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07100086 CIT� OF CUPERTINO ` ` ' ' ` BUILUING DIVISION �ER�T �� * ,: ..,:><. ,..: _ ;::, ;> PERMIT NO. BUILDI g� n �� R ��ADYGROVE DR RESPON�IBLE ROOFING INC 07100086 • PERhIIT ISSUE DATE OWNER'S NAME: T S 2882 SFRING ST 10/10 2007 )NE: SANITARY NO. CONTROL NO. (650)969-6151 BUILDING PERMCI' INFO ARCHITECt/ENGINEER: BLDG ELECT PLUMH MECH � 0 � � i p Q LICENSED CON'fEtACfOR'S DECLARAT[ON JOU DeSCTIptlOfl : U� I hercby afficm �hat I am liccnscd undcr provisions oC Chaptcr 9(commencing ,z� wiihScction70U0)olDivision3ofihcBudncssandProfcssiuns andmyliccnscis RE—ROOF � TEAR OFF EXSTNG ROOF� INSTL NEW BUILT UP �< d in (u0 Corcc and eC ��z LicenscClass G� [.�c.n 3 �� m FIBERGLASS CAP ROOF 33 SQ CLS A : �, � Datc �O� 1 a i!1 "'� Conuacwr � ARCHITECi'S DECLA AT10N 7 a a ! undcrs�and my plans shall bc uscd as public rccords )4U ' t+. F' Liccnsed Pmfcssionai � y � OWNER-BUILDER DECLARATION 1 hcrcby alTirm th�i 1 am cxcmpt Gum U�c Conuactors Liccnac Law for thc � p O (ollowing rescon. (Scction 7()3I.5, Business and Profc.csians Caic: Any city m rnunty �°„ Pi which requi�cs a pertnit w conswct, altcr, improvc, dcmolish, nr mpair any suucture ° Z y prior W i�s issuancc, also rcquires Ihc applicant for such pertnil �o filc a signed stalcmcnt Valuation < �hat he is liccnscd pursuant to thc pcovisions oC ihc Conuacwr's Liccnsc faw (Chapicr 9 ;>q. Ft. Floor Area $10 3 9 5 �'�. F� (commencing wi�h Section 7000) of Division 3 of ihc Busincss and Profcssions Codc) or i�� that 6e is exempt thucfrom and ihe basis Cor �he allegcd exemption. My violaGon oC SecGon 7031.5 by a�ry applicant for a pertnit subjecu the appiicant to a civil penalty of p j�� Number Occupancy Type noc more chan fivc hundred dallars (5500). 3 7 5 4 � � 2 �. TJV ❑[, as ownu of tlie properry, or my employces with wages az thc'v w� compensation. will do thx work, and the swaure is notintendcd or afieeed forsatc (Sec. 7044. Business Required Inspections and Ehofessions Code: 7Le Conuacwr's License Law docs iroi apply w m owner of proputy who builds or improvcs thercan, and who daes such wark himulf or thcough his own employces, provided that such improvements are not intended ar oRered [or sala I[. however. the building or improvement is sold within one year of completion, � owner- builder will have the burden of prvving ihat he did not build or improvc for puryoae of saleJ. ❑ I, as awner of the property, am exclusively conuacGng wiW licensed convxtors ta . constnxt the projm (Sec. 7044. Business and Professions Code:) The Coatrarmr's Li• cense Law docs not apply to an owncr of propeny who builds or improves Ide�eon. and . who contracu for such projects wi�h a conuactoKs) ticensed pursuant to We Convutars - License Law. Q I am aempt under Sec . B& P C for �his rrason Owner Date _. . WORKFR'S COMPENSATtON DECLARA170N I heceby �rta under penalty of perjury onc of ttie following declazatia�s: ❑ I ha.�e and will maintain a CutiGcate of Conscnt to self-insure tor Workers Canpen- sation, as provided for by Section 3700 of the Labor Code, far the perfaemance of U�e work for which this permit is issucd. ❑ I have and will mainwin Worker's Compensation Insurana, az mquired by Scction , 3700 oC thc Labor Codc, Cor thc performance of Uu work for w6ich this permit is issued. My Warlce�rs Campensation Insurance cacrier and Policy number are: /'` Cartier: \� �'I [�_ Poliry No.: 7 � � ~ 7 �v CERTIFICATE OF EXEMP'fION FROM WORKERS' COMPENSATION 1NSURANCE ' (This section need not be completcd i( � permit is for onc hundred dotlus (5100) or Icss.) I cenify ihat in thc perfortnance af the work fw which Wis permii is issucd. 1 shall not e.^.iploy any person in any manner so az m bccomc subject to ihe Worlrcrs Compensation L.aws of Califomia. Datc Applicant NOTICE TO APPLICAM: 1f, af�cr making ihis Ccrti6cau of Excmpuon, you stwulJ bccome subjcct to the Workcr's CompensaUon provisions of thc La6or Code, you must � O forthwith comply with such provisions or this pccmi� shalt hc dccmcd awokcd. z ""' CONSTRUCfION LENDING AGENCY (.� ►�-+ I hcrcby alTirm that thcre is a consuucdnn Icnding agcncy for thc performarcc uf . p�., � ihc wurk fur which this pertnit is issucd (Scc. 3097. Civ. C.) W Q Lendcr's Narnc ' � z L,ender's Address V � � certi(Y �ha� 1 have rcad �his application and staic that ihc above infamauun is w � cortect. l ageee �o comply with all city and county ortiinances and state laws relating to � U building conswction, and hcrcby authori�e represcntativcs of Uiis city to cntcr u�n thc � a abovc-mcntioncd property for inspccuon purposes. (Wc) agree �o save, indemni(y and kecp hartnless thc Ci�y of Cupertino agtinst �� .E"„� � liabitiva, judgmcnts, cos�s and expcnscs which may in any way acccuc against said Ciry � U z in consequencc o[ Ihc granting af Ihis permiL Date L�� APPLICANT UNDERSCANDS AND WILL COMPLY W17H ALL NON-POINT Issued by: SO CE ,�,,�,dy�j%� !a ilaea � Re-roofs ��--�� Signazucc ppli UContractor �� Type of Roof HAZARDOUS MATERIALS DISCLOSURE Will thc applicant or futurc building occupant storc or handlc hazardous matcrial as dcfincd by lhe Cupertino Municipal Codc. Chaplcr 9.12. �nd �hc Hcal� and SaCMy Calc, Sxtion 25532(a)? All roofs �hall be inspected prior to any roofing material being installed. ❑Ycs �o wll the applicant or futurc building occupant usc cyuipment or dcnices which If a roof i� installed without first obtaining an inspection, I agree to remove - emit harardaus air contaminants az fincd by the Bay Area Air Quality Managcmem all new m aterials for inspec�ion. �isvici? ❑ Ycs u 1 havc rcacl �he ha�ardous matcrials requiremcn�s undcr Chap�cr 6.95 of ihc Califor- nia Hcalth & Safcty Codc, Scctions 25505.25533 and 25534. f undcrstar�d that iCthc building docs rroi curten�y have a tenant, �hat it is my responsibiliry to noufy the occupant af thc rc uire tswnich usibem "o�w�u��acac�wr,�a�oro��r. Signature ofApplicant Date y �vvGr��i�✓" 7�� /� � o'�` All roof coverings to be Class ��B�� or better Owner or authori agcm ��M - . ��j��g� CITY OF ��UPERTINO RE��OOF CUPE�Tit�O PERMIT APPI,ICATION FORM APN # 2� 5�`` � d� �' d� Date: I` O-- �� G� � J Building Address: a a 3 s�-do' . �- . -� Owner's Name: `� Phone #: � � '� C �l �a �'- � (o (o -- (� S � � Contractor: i License #: l�es , �s � t 1�� %t _ �.� c, 3� ��°rD Contact: � Cupertino Business License #: � � � C�� Type of Roof Covering: Existing: Proposed: (� Built-Up Roof (�Built-Uproof ❑ Asphalt Shingles O Asphalt Shingles ❑ Wood Shakes O Wood Shakes O 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 Com 1 With Cu �ertino's Tear Off Polic : C� Job Description: r{` ► e t� � !-'�' � s �7�"►/i +r� �` -� . � 1 �,� ll ✓c �� u,- 1�,,a � l�- r,� �� S-1r�r l� �� Residential Commercial ❑ � � Z- J � �iC� Fire Zone: Yes ❑ No [�� Confirmed with Planning De if there are any restrictions: !J Cost of Project: Type of Construction: Occupancy group: �(0 3�}S'.vv _fvn - Qty. if A licable Fee ID Fee Descri tion Fee Grou BPERMFEE E ld Permit Fees BUILDING BENERGY ]:ner BUILDING BSEISMICRE :>eismic Fee Res BUILDING BSEISMICOM :>eismic Commercial BIJILDING BPLANCHK l'la.n Check Fee BUILDING BUSLIC :3usiness License BIJILDING . . 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 (:ity of Cupertino 1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be appliecl without first obtaining all inspection and written approval from the building 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 City, the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspeciion approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without first obtauung an inspection, will require the removal of all new matE rial down to the sheathing, so a proper City inspection can be perfo rmed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee c�f $176.18. The re-inspection fee must be paid before another inspection can l�e scheduled. IMPORTANT 1. Flat roofs must have a m;n;mum of 1 /4 ";�er foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on tY�e job site at the time on inspection. I understand and will comply with the above �.tated policy on re-roofing. � Homeowner's Name: �r-� �! � ; �, �, � Job Site Address: �F' � ot 3 S�, ��1 y c' � �e Roofing Company Name: �� Applican�s Signature: Date: �U - ° l � 7 Greg Casteel Building Official Revised ll/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMI7' RECEIPT OPERATOR: patg COPY # : 1 Sec : Twp : Rng : Sub : B11�:: Lot : APN ......... 37�40020.00 DATE ISSUED.......: 10/10/2007 RECEIPT #.........: BSC00002953 REFERENCE ID # ...: 07100086 SITE ADDRESS .. ...: 62�3 SHADYGROVE DR SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............. TON SIBLEY ADDRESS ..........: 6223 SHADYGROVE CITY/STATE/ZIP ...: CUFERTINO CA, 95014 RECEIVED FROM ....: RESPONSIBLE ROOFING CONTRACTOR .......: ELMORE, PAUL M. LIC # 105 COMPANY ..........: RESPONSIBLE ROOFING INC ADDRESS ..........: 2882 SPRING ST CITY/STATE/ZIP ...: RE�WOOD CITY, CA 94063 TELEPHONE ........: (650)969 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 10,395.00 180.36 0.00 180.36 0.00 BSEISMICRE VALUATION 10,395.00 1.10 0.00 1.10 0.00 -=-�------- ---------- ---------- ---------- TOTAL PERMIT : 181.46 0.00 181.46 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 181.46 #11866 --------------- TOTAL RECEIPT : 181.46