. : J
ReroojApp_201 Ldoc revised 03116111