08020030 CITY OF CUPERTINO °•- :..s•a, ya;'.K:,T:� ` '.- -ti.�•�*�r= :. 6;�
BUILDING DIVISION PEE
NIIT C0NTRACT0RJNF.URMATION:
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BUILgIt(ct.)AgES .DR IANA AVE DIAZ ROOFING PERMIT 08020030
4WNER'S NAME: PERMIT ISSUE DATE
QUINTERNO NOLA ET AL 6 N ROYAL LINKS CIR 02/05/2008
PHONE: SANITARY NO CONTROL NO.
(925) 565-0960
ARCH=/ENGINEER: BURRING PERMIT INFO
BLDG ELECT PLUMB MECH
tI o
6 LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby Atli.that 1 am licensed under Pmvialrna n(Chapter 9(commencing P
wiNSectian]IXI01 ofDivblOn Jarthe BUanrw and Profetd...Cmid"immylicenscla T/O SHAKE, INSTL 30# FLT 1/2" OSB & INSTL COMP 40
n,�u ! f u111 andeff G
1 3 9-.CM '— Lie.♦ ` YR CLASS A SHGLS 32SQ
g�
J Da¢ Conuanor
RCHr1ECrS DECLARATION
1 understand my plans Wa NW he used!u public rectums
u
L Licensed Pmfesommid
OWNER-BUILDER DECLARATION
9 1 herehy affirm that I am exempt from the Contwetors License Law for the
p o following moon.(Section 7031.5,Butdoesc and projections Code:Any city or county
$ which requires a permit m emumet.aide,mpmn,demolish.in repair any somehow
xi prior to its issuance.alas requires the applicant for such permit to file a signed aadmcnt
< that he is licetmd purwmt W the nowuom Of the Convect '$Liana law(Chap.9 Sq.Ft. Floor Area $9000 Valuation
�8 (commencing with Section,100()Of Divwion J of the Business and Prrfuuions Code)at
`t Nat he it exempt,therchman aM the basis f«the alleged camp tom My violatim of
Sci:9.7031.5 by acy application for.permit subjects the applicant to a civil Penalty or Number Occupancy Type
net mom Nast fin hundmd dellvs($500). 32620030
❑L o owner m Btu On srny,«my wntendea with mg.u the(Sec.camPensNon,
will Profession Anse: no Conne ates Liam LAW do fs ML apply W an Owner of Required Inspections
and property who Cade:The Contractors License law circa tot apply lf an Owner of q P
property whoes.proorimpronuthereogandwho d«tie«hworkhimalt f ed for adh his
Own
m.th building thin such Impmsem Within not ear oftoroeered f«WeIf.
however.the building or lmpmnmmt ts halt whin me year of ampnic for the Owner.
builder will nave the Wrdrn of pmNn{that K aid bet hold or harmonic(«purpose of
❑1,o awm of the pa party.am ocluuvely conuacdng with licensed camacion W
construct the prep c,(Sec.70th,Bunn.W Pro(ecdeo Cade:)The Ci mscurea U.
came law it.art apply in an own.or property who builds or Improve t erern,and ,
who cannoneer for such pmjecu wlN acamnnar(al licensed punuot to did Contractors '
License law.
❑l ant exempt under See .B L•.P C for this moon
�nsr Date
WORKER'S COMPENSATION DECLARATION
1 hereby affim under penslty of perjury,am of the following declarearns:
Q I Nas and wiB ma,by eCeNOam of me,Labor self-Wum the Wif.. Campcm
warn, r provided far by Section J]00 0(the tabor Cade.far Na per/omaiice of six
vest for which Nu perch is Want.
❑I ban ad will mainWn Workers Compensation Insunna,in required by Seedon
51N0 Of Ne Labor Code,far the peRrmmeeur the work to,which this pemi,is bound. '
MY Work—er0t`Com dot�Ul d's nn¢cglrn.had Polity nu her
Carrier.'�h �c.j�`1 Polity No.:lM—+
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu aait.mad notbacompleted ifth permit is f«eac hundred di lan($100)
Or lent)
1 certify that in the per(omanco of the work for which this permit is issued,)shell not
employ any person in any mannered u Or became subject to the Worken'CompensNon
laws of California.Cate
Applies,,
NOTICE IO APPLICANT.If.after making this Certificate of Exemption,you should
become subject be the Wok s Compausidan provisions of the labor Cadc,yen mud
.,O forthwith comply with such gravid ml«thts Permit aliall be tamed mated.
?► CONSTRUCTION LENDING AGENCY
[-w Ihereby afrm that them Is a construction lending agency for the Performance or
ai the work for which this perch b trued(Sec.309],Civ,C.)
tg7 Q lender's Name
Z Loaders Addi,• -
V O I certify that I ban mad this application and sod No the show information Is
rL^ corn«1 agree m comply with W city ad county ordinances and sud lam minting m
O LSJ' Wilding cow«tion,and hemby auNOnrz mprcamudna of NU city in enter upon the
yAlen-mentimcd Property f«h speciioa Purposes
(We)ag.m..,indemnify and tap homtem the City of Capertim aj unm
Iq liabilities.judgments.emu and expends which may many my wcme agJnst wit City
U Z ioconsequenarfthegrwtingof Nis Permit.
^ APPLICA UN ERSTANDS AND WILL COMP WITH ALL NON- INT Issued by: Date
SOURCER U DNS, _
� � Re-roofs Q
Signeure of Apoian/Conuamr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIE the applicant,or future building«vmpoitma Or tuned.hawmoo matmJ
deBmd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
W Section ss52ua)1 All roofs shall be inspected prior to any roofing material being installed.
❑Y. 6Nd'
l If a roof is installed without first obtaining an inspection,I agree to remove
Will do applicant or future bash ng occupant uu equipment or devices which
emit hmmiln.air o m ulna ns u dcRncd by the Bay Arco Air Quality Management all new materials for inspection.
Ohmet7
I hoc read the hawmam ma Wialsicquircinens underChapter6.95 of he Califor.
nu H«IN SafaYCode Savans]5505.755JJnu12553e lutitlemaiW NnBth dJding
ciao not ay fun a iahal tNt It ts my mponsiulity m beat]tic aauphat or de
requlm Or \uR be met pdorm�\>ri�ore eras arZ�ateylG Signature of Applicant Date
en�c( 16 O
Owner onuNOm<d egcm Datc All roof coverings to be Class'B"or better
ogo-.�, 003z
CITY OF CUPERTINO
REROOF
•CUPEfZTINO PERMIT APPLICATION
IN# Date: I
� �c, � �� f
1 Building Address:
Owner's Name: �-t CVd�C� Phone M R
LAO Contractor: Phone lCls
Fax#:
Cupertino Business License #: rl Contractor Licen "
(p _z)
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ A�sPhalt Shingles ❑ Asphalt Shingles
p1'Wood Shakes ❑ Wood Shakes
❑ Wood Shingles Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 4 ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:7_rCaV
c�-� � �L 21 ✓�
Residential Commercial ❑
l Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if 1
_ there are any restrictions: ❑
Valuation:
i
•I HZUnderstand and Will Co ply with Cupertino's Tear-Off Policy:
�� 1V
Signature
CITY OF CUPERTINO
010 ,
REROOF
*CUPirvO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF 1
1BSEISMICO Seismic Commercial B
` 1
1REROOFRES Re-roof Residential B 1SFDWLR00F 1
1BSEISMICRE Seismic Residential B 1
4
IREROOFMRES Re-roof Multi-Family B 1MFDWLROOF l
1BSEISMICRE Seismic Residential B 1
f
i IBUSLIC Business License B
O
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 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied 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 inspection approval.
• a) Spark arrester installation.
5. If plywood is installed,a plywood nail inspection is required.
6. Any roofing which is applied without 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 insvection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum 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 the job site at the time on inspection.
I understand and will comply with the nabovve/ tated policy on re-roofing.
Homeowner's Name:
Job Site Address:
Roofing Company Name:
Applicant's Signature: 4 cv, . V V Date: 1
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32620030. 00
DATE ISSUED. . . . . . . : 02/05/2008
RECEIPT #. . . . . . . . . : BS000003858
REFERENCE ID # . . . : 08020030
SITE ADDRESS . . . . . : 10065 ADRIANA AVE
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : QUINTERNO NOLA ET AL
ADDRESS . . . . . . . . . . : 10065 ADRIANA AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, '95014-1125
RECEIVED FROM . . . . : RODOLFO N DIAZ
CONTRACTOR . . . . . . . : RODOLFO DIAZ LIC # 26457
COMPANY . . . . . . . . . . : DIAZ ROOFING
ADDRESS . . . . . . . . . . : 6 N ROYAL LINKS CIR
CITY/STATE/ZIP . . . : ANTIOCH, CA 94509
• TELEPHONE . . . . . . . . : (925) 565-0960
FEE ID UNIT QUANTITY- AMOUNT- - PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -`-------- ---------- --------- --- -
1BSEISMICR VALUATION 9, 000. 00 0 .90 0. 00 0.90 0. 00
1BUSLIC FLAT RATE 1. 00 110 . 00 0. 00 110. 00 0. 00
1RER00FRES SQ FEET 32 . 00 416. 00 0. 00 416 . 00 0. 00
---------- ---------- ---------- --
TOTAL PERMIT 526 .90 0. 00 526 .90 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 526 . 90 #4512
---------------
TOTAL RECEIPT 526 . 90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
I JOB ADDRESS: PERMIT #
I (�r��S �c` Auk /j&Z�)20 0 D o
OWNER'S NAME: PHONE # Ci 2-5 LT —( 4 V
GENERAL CONTRACTOR (�- �L�k� �-✓tc FAX #
Ic I �
I am not using any subcontractors: (_ I
Signature Date
Please check applicable subcontractors and complete the following information:
® SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
�I Linolleum Carpeting
Wood
Glass / Glazing
Heating
( Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank 1
Sheet Metal
I Sh et Rock
Til
u- 11)
Owner/Contractor Signature Date