The URL can be used to link to this page

11010149 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10511 CYPRESS DR CONTRACTOR:KEITH ROOFING CO INC PERMIT NO: 11010149 OWNER'S NAME: BAMBERGER RICHARD J AND ROSE M 920 LINCOLN AVE DATE ISSUED:01/27/2011 VNER'S PHONE: 4082521710 SAN JOSE,CA 95126 PHONE NO:(408)295-8616 LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL EI License Class Lic.#.6-5-"-, RE-ROOF 28 SQ REMOVE SHAKE ROOF INSTAL 7?16 OSB CLASS A Contr for Date �7 I here y affir that I am licensed under the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: 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. Sq.Ft Floor Area: Valuation:$13000 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 APN Number:31630062.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIPIEMF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS 0F PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F AST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the 1— � granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all no nt ource regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: Si atur Date 117 7 All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. OWNER-BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(x)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with pertino Municipal Code,Chapte 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code ctio 25505, 53 and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authoriz agen - permit is issued. 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 Worker's Compensation laws of California. If,after making this certificate of exemption,I CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save l.emnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION s,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 31630062 . 00 DATE ISSUED. . . . . . . : 01/27/2011 RECEIPT # . . . . . . . . . : BS000012585 REFERENCE ID # . . . : 11010149 SITE ADDRESS . . . . . : 10511 CYPRESS DR SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : BAMBERGER RICHARD J AND ROSE M ADDRESS . . . . . . . . . . : 10511 CYPRESS DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2424 RECEIVED FROM . . . . : KEITH ROOFING CONTRACTOR . . . . . . . : BRIGHT, ROGER LIC # 21477 COMPANY . . . . . . . . . . : KEITH ROOFING CO INC ADDRESS . . . . . . . . . . : 920 LINCOLN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 TELEPHONE . . . . . . . . : (408) 295-8616 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 13, 000 . 00 1. 00 0 . 00 1. 00 0 .00 1BSEISMICR VALUATION 13, 000 . 00 1.30 0 . 00 1.30 0 . 00 1REROOFRES SQ FEET 28 . 00 364 . 00 0 .00 364 . 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 366 .30 0 . 00 366 .30 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 366 .30 visa --------------- TOTAL RECEIPT 366 .30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# j OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# O'A14-7 ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCC Y INSPECTION(S) WILL SCHEDULED UNTIL THE GENERAL CONTRACTOR AND A UB NTRACTORS HAVE OB NED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontracto s: / 7 Sig re Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass / Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock er/Contractor Signature Date TY OF CI'T'Y OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION APN# Date: If residential, is house an Eichler? Yes N If yes, needs planning approval. Building Address: 6)S"' 1 ' c, Owner's Name: ; �� ✓ Phone �_�, i f HOA: Yes ❑ No If yes, provide letter from HOA Contractor: \ f� Co T�e_ Phone #: /6 Fax /`7 Cupertino Business License #: 91 y Contractor license #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles t"sphalt 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 Mfg. Installation Specs. Job Description: Co oy 6In i'n�� o,2" S V01QSS Residential Commercial ❑ 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: ❑ applicable, include in plan set & the sheet index. Valuation: eoz> I Hav e , Understa and Will Compl ^With Cupertino's Tear-Off Policy: