07100165C�
CITE' OF CUPER'1'L
BUILDING DIVISION
BUILDING ADDRESS:
ER'S NAME:
ARCHITECT/ENGINEER:
PERMIT
LICENSED CONTKALAUKJ stet-L^M— —11
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code. and my license is
in full force and efffc , 5 (o Zy 1
License Class L7 Lic• ri
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
following reason. (Section 703 1.5, Business and Professions Cc&: Any city or county
which requires a permit to construct. alter. improve, demolish, or repair any structure
prior to its issuance, also requires the applicant for such permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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
not more than five hundred dollars ($500).
0 1, as owner of the property, or my employees with wages as their sots compensation,
will do the work. and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law docs not apply to an owner of
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.).
[11. 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.
cense Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
0 I am exem nder See B & P C for this reason
X_ Date 10-431-04
WORKER'S C PENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
O
] I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
ation, as provided for by Section 3700 of the Labor Code. for the performance of the
work for which this permit is issued.
] 1 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 Worker's Compensation Insurance carrier and Policy number are:
Cartier. �7 C (4 ff— r—V rV 16 Polity No.: O COP — Ott 5'5��—
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100)
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any (nanncr so u co c ylbject to the Workers' Compensation
Laws of CaliforpSa all
Applicant
NOTICE TO A LICANT-. If. after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name
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, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
ISOURRUL TIONfApplicant/ raractor Date
H ARDOUS MATERIALS DISCLOSURE
1 the applicant or future building occupant store or handle hazardous material
'^fined by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
Section 25532(a)?
0 Yes IV No
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
0 Yes 9No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Codc, Sections 25505, 25533 and 25534.1 understand that if the building
does , currently have a tenant, that it is my responsibility to notify the occupant of the
r=;
l l v hwh must be met odor to issuance of a Ccrtificalc of Occupancy.
Owner 1, authorized 'agerf Date
Job Description
RE -ROOF - BONETTI CONSTRUCTION PD BSL 10-23-07
a. Ft. Floor Area
32624034:.00
Issued by:
Re -roofs
Valuation
Occupancy Type
Required Inspections
Type of Roof
All roofs .,hall be inspected prior to any roofing material being installed.
If a roof i, installed without first obtaining an inspection, I agree to remove
all new m iterials for inspection.
of A cant Date All roof coverings to be Class "B" or better
01100 (05 -
CITY OF CUPERTINO
RE ROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # 32-(oV
�� 4 Y O 0
Bldg Permit Fees
Date:
lfj
Energy
BUILDING
Building Address:
Seismic Fee Res
�. 1011,5 E M
- cop-
Owner's Name:
BUILDING
Phone #:
o 6 aT6 o aJF—
BUILDING
SO q68 4
Contractor:
BUILDING
License #.
L3 G r n)sTrz.v` /3
Contact:
Cupertino Business License #:
206641_ 150tir—Tri _ir_ (10g3Cg—
Type o
;oof Covering:
Existing:
Proposed:
❑ Built -Up Roof
;k Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify) tAi2 44 Jr-I%A6 L,
❑ Other (Specify)
Number of existing coverings i
❑ Provide I.C.B.O. Report #
,2� To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With CL
ertino's Tear Off Policy:
Job Description:
PF 2noF-
Residential X Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cgst of Project: Type of Construction:
Occupancy group:
o Un
Qty. if
Annlicahle
Fee ID
Fee Description
Fee Group
�--- BPERMFEE
Bldg Permit Fees
BUILDING
-�� BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
✓ BUSLIC
Business License
BUILDING
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building Department
Subject: Re -roofing policy for the City 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 applied without first obtaining all inspection
and written approval from the building; inspector. A final inspection and
approval shall be obtained from the bu.lding 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 approval.
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 first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection 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 minimum 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 -he job site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
Homeowner's Name: (0 tsC-YL - 6 D N rr
Job Site Address: J 0 Ii 61 0 rL.. 10 1 q _ Ht P I ►e E
Roofing Company Nan
Applicant's Signature:
Greg Casteel
Building Official
0 0 ct)ST.
=&' Jt-- Date: 10-2 3- b +-
Revised 11/2/04
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building ]Department
REROOF TEAR OFF POLICY
1. You must schedule an inspecti:)n for the tear off the day before
you wish the inspection to be made. The procedure is to call the
Building Division (408) 777-32:18 between the hours of 7:30 a.m. and
3:30 p.m. to request a next -day inspection.
2. When the roof is torn off, the nails have been removed or driven in,
and all of the dry -rotted wood has been replaced, you must call the
City Building Division. An inspector will be there within one hour.
There are special hours for this service: from 7:30 a.m. to 10:30 a.m.
and 1:00p.m. to 3:30 p.m., Monday through Thursday and from
7:30 a.m. to 10:30 a.m. and 1:00 p.m. to 2:30 p.m. on Friday. (Note:
Building inspectors are on lunch break from 11:30 a.m. to 12:30 p.m.
and will not be called during that time. City Hall is closed between
12:00 and 1:00 p.m. daily.)
3. If you call for a tear -off inspection 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.
Greg Casteel
Building Official
Revised 8/13/04
3 ITEMS OF 3
CITY OF CUPERTINO
PERMIP RECEIPT
Sec: Twp: Rng: Sub: Bl{: Lot:
APN ......... 32524034.00
DATE ISSUED.......: 10/23/2007
RECEIPT #.......... BSDO0003060
REFERENCE ID # ...: 07100165
SITE ADDRESS .....: 10169 EMPIRE AVE
SUBDIVISION ......
CITY .............. CUPERTINO
IMPACT AREA ......
OPERATOR: patg
COPY # : 1
OWNER ............: BONETTI BARBARA M AND ROBERT J
ADDRESS ..........: 303 CAMILLE CT
CITY/STATE/ZIP ...: MOJNTAIN VIEW CA, 94040-2620
RECEIVED FROM ....: BOAETTI CONSTRUCTN
CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS ..........
CITY/STATE/ZIP ...: ,
TELEPHONE ........
FEE ID UNIT
QUANTITY
AMOUNT PD -TO
-DT
THIS REC
NEW BAL
---------- -------------
BPERMFEE VALUATION
--------------------
5,000.00
----------
115.56
0.00
----------
115.56
----------
0.00
BSEISMICRE VALUATION
5,000.00
0.50
0.00
0.50
0.00
BUSLIC FLAT RATE
1.00
107:00
0.00
107.00
0.00
TOTAL PERMIT
----------
----------
223.06
0.00
----------
223.06
----------
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
NUMBER
----------------- ---------------
CHECK
223.06
--------------------
#10638
---------------
TOTAL RECEIPT
223.06