06080234 CITY OF CUPERTINO
BUILDING DIVISION PERMIT SCO RACTQIi MUItMAT-TON 4
BUILDING ADDRESS: KEN HOLT PERMrrNO.O608O234
OWNER'S NAME: PERMIT fSSUE DAIS
KEN HOLT
NE: SANITARY N0. GDNTRGL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG BUILDING
PLO O
iopLICENSED CONTRACTORS DECLARATION Job Description
i U CC 1 hereby affront that 1 am limmund under provisions of CmPmr 9(Commencing P
U wide Seeman 7")af Dividon 3ofthe Business and Professiam Code,star my Besets
in full force and affect. RE-ROOF, PUT 1/2" OSB, 15LB FELT PAPER. CLASS B
r$Z Licen Class Lic.0
Data Contractor ADD 2 SUNTUNNELS
ARCHrrECrS DECLARATION
M 1 mmollmd my plans shall be used as public mentals
hyU
LicendProfassionel
5 OWNER-BUILDER DECLARATION
ConumON
<E 1 hereby a?m Nm 1 em attempt from the Cctions o License Lew for to
.C o following rouon.(Section 7(01.5,Business and Pro@astnn,Cade:Any city or County
sure
:22 which requires•permit m enm the aIleic impow,demdtsh. file
mash any structure
.zSa
prior minissuenm.also are to the the for achpemitro Bk.Lsw(mmmant
that he is llCCnaed pYfWaalmdb pmvlalON of NC Can"YbM1 IJttnY IJW(Chapler9 Sq.Ft. Floor Area Valuation
$ mommencingwith Section 7000)ofDivision 3oftheBusiness and PatonCode)ur $'7500
3
that he Is exempt therefrom and the bull for me alleged mu mples.Any viobton of
Section 7031.3 by arty appllcanl for a permit subjects the applicant in a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars($300).
❑I,an owner of Ne property,Or my employees with wages an Weir sale compensation, el
will do Wewad4 and Wa museum i. otimandmi foRemA panel.(San.7O44,Business ns Required Inspections
and Profmalons Code:The Coromandel Llan Law don,sot apply in an owns of 9 P
psapeny who builds err im proves theoon,oar who deem much work himself orthrough his
..employ=.provided Wouuch improvements are not Intended oro@Cod fm We.If.
h ,thebuildingwhnpowmenliseall he
at
year or completion.profortheowner-
Isms.helium .m heves the burden ro proving the Ire ithi nm WBd er improv far the dw of
sale.).
le
❑I,as Owner of the property,am eseluslvely convening with licensed Contractors u
compact We project(Sec.7004,Business and Prafmiam Code:)The Couvacm/s Li.
come Law doss not apply to an unrest of properly,who builds or Imposes theron,and
who concocts for such projects with a con ram r(s)licensed!purauem In me Coatxem(f
Laren Law.
❑l am amepl under See ,B At P C for this moon
Owner Dam
WORKER'S COMPENSATION DECLARATION
41 1 hereby srRm under penalty of perjury ore of the following decluWms {� -
❑1 hsve mM will mainWn a CeNficasaofCanm m self-Invert for WaheYs Campen-
mtan,as provided fm by Section 3700 of the Label Cade.far W pmf maha of dee
wart for which this permit is named.
1 have and will maintain Wafter Compensation IM11mMa.as Inquired by Section
37BOOf the Labor Code.far We"Tom".often welk for which this panall U bound.
My workers Crandon lesurata artier and Policy munba are:
Cartier. 4— Policy No.:
CEIMFICA OFEXEMPOON FROM WORKERS'
COMPENSATION INSURANCE
moa rection and not he completed Bte p rook is forme hum mddeean($1013)
or Mu)
1 certify dol in me performance of the work fm which this permit Isismand,l shall not
employ any Peron in any mannerso u m bernn�>tibkc�de Warteri Compens
ationLaws of California.Dam SLr TT A.
Applicant —
NOTICE TO APPLICANT.If.snor making this Cmdricae of Exemption.you should
become subject m the Worker's Compensation provisions of We labor Coda you mesa
�Z forthwith comply with such provisions or this permit shall be deem:d revoked.
zCONSTRUCTION LENDING AGENCY
Er I hereby a8'mm that lbem Is a Construction lending agency for the performance of
ori the work for which this permit Is issued(See.3097,Clv.C.)
QLamho3 None,
a z Lender's Addmsa
U0 1 coNfy Nat 1 have mad this application and sum Wet the above information is
ly F comm.I agree to comply with all City and county ordinances and smm laws mleling m
0 U building Construction,and hereby authorize representatives of this City to anter upon the
W above-mcmioncd properly for inspection purposes.
CL (We)agree to saw,indemnify and keep homeless the City of Cupertino against
rA Iimilito.judgmenv.easu mdexpensas which may in any way accrue against aid City
U z in consequence of the granting of this pamll. .�)
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS. -
/ l g�� � Re-roofs
Signed..ofure Applkas ancr D e
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will theapplicant or future building Occupant smm or handle haardam nu mrial
as defined by the Cupertino Municipal Code.Chapter 9.13•and the Health and Safely
Cafe.41 ❑Yes )(No
U Nseetan us3z(a)7 ��..11o All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or f'oru`m building oaupant use equipment ar devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardnm air conmmim is as defined by to Bay Amo Ail Quality Management all new materials for inspection.
Dismicl7 y
❑Yes Y aU
Ihaveraad the hvalloumaeriatsre33 and 5534.1rCMPand duns llmWilding
nu Healthareer,y Cod.Savwa23303. My responsibility
understand One
Wilding
Janes net cumntly hew s Count WI b u my rtapanstnlliry W netfY the occupant of One � r<•'1/1 ��
myuimmenu wh'hmouhemet 'or missusOce afsCwfinm of Occu Signature Of Applicant DaI
6 O All roof coverings to be Class"B"or better
Owner or authomed agent Dam' "
Community Development
10300 Torre Avenue
J' Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
#UPERTINO
Building Department
JOB ADDRESS: PERMIT #
d+ G-A r 9— I tr+I T w R," 060 y
OWNER'S NAME: K z r] +10 L- T PHONE # 4o g - 8 q 8 - 6h o
GENERAL CONTRACTOR: lj p-�)o F',i /w t- FAX #
I am not using any subcontractors: Cid✓ 8 oe 9 . 6-
Signature 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
•
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31642009 . 00
DATE ISSUED. . . . . . . : 08/29/2006
RECEIPT # . . . . . . . . . : 35810
REFERENCE ID # . . . : 06080234
i
SITE ADDRESS . . . . . : 20282 CARTWRIGHT WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER KEN HOLT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CD ROOFING COMPANY
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY KEN HOLT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- -------- ----------- ---------- -- -------- ---------- ---------- ----------
BPERMFEE VALUATION 8, 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00
BSEISMICRE VALUATION 8, 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 253 . 76 0 . 00 253 . 76 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 253 . 76 175
TOTAL RECEIPT 253 . 76
owo8p234
CITY OF CUPERTINO
IL REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
SILO- 42-C 8
Building Address:
0 z y -L c,fl Iz H 7 w fl
Owner's Name: Phone#:
k c (\/ 6 O L_ T o - 3q -7 -
Contractor:
q7 -Contractor: License#:
C,+1 -6 F- L 2 C,,2 -1 9 q
Contact: Cupertino Business License #:
C+i ft K-L I iE ---'-b 0 o N
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 4 Asphalt Shingles
qI. Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
Cl To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
N TI s L B S FG-F T -P-A
Residential Co Commercial ❑
Fire Zone: Yes ❑ No Confined with Planning Dfft. if
there are any restrictions: LJ
Cost of Project: Type of ",struction: Occupancy roup:
9 -500 . o D
Qty. if
Applicable Fee lD Fee Description Fee Guru
BPERMFEE Bldg Permit Fees BUILDING
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 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 inspection 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 above stated policy on re-roofing.
Homeowner's Name: tl 14 +I o L 7-
job
Job Site Address: f 0 d- k a c,+ IZ T u P- I 4-H 7 i,u -A.h W PF 2 T /1-V O
Roofing Company Name: C..-D R-o o i= i N f--
Applicant's
Applicant's Signature: 64W"� Date: _14I 0 6
Greg Casteel
Building Official
Revised 11/2/04