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07100163 CITY OF CUPERTINO susa��N�n=��s�oiv PERMIT ����•�'Q������� ; ... .:. : : ,: ... . PERMIT NO. BUILDING AD�RESS: 7558 HEATHERWOOD DR FOUR BR()THERS ROOFING 07100163 • PERMTT ISSUE DATE .�ER'S NAME: , BUCKEL JOHN J AND ELIZABETH R 488 N 1'�TH ST 10 22 2007 SANITARY NO. CONTROL NO. PHONE: (408) 8�35-1299 BUILDING PERMITINFO ARCHITECT/ENGiNEER: BLDG ELECT PLUMB MECH � � � 0 i p p LICENSED CONTRACTOR'S DECLARATION IOI� DOSCilptl0❑ ; V� I hcreby affirm that I am liccnsed un�icr provisions oC Chaptcr 9(commencing ; Z� with Scction 7000) o( Division 3 of thc Busincss and ProCcssions Codc and my liccnsc is T EAR O F.' , I N S TAL L 1/ 2" C DX P LY , 15 L B F E LT � 4 � S Q �< d in full Coree and eCfec4 � i�z Licen ass_ ' L�.� � 3 �� PRESIDE]JTIAL� CLASS A p Datc — Conuactor : � � ARCHITECTS DECLARATION i� . � e I undcrswnd my plans shall bc uscd as public rccords )aU ' u. y Liccnscd Pn�fcssional : � a OWNER-BUILDER DECLARATION j a� 1 hcrcby al�rm �hat 1 am ezcmpt from thc CanUactors Liccnsc Law for thc . p O following rcuon. (Sccaon 7031.5. Busincss and Profcssions Calc: Any ciry ar couniy �,°, � which rcquires a pcnnit to conswct, altcr. improvc, dcmolish, or repair any swctucc �" y prior ni i1s issuancc, aisu rcquires ihc applican� Cor such permit to filc a signcd s�a�emcn� Valuation "? < that he is Iicensed pursuant ta �he provisions aC the Contractor's License Law (Chapter 9 3q. Ft. Floor Area $18 5 0 0 � t �(commencing with Section 7000) o( Division 3 0( ihe Business and Professions Cade) or ��� that he is ezempt theicfrom and the basis for the allegcd exemption. Any violauon o( SecUon 7031.5 by a�ry applicant tor a permit subjects �he applicant to a civil penalty of Number Oecupaney Type not more than fivc hundmd dollars (5500). 3 5 9 2 8 0 4��� ❑[, as owncr oC tt�e property. or my cmployces with wages az iheir solc compensation, wilido�hcwark,andlhest�ucweeisnotintendedorollered Required Inspections and Pro[essions Cade: The Conuactor's License Law does not appiy to sn awnu of property who builds or improves thereon, and who does such work himseif ar Uuough his own employces, providcd that such improvements are no[ imm�ded or ollered for sala If. however, the building or imp�ovement is sotd within onc year o[ complction, the owner- buildet will have tlx burde� oC proving �hat he did not build or improvc for purpose of sale.). ❑ I, as awner of the property. am exctusively contracting with licensed rnnuxtors w wnstruct Uu peoject (Sec. 7044. Business and Professions Code:) The Convacmr's Li- cense Law docs not apply �o an awner of propeny who builds or impraves �hemon, and . who conuacts far such projects wi�h a coniractor(s) licensed pursuant to �he Convactars [.icense Law. I am ezempt undu Sec. . B& P C for ihis rcason wner Da�e WORKER'S COMPENSAT[ON DECLARATION I hereby affirm under penalty of perjury one ot the following declarations: ❑[ h:ve and will maintain a CeniGcate of Consent to seif-insure for Workc�s Compen- sation, as providcd for by Sec[ion 3700 of ehe Labor Code, for the performancc at �hc work tor which Ihis pertnit is issued. ❑ I have and will maintain Wwkds Compensation Insurance, as icquired by Section • 3700 of ttic Labor Codc, fw �hc pertormance oC �he work for which �his permi� is issucd. My Workers Compensati Insurancc crier and Policy number arc: rk C � � 'r � Carrier. - 7�L7�.e 1( �`^ Poliry No.:� 1�S `���� CERTIFICATE OF EXEMP'I'[ON FROM WORKERS' COMPENSATION INSURANCE (This section necd not be completed if the pecmit is tor ane hundred dotlars (S 100) or Icss.) I cenify �h�t in thc pertormance of thc work for which �his permit is iscued, 1 shall not eenploy any person in any manner so as to become subject to �he Workers' Compensation Laws oC Califomia. Datc Applicant NOTICE TO APPLICAM: If, aftcr making this Ceniticatc of Ezcmption, you should bccome subjcct to thc Workcr's Compcnsation provisions of Uic Lalwr Cadc, you mus� � O forthwith comply with such provisions or this permi� shall Ec dccmcd revokcd. Z ""' CONSTRUCiION LENDING AGENCY [.�.� r�-. I hercby aRrtn that there is a conswcuon Icnding agcncy Cor thc performance uf �.� thc wurk fur which ihis permi� is issucd (Scc. 3097, Civ. C.) , W Q Lendcr's Namc � z L.endersAddress (� � 1 cenify �ha� I have rcad this applicauon and siate ihat Ihe ahove infocmatiun is � ►-� corrcct. I agree to comply with all city and county onlina�u:es and state Iaws relating �o � U building conswction, and hc�cby authori�e rcprescntativcs o( this city to cntcr u�n thc � W aAove-mcniiuned properry for inspecuon purposes. a (Wc) ag2e to save, indcmnify and kecp harmless ihc Ciry of Cuperuno against H � liabilities, judgmcn�s, cos�s and expenscs which may in any way accruc against said City U,'� in consequence of thc granting of Ihis permit. Date /' � APPLICANT UNDERSTANDS AND WILL COMPLY W1TH ALL NON-POINT ISSUCd by: v ZZ S EGU ATIONS. ,..+�--- � � ( C� �' Re-roofs % Sign�rc of ApplicanUContractor Datc `�/ HAZARDOUS MATERIALS DISCLOSURE Type of F.00f Wil! Ihc applicant or futurc building occupant storc or handlc ha•rardous matcrial Icfincd by thc Cupertino Municipal Codc. Chap�cr 9.12, and thc Hcalth and SaCcty ,a� Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. � �� If a roof �s installed without first obtaining an inspection, I agree to remove - Will the applicant or futurc building occupant use eyuipment or devices which cmi� harardous air contaminants u dcfincd by the Bay Arca Air QualitY Managcmcnt all new R iaterials for inspection. DisUict? ❑ Ycs [� 1 havc read the hvarCous matcrials reyuiremcn�s undcrChap�cr 6.95 of thc CaliCor- nia Hcal�h & Satcty Cadc, Scctions 25505, 25533 and 25534.1 undcrstv�d thu i( Urc building Jocs not currcntly havc a �cnan� Ihat il is my responsibility to noG(y Ure a:cupanl nf �lic « �swh' musi6cme�priortoissuan m�-ora�P��r. Signature ofApplicant Date ,-- r� ��� `� � All roof coverings to be Class "B" or better Owncr or authorizcd agcm �°� �J � � o�l � 3 CITY OF ��UPERTINO .:;..��.,-��`� RE:E�O�F CU�E�T1t�o PERMIT APPI,ICATION FORM APN # Date: � • , �v (C� � -� Building Address: �'7 SS `6 �c�ti�l.�a i--�� o� r - Owner's Name: Phone #: �, �� �o�-�1��-3�3�5 Contractor: License � � �-r- �� �� ^^� �`� �� �I Contact: � Cupertino Business License #: Q��u � �(�� r���. Type of F;oof Covering: E�sting: Proposed: 0 Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles � Asphalt Shingles � Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With CL_ ertino's Tear Off Policy: ❑ � Job Description:�^p� e . � ('� S��- �` �� �`�X 7i � � � �_ �� (f � �!'J � rps�� ��' r � � l., ss Residential ` Commercial ❑ Fire Zone: Yes ❑ No [� Conf'irmed with Planning Dept. if there are any restrictions: U Cost of Project: � � Type of Co stn ction• Occupancy group: � LJ �� i� o Q� �r � lk` 1� �� Qty. if Applicable Fee ID Fee Description Fee Group BPERIVIFEE Bldg Permit Fees BtTILDING 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 I�epartment Subject: Re-roofing policy for the C'iiy of Cupertino 1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards and manufaciurers specifications on re-roofing. 2. New roof coverings shall not be applieci without first obtaining all inspection and written approval from the buildin� 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 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 i irst obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be perf��rmed. 7. NOTE: If you call for a plywood nail vtispection and the job is not ready, you will be charged a re-inspection fee of $176.18. The re-inspection fee must be �aid 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 abovf stated policy on re-roofing. � �e� Homeowner's Name: � 6 1�... ��'�`�- Job Site Address: � � � � �* �`� � r ��� - � � /�. �- �,� ' 1 2� Roofing Company Name: r��'` r a (�'�� � Applicant's Signature: � ---- Date: r � � 2= �� Greg Casteel Building Official Revis��d 11/2/04 � CITY OF CUPERTINO 2 ITEMS OF 2 pERMI�' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: BlJ:: Lot: APN ......... 35:�28042.00 DATE ISSUED.......: 10'22/2007 RECEIPT #.........: BS�)00003052 REFERENCE ID # ...: 07:L00163 SITE ADDRESS .....: 75i8 HEATHERWOOD DR SUBDIVISION ....... CITY .............. CU?ERTINO IMPACT AREA ....... OWNER ............: BU�:KEL JOHN J AND ELIZABETH R ADDRESS ..........: 75�8 HEATHERWOOD DR CITY/STATE/ZIP ...: CU?ERTINO, CA 95014 RECEIVED FROM ....: BRLAN R SKARBEK CONTR.ACTOR .......: BRLAN SKARBEK LIC # 28901 COMPANY ..........: FOJR.BROTHERS ROOFING ADDRESS ........... 483 N 17TH ST CITY/STATE/ZIP ...: SAV JOSE, CA 95112 TELEPHONE ........: (4J8) 885 FEE ID UNIT QUANTITY �MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 18,500.00 266.76 0.00 266.76 0.00 BSEISMICRE VALUATION 18,500.00 1.90 0.00 1.90 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 268.66 0.00 268.66 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 268.66 VISA --------------- TOTAL RECEIPT : 268.66 C