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07100093 � CIT�,OF CUPERTINO " ' 7�,� BU[LQ[NG Drt')SION PERMIT �� : .:: .._ .:: PERMIT NO. BUILD �D��ESN BLANEY AVE TBD — T() BE DETERMINED 0 710 0 0 9 3 � PERMIT LSSUE DATE OW NER'S NAME: , JON CROCKETT 10 11 2007 SANITARY NO. CONTROL NO. NE: BUILDING PERMIT (NFO ARCH]TECT/ENGINEER: BLDG ELECT PLUMB MECH � � � U i p � LICENSED CONTRACTOR'S DECLARA7'[ON JOb DeSCTIptIOTI : v r,:. I hcreby affirtn that I am licenscd undcr provisions oC Chaptcr 9(commcncing ;Z� withScction7000)afDivision3ofiheBusincssandProfcssiunsCodc RE—ROOF PITCH ROOF APPX 3 � SQ 1/ 2" CDX W/ 3 � FELT � �� y in full foree and eftecL•-' ��? Licensc CI : ��. x _ C LA S S B. ; f � p Convaclor � ARCHITECI'S DECLARATION j a a 1 undcrstand my plans shall be uscd as public rcconls )aU ' u. y Licensed Pmfessianal : � < OWNER-BUILDER DECLARATION � �� 1 hcrcAy alTirm Ihat 1 am cxcmpt trom ihc Convactor's Liccnsc Law far �hc p o Collowing suon. (Scction 7031.5, Busincss and Profcscions Ca1c: Any city or coun�y �°� �i which rcquires a pcimit co conswct, al�cr, improvc, dcmolish, or rep�ir any structure �" N prior w i�s issuancc, alsu rcquires ihc applicant for such pertnit to filc a signcd sta�mcnt i, Valuation �?< that he is IiccnscJ pursuant to thc provisions of thc Contracu�t's Liccnsc Law (Chaptcr 9 .� Ft. Floor Area ,� t �(commencing wiih Section 7000) of Division 3 of ihe Business and Professions Cade) or � 1 � � � � L�� that he is ezempt thcrefrom and the basis for the allcgcd ezemption. Any violation o[ Section 7031.5 by arty applicant (or a petmit subjccu the applicant to a civil pcnalty o( /� Number Oceupancy Type not more than fiw hundrcd dollars (SSUO)• 3 1 6 3 � 1 � 3. V� ❑ I, as owner of tt�e propccty, or my employces with wages az We'v salc compensadon, wil! do �hc work snd t6e structucc is not intendcd or of[ered forsalc (Sec.7044. Business Required Inspeetions and Professions Cade: The Canuactor's License Law does not apply �o an owner of propeny who builds ot impravet Uurcon, and who daes such wort himself or through his own employees, provided that such improvements are not imended ar offeced for sala If. however, �he buildiag or impcovement is sold within one year o[ completion, �he owner- builder witl have the burden oC proving diat he did not build or improvc for purpose of sa�J. ❑ I, as awner of the propeny. am ezclusively convacting with licensed convutors W constnut the projen (Scc. 7044. Business and Professions Code:) The Contracmr's Li- cense Iaw docs not apply �o an owncr of propeny who builds ar improves Uumon, and , who convacu Cor suc6 projec�s wi�h a conuactor(s) licensed pursuant to Uu Convactafs License Law. 0 1 am ezemPt undu Sec . B& P C for ihis reasan Ownu Date _ . - WORKER'S COMPENSATION DECLARATION 1 hercby affirm under penalty ot pc�jury nne of the folbwing declaruions: �.�e and will main�sin a Cutifiwtc of Consent to se!(-insurc tor Workcr's Compen- satwn, as provided for by Section 3700 of the Labor Code, for the pecfortnancc of the work for which this pertnit is issucd. ❑ I havc and will maintain Workcr's Compensation Insurance, as �cquired by Scction . 3700 aC Ne Labor Codc. Cor thc perfortnancc af �he work for which �his pertnit is issued. My Worke� Co nsation Insorance carricr and Policy nu ber aze: Carrier. ��:� ��d- po�, No.: i� CERTIFICA7'E OF EXEMPTION FROM WORKERS' COMPENSATION [NSURANCE (This section need no[ bc camplctcd if the permit is for onc hundrcd dollazs ($100) or Icss.) I ceniCy th.t in thc perfarmancc of thc work for which Ihis pertnit is issucd. I shall not employ any person in any manner so as to become mbject to �he Worlcers' Compensation Laws of Califomia Datc Applicant NOTICE'CO APPC.ICAM: If, af�cr making Uiis CcrtiGcate of Excmption, you should bccome subjcct to thc Workers Compcnsauon provisions af the Labor Codc, you muu � O forthwith comply with such provisions or this permit shall be dccmcd revokcd. z ' � CONSfRUCT10N LENDING AGENCY F i-�r ( hcreby a(tirtn ihat there is a construction Icnding agcncy Cor the perCurmanc:c ut . p� . ihc wurk Cur which this permit is issucd (Scc. 3097, Civ. CJ , k.l Q L.endcr's Namc a z C.cnder's Address V 0 I certi(y U�at 1 havc road this applieation and siam lhat thc a6ovc infocmauon is w � cortec�. 1 agrce �o comply with all city and county orelinances and state laws rclating �o rJ U bvildiag conswctian, and heceby authori�e reprcsenutives of �his city to enter upon the � W abovc-mcntioncd property for inspccuon pur�wses. a (Wc) agme to save, indcmnify and kecp harmless the Ci�y o( Cupertino against H � liabilitiu, judgmcn�s, costs and expenscs which may in any way acccuc agains� said City �+ U z in consequence oC thc granling o( Ihis permit. DSLO /, � ►� APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by � ll "�✓ 7 SO LATIONS. Re-roofs ``'�`''� Signat ApplicanUCon tor �a� T of R oof HAZARDOUS MATERIAI.S DISCLOSURE }�� Will ihe applicant or futwc building occupant store or handle ha•rardous material as dcfincd by Ihc Cupertino Municipal Codc. Ct�ap�cr 9.12, and the Hcalth and Safcty co� Section 25532(a)? All roofs �hall be inspecLed prior to any roofing material being installed. p Ycs 9� . Will the applicant or [uwrc building accupant use eyuipment or devices which If a roof i� installed without first obtaining an inspection, I agrze to remove cmii harardous air comaminants as dcGncd by the Bay Arca Air Quality Managcmrn� all new m aterials for inspection. District7 �,��/' ❑ Ycs L�}c�u � 1 havc rcad the hvardcws maicrials rcyuircmcn�t undcrChaptcr 6.95 of �hc Califor- f, nia Hcalth & Safcry Codc, Sccuong 25505, 25533 and 25534.1 undcrstand �hu iCthc building �� CJ (( �� docs not curtcntly havc a tcnan4 Ihat il is my responsibility to nouCy Uu occupam of Nc � m �nm�s�xme� � ;u��uorac�;r�a�ora�P��r. Signature ofApplicant ' Date � p �� All roof coverings to be Class "B" or better Owncr orG orizcd agcm ` _ o��n�q� CITY OF I�UPERTINO ��:" RE�tZO�F Cu��T��o PERMIT APPI,ICATION FORM APN # Date: � �-3 O� o oc� /0 0 Building Address: -�-1.. . o Owner's Name: Phone #: � � �. � — Con actor: � License #: � �✓� Contact: Cupertino Business License #: L 0 �i �..-c �� Type of R.00f Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles � Asphalt Shingles `�'�Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) 0 Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Und rstand and Will Com ly With Cupertino's Tear Off Policy: Job Description: j ��}'�rc� 3d S°�, %Z� C.l�X � 3d C Residential [� Commercial ❑ Fire Zone: Yes ❑ No [�, Conf'umed with Planning D�t. if there are any restrictions: LJ Cost of Project: «�pe of Constru�tion: Occupancy group: t t� oc�c.� � v,V —� Qty. if Applicable Fee ID Fee Description Fee Group BPER1Vg'EE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BLTILDING _ Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building l�epartment Subject: Re-roofing policy for the C;ity of Cupertino 1. Prior to permit issuance, you must agrE e to comply with 1997 UBC Standards and manufacturers specifications on re- roofing. 2. New roof coverings shall not be applieci without first obtauung all inspection and written approval from the buildin�; inspector. A final inspection and approval shall be obtained from the bulding 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 City, the following steps are required: 1) Pre-inspection and/or tear off apprc�val. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. __ _ 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without f irst obtaining an inspection, will require the removal of all new mat�rial down to the sheathing, so a proper City inspection can be perfc�rmed. 7. NOTE: If you call for a plywood nail nispection 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 m;nimum of 1 /4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on 1he job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: `�� l�, 1"6 C,��--�� Job Site Address: / D 5le � !U � ` �� Q "�� Roofing Company Name: (�(, � i�li�) Applicant's Signature: �- f� C�� f] Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO 3 ITEMS OF 3 PERMI'I' RECEIPT OPER.ATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk.: Lot: APN ... ...... 31E30108.00 DATE ISSUED.......: 10/11/2007 RECEIPT #.........: BSC00002965 REFERENCE ID # ...: 07�00093 SITE ADDRESS .....: 10_`64 N BLANEY AVE SUBDIVISION ....... CITY .............. CUF'ERTINO IMPACT AREA ....... OWNER ............. JOI`f CROCKETT ADDRESS ..........: 10_`�64 N BLANEY AVE CITY/STATE/ZIP ...: CU�'ERTINO CA, 95014-2455 RECEIVED FROM ....: CU:�TOM BLDG & DESIG CONTRACTOR .......: TBI) - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBI) - TO BE DETERMINED ADDRESS .......... CITY/STATE/ZIP ...: , TELEPHONE ......... FEE ID UNIT QUANTITY ��'IOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 10,000.00 169.56 0.00 169.56 0.00 BSEISMICRE VALUATION 10,000.00 1.00 0.00 1.00 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 ----------- ---------- ---------- ---------- TOTAL PERMIT : 277.56 0.00 277.56 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 277.56 #1362 --------------- TOTAL RECEIPT : 277.56 ��,` . Community Development 10300 Torre Avenue !�' �' Cupertino CA 95014 Telephone (408) 777-3228 C1TY OF Fax (408) 777-3333 �UPEI�TINO Buildi:n De artment JOB ADDRESS: fd,�(��f B�G.y��,� ��-�J �.. PERMIT # �� Q � OWNER'S NAME: �-b G 1�� PHONE # �2 —v3`7 GENERAL CONTRACTOR ' F # I am not using any subcontractors: `� �� d i;;n ture Da e Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIrTESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electri.cal 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 Owner/Co actor Signature Date