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07110113 CITY OF CUpERTINO � ` BUILDING DIVISION PE111Y11T �� ' > ,:. ;_:,_ ; ,: .: ,. ,; .. ...:: -.. . pERMIT NO. BUILDINGADDRESS: TBD — TC BE DETERMINED 07110113 20077 JOHN DR ' PERMIT LSSUE DATE _ .. tVER'S NAME: . TOM BATES 11/19/2007 SANITARY NO. CONTROL NO. PHONE: BUiLDING PERMIT INFO ARCHITECT/ENGINEER: BI.DG ELECT PLUMB MECH � 0 0 0 y p � LICENSED CONfRACI'OR'S DECLARATION JOU DeSCT1pLlOi1 � V� �►�by sfCrtn �ha� ( am licenscd unJcr provisions o[ Chaptcr 9(commencing W withScction7000)o(Division3of�hc FLT RF C�VRLAY W/TORCCH ON PTCH ROOF T/OFF, INSTL �� inful i Corcean de f f �. � �� y� 1'� � NEW SHT & COMP, 2 2 S Q � � ? Licenac Class ContracWr � y F , p Datc '� ' � ARCHITECI'S DECLARATI N e 1 undcrstand my plans shall 6c uud as public records jyU 4 O y Licensed Pro(cssional y e� OWNER-BUtLDER DECLARATION +� 1 hcrcby affirm d�at 1 am excmpt !rom thc Convactors Liccnsc law for thc i O o follawing resson. (Scction 703I.5, Busincu and Profc.csioes Calc: Any city or county y� Pi which rcquices a pc�mit to cnnsuuct, altcr, imprnvc. domolisli, nr icpvr any svucwrc prior w i�s issuancc, also rcquiccs ihc applicant for such permit to filc a signcd s�a�cmcnt <� y , Ft. Floor Area Valuation —^<�� is liccnscd putsuant to t h c pmvisions o[ t h c C o n l r a c t o r' s L i c c n s c L a w ( C h a p t c r 9 � $' 7 Q Q Q Y h = - $(commencing wi�h Scction 7000) of Division 3 of thc Busincss and Profcssions Codc) ur i�" t�a� he is e�cempt thecctrom and We basis [or ihe allcged eumption. Any violauon of Number Occupancy Type Section 7031.5 by airy applicant for a permit wbjecu ihe applicant w a civil penalty of 3 6 9 3 3 � 5. �� not moie �han five hundred dollazs (5500)• ��, 0 I. u owncr oCtlie property. or my empioyces with wages as �he'v aole compensatlon, willdothework.and�estroctmeisnotineendedoroHeredforsale Required Inspections and P�ofessions Code:'!'he Cantncwr's Liw�se Ltw dacs not apply w an ar+nw of property who builds a impcoves thereoa. and who das such work himaeltar thmugh hia own employces, provided that such improvements are not imended ar oRercd for saie. lt, hawever, the building or improvement is sold within oro year of completion. �he ownu- builder wiR have �he borden o[ proving �Aat he did noi build or improvc tor purpox of salc J. 0 1. as awnec of the property. am exclusively conuacting wilh licenaed rnnuacwrs W conswct �he projea (Sec. 7044. Businm and Protessions Code:) 7Le Conuacwrs Li- cense Law does no� apply to an m�mer of properry who builds or improves iheceon, and , who conuac�s for such p�ojects with a convactoKs) Gcensed pursusnt w ihe Convacto�s ' � tnse Law. am eaeempt undu Sec. . B dc P C for this muon uwner Date WORKER'S COMPENSA770N DECLARATION 16ereby �cm under penalty of perjury one o[ the following declaruions: ❑ I hire and will mainuin a Certificate of Consent to ulf-insure (or Workcr's Compen- sation, as prm�idcd fw by Secuon 3700 of �tie Labor Cade. [or ihe pecfarmance ot thc woric for which this petmit is issued. ❑ I havc and will maintain Workcrs Compensation Insurancc. as rcquircd 6y Scction , 3700 oC thc labor Codc. Cor thc performance of the work for which Nis pertnit is istiued. My Workers Compenaalian Insurance cartic* end Policy numbcr ue: Cartier: �`�� Polity No.:"_��7 �—� 4� CERTIFICATE OF EXEMPI70N FROM WORKERS' , COMPENSATIONINSURANCE (This scction necd iro� bc cample�ed if the pecmit is for onc hundred dollars (SlUO) . or Icss.) I cenify that in thc performancc af thc work for which �his permit is issucd, l shail not cmploy any person in any manncr so u to bccome subject w ihe Workers' Compensauon (,aws oC Cslifomia Dalc Applicant NOTICE 7'O APPLlCANT: If. aftcr making �his CcrtiGca�c of Exemption, yau shoulJ become subject to the Worlcer's CompenssGon provisions of �c Lal+oc Code, you must �,'� forthwiU� comply with weh proviaions or this pecmil shall be dcemed n.woked. � O CONSTRUCCION LENDING AGENCY Er �--� 1 hc�cby slGrm �hat thcre ia a consuuction Icnding agency (or thc per[ortnancc of p(, � tdc work for which �his permit is iuued (Scc. 3097, Civ. C.) , � A L.endcrs Nunc Lende�s Address I certify �hat 1 haw resd �his application and su�c ihu thc abovc infartnatiun is U � cortcct I agrce w comply wi�h all ciry and counry ordinarces and sta�e laws reladng w � U building consvuction, and hereby authorise representativcs of �his city to emcr upon tMe abovc-mcnaoned properry for inspection purpoxs �" a (We) agrce to save, indemnify and kecp harmlest �he Ci�y of Cupertino agsinst H � liabilities, jud cn�s, costs and expenscs which may in any way uccuc agains� said City / V z in conseq f the granting o[ this pe Date / ��"�� APPWC UNDERSTANDS AND 1 L COMPL TH ALL NON-PO1NT Issued by : SOUR EGULA770NS. � �!—1 '! Re-roofs � s� ofAppliant/C � D i 1 C T of R.00f H DOUS MA'IFRIALS D[SCLOSURE YPe Will Ihc appli t or futwc building occupant storc or Aandlc harardous ma�crial cfined by the Cuperlino Municipal Codc. Chaplcr 9.12. md the Hcalth and SafMy _,�a� Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed. � � If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipmenl or devices which cmii ha•rardous air conuminants u dcfincd by the Bay Area Air Quality Managcmcnl all new n for inspec�ion. / � Disvict? � �� / ❑ Y� � , ` `,: / 1 havc rcad the he�udous maicrials re uimmcnu undcr Chaptcr 6.95 of ihe Califor- _ j ha q nia Hcalih & Safcty Codc, Scctions 75505.25533 am125534. l undctsiand ihat if Ux building �� ii� /� �, � J � does not wncnUy havc a tcnan4 that't is my rcsponsibil� m noufy itrc acupant a( ihc � � Date rcquirements which mus� bc met p�W issuancc o[ a ficaic of q��r. Sign�ture of Applic t �� ` � All roof coverings to be Class "B" or better Owncr or auihomrd agcn� � D �� CITY OF CUPERTINO 3 ITEMS OF 3 PERMI`[' RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Bl.c: Lot: APN ......... 36�33051.00 DATE ISSUED..... 11i19/2007 RECEIPT #.........: BS)00003286 REFERENCE ID # ...: 07110113 SITE ADDRESS .....: 20)77 JOHN DR SUBDIVISION ....... CITY .............. CU?ERTINO IMPACT AREA ....... OWNER ............. TO:�I BATES ADDRESS ......... 20�77 JOHN DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 RECEIVED FROM ....: APEX ROOFING CONTRACTOR .......: TB� - TO BE DETERMINED LIC # 00096 COMPANY ..........: TB� - TO BE DETERMINED ADDRESS ........... CITY/STATE/ZIP ...: , TELEPHONE ......... FEE ID UNIT QUANTITY �NlOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 7,000.00 137.16 0.00 137.16 0.00 BSEISMICRE VALUATION 7,000.00 0.70 0.00 0.70 0.00 BUSLIC FLAT RATE 1.00 107.00 0.00 107.00 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT : 244.86 0.00 244.86 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 244.86 #4573 --------------- TOTAL RECEIPT : 244.86 INVOICE INVOICE INVOICE INVOICE ITVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO PERMIZ INVOICE OPERATOR: patg Sec: 'Pwp: Rng: Sub: Blk: Lot: APN ... ...... 36933051.00 INVOICE DATE......: 11/19/2007 REFERENCE ID # ...: 07110113 � SITE ADDRESS .....: 20077 JOHN DR SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... OWNER ............. TOM BATES ADDRESS ........... 20077 JOHN DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096 COMPANY ..........: TBD - TO BE DETERMINED ADDRESS ........... CITY/STATE/ZIP ...: , TELEPHONE ......... FEE DESCRIPTION DUE FOR AMOUNT DUE PAID BALANCE --------------------------- ---------------- ---------- ---------- ---------- BLDG PERMIT FEES PRINTING PERMIT 137.16 0.00 137.16 SEISMIC RESIDENTIAL PRINTING PERMIT 0.70 0.00 0.70 BUSINESS LICFNSE APPLICATIOV 107.00 0.00 107.00� � 244.86 0.00 244.86 �� ( � �� CITY OF �CUPERTINO ��' l�E ROOF CUP��T1N� PERMIT APPI�ICATION FORM � __,_ Date: APN # � `�:� �5 � -� � U . Z "" I (� " l'� � Building Address: ZaD71 c� . � IJ � Owner's Nam�• I Phone #: � 2� �E S f 1 Contractor: License #: � t � 7 I � Contact: , Cupertino Business License #: . i Type of ILoof Covering: E�sting: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑�Asphalt Shingles O�sphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ��Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Nuinber of existing coverings ❑ Provide I.C.B.O. Report # m�-To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and W'll Com ly With Cii ertino's ear Off Policy: Job Desc ' tio : �� '� '�'"� �� (td�',, � A- fl� t� i—� c r ?S. 11JS 1� vJ �' Residential Di Commercial ❑ � � �� .; � �� ' Fire Zone: Yes ❑ No Confirmed with Planning D�t. if there are any restrictions: Cost of Project: ` Type of Cons��ction: Occupancy grou� `� p t�p °� ' U.� Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BIJILDING 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 agre� 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 bui 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 f irst obtaining an inspection, will require the removal of all new mat�rial down to the sheathing, so a proper City inspection can be perfc�rmed. 7. NOTE: If you call for a plywood nail vispection and the job is not ready, you will be charged a re-inspection fee of $176.18. T'he re-inspection fee must be�aid before another inspection can be scheduled. IMPORTANT 1. Flat roofs must have a m;n;mum 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: �1�-. ��T� > ob Site Address: 2 ' 0 � � � �`�`� ��' �- � U J � Roofing Company Name: � �t= Applicant's Signature: \ Date: �� Greg Casteel Building Official Revis��d 11/2/04