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10040118 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 6394 COTTONWOOD CT CONTRACTOR:MAXIMUM ROOF CARE PERMIT NO: 10040118 CORP "NER'S NAME: CARLSON CARL W AND HELEN 1182 OLIVE BRANCH LN DATE ISSUED:04/19/2010 t,WNER'S PHONE: 4082574181 SAN JOSE,CA 95120 PHONE NO:(408)441-0933 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r— PLUMB r— License Classl^ 1 3�Lic.# ZO- yC� J MECH RESIDENTIAL COMMERCIAL r ( Contractor "4 e 1 I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF OVERLAY 30 YR GAF TIMERLINE SHINGLE (commencing with Section 7000)of Division 3 of the Business&Professions D3462 Code and that m license is in full force and effect. &30LB FELT OVER 3TAB COMP SHINGLES 1 LAYER CLASS Y A 22SQ**SEE NOTES** 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. 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 permit is issued. Sq.Ft Floor Area: Valuation:$6221 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36918011.00 Occupancy Type: 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 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 understands and will comply WITHIN 1 0 AVS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DA OM LAST CALLED INSPECTION. 9.18. 1 `—� ) )q c:_-�ature Date--«=e/ Issued by: r/ / Date: ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following 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 without first obtainin an inspec. n I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applicant: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Qo0e, ctions 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must Owner z n : J forthwith comply with such provisions or this permit shall be deemed revoked. f Date: "J APPLICANT CERTIFICATION CONSTRUCTION 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.) the above mentioned property for inspection purposes.(We)agree to save Lender's Name 1:.1ify and keep harmless the City of Cupertino against liabilities,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-p 'nt source re ulati ns per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION 9.18. jl I understand my plans shall be used as public records. Signature Date V Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36918011. 00 DATE ISSUED. . . . . . . : 04/19/2010 RECEIPT # . . . . . . . . . : BS000010216 REFERENCE ID # . . . : 10040118 SITE ADDRESS 6394 COTTONWOOD CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER CARLSON CARL W AND HELEN ADDRESS 6394 COTTONWOOD CT CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4620 RECEIVED FROM . . . . : STEVEN HUNTER CONTRACTOR . . . . . . . : STEVE HUNTER LIC # 22369 COMPANY MAXIMUM ROOF CARE CORP ADDRESS 1182 OLIVE BRANCH LN CITY/STATE/ZIP . . . : SAN JOSE, CA 95120 TELEPHONE . . . . . . . . : (408) 441-0933 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 221 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 6, 221 . 00 0 . 70 0 . 00 0 . 70 0 . 00 1REROOFRES SQ FEET 22 . 00 286 . 00 0 . 00 286 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 287 . 70 0 . 00 287 . 70 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION APN # Date: �` 1 Building Address: 1,o 3 Phone #: Owner's Name: �� C9�tr�S4� _I HOA: Yes ❑ No © If yes, provide letter from HOA Phone #: Contractor: CRS- U �.�tm� Fax#: g fo— 3 � `� X73 Contractor License #: Cupertino Business License#: j Z0S­ef�6 Type of Roof Covering: Existing: Proposed: ❑ Built-Up roof ❑ Built-Up Roof •K Asphalt Shingles Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Provide I.C.C.E.S. Report# Number of existing coverings ❑ ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: 0 Ucc CtL� d��. �� � ,�5 Commercial Residential Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the applicati or if there are any restrictions: a licable, include in plan set & the sheet index. Valuation: . I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINOLM Y REROOF CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1C0MMLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMIC0 Seismic Commercial B 1REROOFRES Re-roof Residential B 1SFDWLR00F 22- ' 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B Building Department lLiz City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# f f/ OWNER'S NAME: - PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# 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 OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBC NTRAC HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: Signature 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 Tile Owner/Contractor Signature Date