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09070215 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS! 22359 JANICE AVE CONTRACTOR:BILL HAMILTON ROOFING PERMIT NO:09070215 INC t""NER'S NAME: O'BRIEN JEANNE AND GEORGE '140 CAMDEN AVE STE E DATE ISSUED:07/31/2009 t?ir NER'S PHONE: 4082556093 _'AMPBELL,CA 95008 PHONE NO:(408)687-2540 V LICENSED CONTRACTOR'S DECLARATION WILDING PERMIT INFO: BLDG r— ELECT r PLUMB I— License Class_G 3 Lie.# r MECH RESIDENTIAL COMMERCIAL Contractor bdI`` [tQ/1��1 fin 6�'s Date l o 1 hereby affirm that 1 am licensed under the provisions of Chapter 9 COB DESCRIPTION:RE-ROOF REMOVE EXISTING FIRE FREE ROOF& (commencing with Section 7000)of Division 3 of the Business&Professions NSTALL Code and that my license is in full force and effect. S0#FELT AND CERTAINTEED PRES TL COMP,CLS A 23SQ 1 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 ;;q,Ft Floor Area: Valuation:$11347 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. \PN Number:35701044.00 Occupancy Type: APPLICANT CERTIFICATION 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non- t source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: Date: S' -lure Date �Jt © / ❑ OWNER-BUILDER DECLARATION RE-ROOFS: %]I roofs shall be inspected prior to any roofing material being installed.If a roof is 1 hereby affirm that I am exempt from the Contractor's License Law for one of nstalled without first obtaining an inspection,I agree to remove all new materials for the following two reasons: nspection. I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, iignatur of pplicant: Date: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: 1 have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the 2alifornia Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. :ompliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by iafety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this kdditionally,should 1 use equipment or devices which emit hazardous air :ontaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall I lealth&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Dwner r authorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is I'or which this permit is issued(Sec.3097,Civ C.) correct. I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter L, 'ie above mentioned property for inspection purposes.(We)agree to save Lender's Address ir+, aify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date___ CITY OF CUPERTINO RE ROOF CUPEKTINO PERMIT APPLICATION APN # � �r-10 ` � c � � Date: Building Address: -- l ,;�A Owner's Name: r(r1 — C'1 6 r.1�� Phone #: HOA: Yes ElNo If yes, provide let ter from HOA q0 g — �z 5! ^ (0 c)q 3 Contractor: Phone #: Llo 8 - 6 Lf U Fax #: qo,� - ?:) 1 1 iv Cupertino Business License #: Contractor License #: _-L1 l 5 6 4q4 DO Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles � Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles al Other(Specify) {' Y L r ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. h Q.vin Job Description: 11 C Cars ,g- Residential Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation CQj I Have Read, Understand and Will Comply with C'upertino's Tear-Off Policy: r Signature Revised 02/05/09 CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot : APN 35201044 . 00 DATE ISSUED. . . . . . . : 07/31/2009 RECEIPT # . . . . . . . . . : BSC00008330 REFERENCE ID # . . . : 09C70215 SITE ADDRESS . . . . . : 22359 JANICE AVE SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER O'ERIEN JEANNE AND GEORGE ADDRESS 22359 JANICE AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2730 RECEIVED FROM . . . . : BIIL HAMILTON ROOF CONTRACTOR . . . . . . . : BIIL HAMILTON LIC # 27915 COMPANY BILL HAMILTON ROOFING INC ADDRESS 74C CAMDEN AVE STE E CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE (4C8) 687-2540 FEE ID UNIT QUANTITY IMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- 1BCBSC VALUATION 11, 347 .00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 11, 347 . 00 1 .20 0 .00 1 .20 0 .00 1REROOFRES SQ FEET 23 . 00 299 . 00 0 .00 299 . 00 0 . 00 -- -------- ---------- ---------- ---------- TOTAL PERMIT 301 .20 0 . 00 301 .20 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 301 .20 #12117 --------------- TOTAL RECEIPT 301 .20 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF 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 agree to comply with 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the buildvtg inspector. A final inspection and approval shall be obtained from the building 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 Ci-.y,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 na it inspection is required. 6. Any roofing which is applied withou: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/ "per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O.report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: �� r�,� V 6 �i VeJob Site Address: o2� !� �J CA Roofing Company Name: i M i j 6 i/k .J n L Applicant's Signature: Date: Greg Casteel Building Official Revi:ed 07/30/08 Community Development 10300 Torre Avenue ✓` Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 ,'UPE�TINO Building Department JOB ADDRESS: PERMIT# ;2 jet 141 C(!� VQ, ,?Q 20 2-ls OWNER'S NAME: r 0, ri Gt t,`_ PHONE # - p GENERAL CONTRACTOR N( '1 I- FAX # q I am not using any subcontractors: C9Lo Si;nature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical 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 Le #-3/ 0 Owner/Contractor Signature Date