06090207CITY OF,CUPERTINO
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BUILDING DIVIS16N PERMIT
n..„a1'v;xF,r'o ,r b'P.FW�' eC,4,
BUI INOADORE9S:
N ROOFING
PERMrrNo.06090207
21673 CASTLETON ST
OWNER'S NAME:
PERMR ISSUE DATE
WRIGHT WILLIAM
1988 LEGHORN ST ST C
2006
NE:
SANITARY NO. CONTROL NO.
(650)961-7699
ARCHIIECT/ENGINEER:
BUILDING PERMIT INFO
BLDG MECH
O O
LICENSED CONTRACTOR'S DECLARATION
Job Description
P
I hctcby anion that I am licensed under provisions of Chapter 9 (commeming
with ands! an3ofdm Bulinus and �R(a10,mns Code%aM mylkenseb
REROOF- TEAR OFF SHAKES, RESHEET W1 1/211 CDX AD
,am Clus Lk.d
Dem 6 ConD
AR L� ION a
30 YR COMP SHINGLES. CLASS A.
e
1 undersexed my pl�iall ECu�i� •corJ�
Z
Licensed Pndcssionel
OWNER -exempt (r DECLARATION
1 hereby .('firm that 1 exempt from the Contractors License taw for the
o 1. Bualau and Profusi.N Code: Any city of county
following mason. (Section R o
Q
which requiru gamin fo elo plus. hnpmvu, demdorh, of mPsi, any strunum
issuance. um psom dct,
beProapionso Car such Cannot Ucnumo fil Law(uumem
bslensedPPutman, the ucenmlaw(Chau?9
Sq. Ft. Floor Area
VaIU 480
this tee licensedpursuant to
dot of the eBain= Cade) or
Of Division ess and Professions
(commencing with Steuart]asi0) of
but,f3of alleged Any
Wt he or exempt therefrom and the bu4 for the sikpd eumpdon. Any vlolsllon of
r
Occupancy Type
Section 1031.5 by any applicant fore permit wbjcm the applicant m a civil penalty of
at mom than (am hundred dollars IS300)•
3 5 618
�� . 00
I,uwlmroflhepmpwy.mmyuopioycuwithwagmudmkwiecompe don,
Required Inspections
will do the work and the siwcmm it atkonded or offered forsale(Sm.]ON,BWIau
Nd ProfCadoN Cade: The Conuacmes License law does sat apply m N owner of
9 P
progeny who builds or impro ms thereon. and whadoessuch workhlmself W through his
owaemploycas. provided Out each improwraenu art notimmded reoffered fronk. If.
however, the building or Improwmant is sold within tea you of eampletion, the owner-
builda wlil hay. the burden of pmving gut be did ant build or impmw for purpose of
nit ).
❑ 1. u r weer of the property, w exelWiwly conuudng with Bscnsed cenuunon lo
consumer the pension (Sec. 7016, Business lad PrafesdaN Code) The Contractor's LI,
came Taw does not apply m an owner of property who builds or improvca thereon. and
who contracts for such projects with acommmar0) licensed puma or m the eontrumr's
Litems, Law.
❑ lamexunptundn See .B&PCforlhiarruon
Owns Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arm of the following declarations:
I new and will annuls aCartificam of Cmumm m ulf-Wore fa WaMSCompcn-
sation, u provided for by Section 3]00 of the Label Code. for chs, performance of the
wart far which this permit is issued.
1 how and will maintain Wormes CompeNNon Insurua, u required by Semon
]00 ofthe laborCode. far the punmmmce ofthe work for which this permit u found.
'
My Wort<fs Cam camiv and Polity number tae:
� No.!S%%iO8iw X05
Cartier: Polity
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CM13 sect ere sed Out N completed Ethe permlt or foraahunCrtddahn ($Iasi)
lir kis.)
I certify that in the performance of the work for which this Permit is issad, I shall not
employ any person in my muter so u m became wbjat m the Workm Compensation
CA” of Califomie. Data
Appliaor
NOTICE TO APPLICANT: If, cher making this Cenlacam of Exemption, you should
became Subject m the Worker's Compcmdan provisions of thm Labor Code, you most
comply wit each provisions or Nu permit shall he dcemW revoked.
CONSTRUCTION LENDING AGENCY
1 herchy affirm them dere h a mmurednn knding.Vocy for the peeformmux of
the work far which this permit is wood (Sec. 309], Civ. C.)
..
Neem
Landefa Address
I wtify Nn 1 ban read this application and were Nal the &how information u
contact. l gree to comply with all city and county ordinances and auto laws relating m
building construction, and hereby authorim repracmatives of this city to enter upon the
.hove-memi... d property for inspection P liaxas.
(We) agree to saw, indemnify and kap reform the City of Captain. agdmi
Iiabilitia,judgmenu.caau tad eapeNW which may In any way ucrucsoust said Cry
in consequence of the of this permit
granting
APPLICANT ERSTAN S TILL CO PLY WITH A/LY NON -POINT
j
Issued by: Date
SOURCE R ATIG (J/ 00 L
Re -roofs
Type of Roof
Signuure of ApplicaDam
US MATERIApa DISCLOSURE
HAZARDOUS
WIII the buildingac sono or handle hmudousd
Capstor(Mum
Safety u defined by the Cuania Municipal Cade. Chepmr 9.11. and the Halth and Safety
hoes
Cade. Semon 15331(.)]_
All roofs shall be inspected to any roofing material being installed.
❑ Ya
prior
If a roof is installed without first obtaining an inspection, I agree to remove
WIII the applicant of fumm building ottupant use equipment or dcvicn which
emit havamnW air contaminator U deliad by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yn Lslbw�
I have roW the m 55 underChPor 6.93 the Gelding
me, S.6usmaodola
nisi HusW&Safctyhe.. ati 33 and if the building
/ /y( /s
4dorOi253lland25334,10dcnemde
dao at cMreathy haw • umsoL this It k my mapoNlMlity o notify the esu 1.f the
requirementswhkh be f III ofSignature
of Applicant Date
All roof coverings to be Class "B" or better
Owner tar aMRari>.ed�a i 7 Dam
CITY OF CUPERTINO
am 3 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # : 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35618065.00
DATE ISSUED.......: 09/21/2006
RECEIPT #.........: 36140
REFERENCE ID # ... 06090207
SITE ADDRESS .....: 21673 CASTLETON ST
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER WRIGHT WILLIAM
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4702
RECEIVED FROM ....: BONITA JENKINS
CONTRACTOR .......: WRAY, RICHARD LIC # 20755
COMPANY ..........: SHELTON ROOFING
ADDRESS ..........: 1988 LEGHORN ST, STE C
CITY/STATE/ZIP ...: MT VIEW, CA 94043
TELEPHONE ........: (650)961-7699
•FEE ID UNIT QUANTITY
---------------------------------
BPERMFEE VALUATION 12,000.00
BSEISMICRE VALUATION 12,000.00
TOTAL PERMIT :
METHOD OF PAYMENT
-----------------
OTHER
TOTAL RECEIPT :
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
191.16
----------
0.00
----------
191.16
----------
0.00
1.20
0.00
1.20
0.00
----------
192.36
----------
0.00
----------
192.36
----------
0.00
NUMBER
------------------
VISA
E
JOB ADDRESS: Z/ G'2 3
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Sr38' 3282 - FSouNle,
Buildine Department
V W N r tc"S NAMIr:. LcG., W n4. sl�I PHONE # 7-5 3 5 7 0 I
GENERAL CONTRACTOR n,41e�o�—dle. I FAX # I
* I am not using any
�. 1/240 6
Date
Please check auvlicable subcontractors and cmmnlptp tht+ fnllnurino• infnrmatinn-
Owner/d&tractor!�ignatureE
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
AIK
Tile
Owner/d&tractor!�ignatureE
c
CITY
is CUPERTINO
•
0
ocpog020-1
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # ^ 11113-1)(1,51
Y
Bldg Permit Fees
Date: z O /
to
Building Address:
2i6-73
Energy
Owner's Natge:
/L-,-
BSEISMICRE
Phone #:
25 3 -75 7 a
Contractor:
BSEISMICOM
_
License #:
zrero9 �
Contact:
Plan Check Fee
Cupertino Business License #:
BUSLIC
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
Asphalt Shingles
*19 Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings I
❑ Provide I.C.B.O. Report #
To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply
With Cu ertino's Tear Off Policy:
Job Description: To D /
l RN "A19 3 p y^ CCU—/' n - . -_ 61
Residential Commercial E3"30
Fire Zone: Yes ❑ No
Confirmed with Planning Dept. if
there are an restrictions: U
Cost of Project: of Type of Cortstruction: Occupancy_ gio�tp:
✓ (
Qty. if
Applicable
Fee ID
Fee Description
Fee Group
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: t
1. Flat roofs musf 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:
lob Site Address:
Roofing Company Name4-6�0'Azt-g.';� /
Applicant's Signature: Date: 2 s -t a6
Greg Casteel •
Building Official
Revised 11/2/04
CITY OF CUPERTINO
40m 1 of 1 PERMIT RECEIPT OPERATO.
COPY #
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35618065.00
DATE ISSUED.......: 10/31/2006
RECEIPT #.........: 36622
REFERENCE ID # ...: 06090207
SITE ADDRESS .....: 21673 CASTLETON ST
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: WRIGHT WILLIAM
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4702
RECEIVED FROM ....: JANICE OGAWA
CONTRACTOR .......: WRAY, RICHARD LIC # 20755
COMPANY ........:.: SHELTON ROOFING
ADDRESS ..........: 1988 LEGHORN ST, STE C
CITY/STATE/ZIP ...: MT VIEW, CA 94043
TELEPHONE ........: (650)961-7699
32417d!62990
BUILOINC,
10300 TORR[. AVE
iUPFRIIRO. CP 95014
408!?,A3282
Phone Order
:u. n
1P 11: 4 i:40
I AVS Cod,: N
pr8p
CPV? Code, P
Wr l,d:; NIM fovq; 9@u`fi3
'8 126,18
h.QuOi;
LAO
1118
S
E ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
BPERMFEE VALUATION 12,000.00 191.16 191.16 0.00 0.00
BREINSPECT FLAT RATE 1.00 176.18 0.00 176.18 0.00
BSEISMICRE VALUATION 12,000.00 1.20 1.20 0.00 0.00
TOTAL PERMIT : 366.54 192.36 176.18 0.00
METHOD OF PAYMENT AMOUNT NUMBER
OTHER ------176.18 VISA
TOTAL RECEIPT 176.18
VOICE ID DESCRIPTION
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
/
Ii
VOICE ID
602
DESCRIPTION
ROOF PLYWOOD NAIL