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15040244CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10171 E ESTATES DR CONTRACTOR: BAY 101 ROOFING PERMIT NO: 15040244 OWNER'S NAME: FLESHMAN STEVEN G AND RITA K E PO BOX 925 DATE ISSUED: 04/30/2015 OWNER'S PHONE: ALVISO, CA 95002 PHONE NO: (408) 957-0531 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL ❑ COMMERCIAL E] REMOVE EXISTING MATERIAL AND REPLACE WITH 50 License Class Lic.# YR COMP Contractor Date I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I 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 Sq. Ft Floor Area: Valuation: $12000 performance of the work for whichthis permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this APN Number: 36908004.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct. I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply Issued by: Date: with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. RE -ROOFS: Signature Date All roofs shall be inspected prior to any roofing material berg installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. ❑ OWNER -BUILDER DECLARATION Signature of Applicant: Date: I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER 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, Business & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project (Sec.7044, Business & Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. 1 will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the declarations: Health & Safety Code, Section 25532(a) should I store or handle hazardous I have and will maintain a Certificate of Consent to self -insure for Worker's material. Additionally, should I use equipment or devices which emit hazardous Compensation, as provided for by Section 3700 of the Labor Code, for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and I have and will maintain Worker's Compensation Insurance, as provided for by the Health & Safety Code, Sections 25505, 25533, and 25534. Section 3700 of the Labor Code, for flee performance of the work for which this Owner or authorized agent: Date: permit is issued. I certify that in the performance of the work for which this permit is issued, I shall 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 CONSTRUCTION LENDING AGENCY become subject to the Worker's Compensation provisions of the Labor Code, I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, ARCHITECT'S DECLARATION costs, and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO BUILDING PERMIT INSPECTION CARD BUILDING ADDRESS: 10171 E ESTATES DR CONTRACTOR: BAY 101 ROOFING PERMIT NO: 15040244 OWNER'S NAME: FLESHMAN STEVEN G AND RITA {E PO BOX 925 DATE ISSUED: 04/30/2015 OWNER'S PHONE: ALVISO, CA 95002 PHONE NO: (408) 957-0531 INSPECTIONS DATE INSPECTOR BUILDING PERMIT INFO: BLDG ELECT PLUMB MECH RESIDENTIAL F COMMERCIAL F JOB DESCRIPTION: REMOVE EXISTING MATERIAL AND REPLACE WITH 50 YR COMP FOUNDATION/PIERS/H.D.S. UFER GROUND PAD/SETBACK-CFRT GARAGE SLABS/PREGUNITE FIRE — CALL (408) 378-4010 POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB SANITARY (408) 253-7071 UNDERGROUND PLUMBING UNDERGROUND ELECTRICAL ELECTTRICAL DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED UNDERFLOOR PLUMBING IN PROGRESS Inspector• Date: UNDERFLOOR MECHANICAL UNDERFLOOR ELECTRICAL WILDLAND URBAN INTERFACE FIRE AREA ER# TO ARRANGE INSPECTION Call 777-3228 between 7:30 am and 3:30 pm Monday through Friday, at least 24 hours before required inspection. Job address and Permit Numbers are needed when requesting an inspection. CUPERTINO SANITARY DISTRICT Closed circuit video inspection of property line cleanout, point of connection and street lateral required prior to passing FINAL CITY PLUMBING INSPECTION. Call the District (408-253-7071) for an appointment. NO BUILDING FINALS INSPECTIONS UNTIL ALL REQUIRED BUSINESS LICENSES ARE OBTAINED UNDERFLOOR FRAMING VENTS FINAL. Inspector Date: UNDERFLOOR INSULATION PLACE NO SUBFLOORUNTIL ABOVE RAS BEEN SIGNED ROOF SHEATHING HANDICAP ROUGH PLUMBING NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION. ENERGY TUBS & SHOWER PAN * OCCUPANCY OF BUILDING NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY ROUGH MECHANICAL ROUGH ELECTRICAL/POOL BOND INSPECTOR BUILDING FRAMING/STAIRS/E. EGRESS INSULATIONNENTILATION COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT EXTERIOR: SHEAR/HOLD DOWN ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. INTERIOR SHEAR/HOLD DOWN SHEETROCK/SHEETROCK SHEAR IMPORTANT When a permit has expired, a charge totaling one-half the fees to obtain a new permit EXTERIOR LATH/W-SCREED must be paid in order to reactivate the permit. If a permit has been expired for more INTERIOR LATH than one year, a charge totaling the full fees to obtain a new permit must be paid NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED to reactivate the permit. SCRATCH COAT NOTES: SEWER/WATER T-BAR/MECH/ELECT ABOVE CEIL FINALS SPECIAL INSPECTIONS Inspector: Date: ELECTRIC METER RELEASE GASTEST/METER RELEASE ROOF INSPECTIONS GRADE - PUBLIC WORKS PRE -INSPECTION: Inspector• Date: TEAR -OFF Inspector- Date: PLYWOOD- Inspector• Date: FIRE — CALL (408) 378-4010 PLANNING (408) 777-3308 SANITARY (408) 253-7071 BATTENS: Inspector: Date: ELECTTRICAL IN PROGRESS Inspector• Date: MECHANICAL FINAL. Inspector Date: PLUMBING HANDICAP NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION. ENERGY * OCCUPANCY OF BUILDING NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY INSPECTOR BUILDING CERTIFICATE OF OCCUPANCY * I I I1