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07100162 CITY OF CUPERTINO °' ` (� ` n BUILDINC; DIVISIOIV PERMIT �'�� "�� ....:. . ;>: ;:- _ _ _ PERMIT NQ. BUILD NG 4. DRESS: �O�ti5 STEVENS CREEK BLVD STATEWII�E ROOFING INC 07100162 � PERMIT LSSUE DATE �JER'S NAME: COATES & SOWARDS 5542 MOrITEREY RD 10/22 2007 SANITARY NO. CONTROL Na. PHONE: (408)28f�-8680 BUILDING PERMIT INFO ARCHIIECT/ENGINEER: BLDG ELEG7 PLUMH MECH C� � 0 � i p � LICENSED CONTRACTOR'S DECLARATION JOU DOSCfljJC10❑ : V� I hcrcby aCGrm that I am liccnscd undcr provisions of CAaptcr 9(commcncing ;z� wiihScciion7000)ofDivision3of�hcBusinessand ofcssiunsCadc,andm liccnseis SHAKE M:�NSAkD, REMV WOOD SHAKES, INSTALL 1/2 " �� y in full force and eCf �� 2 � j�? Licensc Class Lic. # � C DX :F� � ARCHITECI'SDFCLARA7'ION PLYWOOD, 3OLB FELT, 3O YR COMP, CLASS A 82 SQ. j a a 1 undcrstand my plans shall bc used as public recon)s )yU ' a y Liccnscd Pn�[cssional : � < OWNER-BUILDER DECLARATION �N� �' 1 hcrc6y alTirm that I am cxcmpt Crom ihc Contractor's l.iccnsc L.aw Car ihc � p o foltowing reason. (Sccuon 7Q31.5, Busincss and Profcssions Codc: Any ciry ar county �,°, � which requires a pL'miit to cnnswct, altcr, impmvc, dcmolish, or rcpair any suuctum ° Z y prior w i�s issuancc, alsu rcquires thc applicant far such permit to filc a signcd s�a�cmcnt ,. Valuation < �hat hc is liccnsed pursuant to thc provisions oC ihc Contractor's Liccnx Law (Chaptcr 9 ,�q. Ft. Floor Area $ 2 8 9 6 9 � t �(commencing wi�h Secdon 7000) of Division 3 aC Ihc Busincss and Profcssions Cadc) w L�� that he is exempt t6c�cfrom and the batis [or the alleged exempdoa Any violation of Secdon 7031.5 by a�ry applicant for a permit subjecu �he applicant to a civil penalty ot ,_��1 Number Oeeupancy Type not more than fivc hundred dollars (SS00). 3 1 6 2 3 0 2.) ❑ I, as owncr oC Uie property. or my cmployca witA wages as thcir solc compensation, will do thc work, and �he suucwre is noc intendcd or offered for salc (Sec. 7044 a�;� Required Inspections and Professions Code: 'Che Conuacwr's License Law does not apply w an owne� of property who builds or improves thercon, and who does such wort himself ar Ituough his own emptayccs, provided U�at such improvemenLS are not intended or o[fered tor sala [[, however, the building or improvement is sold within one yesr oC complction, the ownu- builder will have ihe burden o[ proving �hat he did not build or improvc Car pu�pose of salc.). ❑ 1. as awner of the propeny. am occlusively conuacting with licensed rnnuu�ors w consuuct the projett (Sec. 7044. Business and Pcofessions Code:) The Conuxtor's Li- cense Law docs oot apply to an ownu of propeny who builds or impmves ihaeon, and , who conuacts for such projeas with a contnctor(s) littnsed pursuant a ihe Conuactofs �.icense Law. I am exempt undu Sec. , B dc P C for ihis rcason ,.,wner Date _... _: WORKER'S COMPENSA'I70N DECLARATION I hereby �rm under penalty af perjury one a( U�e following dxlantions: ❑] hsve and will maimain a Cenificate oCConsent ta sel(-insure for Worlrec'sCompen- sation, as provided for by Section 3700 af the [abor Code, Cor the perfarmance of �he work for which ihis pertnit is issued. ❑ I have and will maintain Worker's CompensaUan Insunnce, as rcquired by Scction , 3700 oC ehe [abor Code, Cor the perCormance of the worlc for wAich �his peemit is issued. My Worke�'s Compensation Insurancc carticr and Poliry num6er azc: � f Cartier. TfQ->f% ff Rc /v �. Policy No.: �OiO�D I Z� - 2/> e CERTIFICA7'E Ol�EXEMP7'[ON FROM WORKERS' COMPENSATIONINSURANCE (I'his section nccd not bc completcd if the pccmit is for onc hundred dollus (S 100) or less.) I certify thxt in the performance af the work Cor which �his pertnit is issucd, l shall not e�ploy any person in any manncr so as to bccomc subjcct to the Worlccrs Compcnsatian Laws of Califomia. Datc Applicant NOTICE TO APPLICANT: If, attcr making �his CcrtiRcate of Exemption, yau should bccome subjcct to �hc Workcr's Compcnsation provisions oC thc Labor Codc, you must , O forthwi�h comply wi�h such provisions or this pecmi� shall bc decmed revoked. z "" CONSTRUCTION LENDMG AGENCY E.r ��-. I hcrcby aR'irtn ihat thcm is a construcuon knding agcncy for thc performancc a( p(, � ihc work for which ihis permit is issued (Scc. 3097, Civ. C.) a A Lendcr's Namc � z LcndeisAddress (� � [ cenify U�at 1 have read ihis appticatioo and siate thai the above intormatiun is �� cortcct. I agree �o comply with all city and caunty oniinances and sute laws relaung to � U building conswction, and hcreby authori7e repmscntativcs of this city to cntcr u�n thc � W abovc-mcmioncd propcny for inspccuon pur{wses. a (Wc) agrce �o save, indcm�i(y and kccp hartnleu lhc City o( Cupcnino against �� liabilities, judgmcnts, costs and expenses which may in any way accruc against said City U z in con:equence oC �he granting o( U�is permi� �+ APPLICAM NDERS ANDS AN� WI}� COMPLY WITH ALL NON-POIM Issued by Date O - Z"L�G.• SOURCE RE L L "�"'- ` %G l � — Z - o Re-roofs �''�.----�'� Signa urc o( ApplicanVConlrac�or �� T e of R oof HAZARDOUS MATERIALS DISCLOSURE YP Will Ihe applicant or Cuturc building oceupantstorc or handlc ha•rardous matcrial definM by the Cupenino Municipa[ Codc. Chap�cr 9.12, and Ux Healih and Safcty .:alc, SccUon 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Ycs O No . �11 ihc applicam or Cuturc 6uilding occupant usc cyuipmcnt or dcvices whicA If a roof i� installed without first obtaining an inspection, I agree to remove emit harardous air contaminana at dc6ncd by Uie Bay Area Air Quali�y Mana6cmcnt all new rr aterials for inspecr.ion. DistricQ Q Ycs ❑ No 1 havc ccaJ the ha�ardcws matcrials rcquircmcn�c undcr Chapter6.95 o(ihc Cali(or- nia Hcalth & Safcty Codc, Scctions 25505.25533 and 25534.1 uncicrstand thai iCthc buikling docs not curtentl havc nan4 ihat it is my ponsibility m noul'y �hc occupant o( Uic reyuircmcn�c �ch m be me rior * i orac��;r�a�ora��r. Signature of Applicant Da[e � ' �v ^ All roof coverings to be Class "B" or better Owncr or au�ri�.cd agcn� Datc CITY OF CUPERTINO 2 ITEMS OF �, PERMI�' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl}:: Lot: APN ......... 31E>23025.00 DATE ISSUED.......: 10,'22/2007 RECEIPT #.........: BS()00003048 REFERENCE ID # ...: 07:_00162 SITE ADDRESS .....: 20()85 STEVENS CREEK BLVD SUBDIVISION ....... CITY .............. CU]�ERTINO IMPACT AREA ....... OWNER ............: CO��TES & SOWARDS ADDRESS ..........: 17:'.5 S BASCOM AVE STE 104 CITY/STATE/ZIP ...: CAT4PBELL, CA 95008 RECEIVED FROM ....: ST�?TEWIDE ROOFING CONTR.ACTOR .......: KY]�E HYPES LIC # 23509 COMPANY ..........: ST��TEWIDE ROOFING INC ADDRESS ..........: 55�12 MONTEREY RD CITY/STATE/ZIP ...: SAI7 JOSE, CA 95138 TELEPHONE ........: (4i)8)288 FEE ID UNIT QUANTITY ��NiOUNT PD-TO-DT THIS REC NEW BAL ---------- -------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 28,969.00 358.56 0.00 358.56 0.00 BSEISMICOM VALUATION 28,969.00 6.09 0.00 6.09 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 364.65 0.00 364.65 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ------------------ --------------- -------------------- CHECK 364.65 #5712 --------------- TOTAL RECEI]?T : 364.65 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ----------------------------- -------- ---------------------------- 305 FR.AME 307 INSULATION 601 ROUF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS �� 1 �� CITY OF ��UPERTINO RE ItOOF CUPEt�TINU PERMIT APPI,ICATION FORM APN # �) � � �'� �' � ` � � Date: . �� Building Address�: ' � � 5�� Owner's e: � Phone #: � � � � �� s O �,.3 � Contracto � �� License #�� Contact: � � Cupertino Business License #: y � Type of P.00f Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles � Asphalt Shingles �, Wood Shakes ❑ Wood Shakes ❑ Wood Shin€;les ❑ Wood Shingles O Other (Specify) ❑ Other (Specify) Number of existi.ng coverings ❑ Provide I.C.B.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Uncierstand d Will Com ly With Cupe no's Tear Off Policy: Jo escription:�� ' � � � � �� i "�-� / 3a� � � � -, /� Residential ❑ Comme cial �. �f' ./-� 2 Fire Zone: Yes ❑ No �� Confirmed with Planning Dept. if there are any restrictions: LJ Cost � j�t: ' Type of Cons ',ti�Q Occupancy oup: � � ��oo ,�G' � Qty. if A licable Fee ID Fee Descri tion Fee Grou BPERMFEE �31d Permit Fees BUILDING - BENERGY Ener BLTILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BU SLIC Business License BUILDING Community Development ; '�� 10300 Torre Avenue �=M. � . Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 CUPEf�TiNO Buildin De artment JOB ADDRESS: _ PERMIT # `2- oca �-� S--t-�„� c r-I� � 7l� C`� �� ( a ��'Z' OWNER'S NAME: C -� � S�� ( �� PHONE # �' Z rs' Z GENERAL CONTRACTOR � FAX # . _ � I am not using any subcontractors: r�� 2��' Si gnature Date � Please check a licable subcontractors and com �lete the followin information: SUBCONTRACTOR BUSIr1ESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Fini.shing IIectrical 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 Tile Owner/Contractor Signature Date