08020079 -
13137LDINC DY1'ISION PERMIT CO1VT=RACTQRII! URiVIATIQ�,-x,
MIT NO.
Bu11,91'+02A�DR�,sEEKLINE DR LOS GATOS ROOFING P 08020079.
ERtl AL
_, - PERMIT ISSUE DATE
DAN LE P 0 BOX 1726 02/13/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECf/ENOINEER: BUILDING PERMITINFO
RE-ROOF/RMV SHK, INSTIL 7/16" BLDG Prcr-r PLUMB MFcx
0 0 0 0
wap LICENSED CONTRACTORS DECLARATION Job Description
e F 1 Mreby affirm Nn 1 am licensed under pmvisimu of Chapter 9(commencing ^^^^
e 4 wiNSecdo 70011)of Division 3 of du Business and Professions Cade.,nd my Bcerse is
n to in rull forte a "act
CMZ Lken CI a ' 3 Lk.N
Dew Contractor
9 v- a
ARCHMICT'S DECLARA ON
I andushand my plus shall Ise used u public meets
gd
htad
Licensed Professional
M OWNER-BUILDER DECLARATION
f I hereby M.that I em exempt from the Comirkwes License Law for the
L O o following maker.(Sado 1D51.5,Business and Proresdau Code:Any city or county
j@ff which acquires a permit to cosuaL a toes Improve,dem.lish,or repair toy structure priorm its issuance.alto requires theapplicant far such permit to file amigned statement
< that be is licensed Preteen to the Provisions of theConuacmr'WmnuLaw(Chapter 9 Sq.Ft.Floor Area Valuation
3 (commencing with Seedon 7000).(Diviaion 3.f ft Businecond Protea...Cade)ar
.. That k is exempt therefrom and the buds,for dw allegedexemption.Any violation of
Section 90.31.5 by airy applicant far a permit subjects the,applicant to,civil Porosity of ppN Number Occupancy Type
tot more than Eve hundacd dollars(55001
Q 1,an owner of de property.or my employees with wages as Nei tele eomperudon,
will do the wort tad site muctum is not intended or offered Tarsale(Sec.10,1,Business
send Profesdom Cade:The Commences License law dao ter apply to an owner or Required Inspections
Mitsui,wW Wilda orimpreves mMrnn.,M who daasah wort him elfmduougb his
muni employees,provided Nat such improvements shat notinum croRered for We If.
hawser,the building or impommocnt Is old whole ane your of completion.the awner-
W ilder will haw the Waden of paving that In,did not Wild or improve for purpose of
me.).
Q I,as owner of the Property,am exclusively contracting with licensed enntrxetap M
couwet the pmjeu(me.7W.Business tad profeseans Cade:)The ConuacMr's U.
cove law does not apply to an owner of property who Wilds or impmw thereon.ad.
who contracts for soh pmjem with a commeter(s)0ansed Pulman m time Conuuun'.
Lkense law.
Q tun exempt undo See ,B&PC ran els maim"
ee Date
WORKERS COMPENSATION DECLARATION
1 kreby&Dbm under pally of perjury am of the fallawing decluulome
Q 1 have and will maintain a CaNOnw of Consent to self-impute for Warks Cooper-
Won,
oo per-
W on,an provided for by Section 3100 of the Labor Code,far the perform ina of the
work for which this permit is Ismail.
Q i haw and will maintain Work's Compmnlon Insunnco,u retained by SeNon
3700 of the Lal r Code,far os,performance of the wast fwwhich this Permit u issued. '
My Work. �C'4 ew'pn in,yypaace esrfu and Policy number a am:
Cartier. n J (d Policy Na:?2-'A-7»eJ,L_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thusemian need not W completed if Oe permit is fortune handed dollars($100)
or less)
I Unity dust in the performance of the work for which this permit is issued.1 shall not
employ any person many manarm u m became subject in the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT.IL after making this Certificate of Exemption,you mould
Wmmme subject te the Workers Compenution provisions of dm Labor Code,you am
.,Z, forthwith comply with each providens a thin permit Nall be doomed nevvkd.
z O CONSTRUCTION LENDING AGENCY
t.. I kacby affirm that thea k a conduction lending agency for do Performance of
a the work for which this permit Is issued(Sen.31191,Civ.Ql
W Lenders Name
7 z Landers Address
UD Q I certify that I haw read this application tad main that the above information Is
^m correct 1 agree M amply with all city and county anikances and mute Im kinking in
0 SV' Wilding construction.tab o
kmby oario v
repes nutiwof this city to color upon the -
E akve-rtentioned property for inspection purposes
f}..m LL (Wc)agree to ave.indemnity and keep harmless the City of Cupertino agairm
i..m f/1 liabilitles,Judgmenu,cod and expenses which may in toy way amuse against said City
I.to or Lb -no
of this
C.1? APPTCCANT UNDe ANDS AND WILL COMPLY WITHALL ON-POINT Issued by: Date
/�
SOURCE REOU /`—
�
/ � �� Re-roofs
Signature of Appikina mmetar Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future building occcl antatom m handle hualloa newrial
dcOned by the Cupenia MuMcipal Cmdc,Chapter 9.11,and due Health tad safety
da.Section 155314)? All roofs shall be inspected prior to any roofing material being installed.
QYes No
Will the appliant or rata Wilding aavpanl too equipment a dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
emit havard.ns air comannum s a darned by the Bay Arca Air Quality Manaceme.l all new materials for inspection.
District? ``��
QYes �No
I haw mad the ba erdms mma.is mquimmenu under Chapwr6.95 of th.Cdifor-
niAHuldu&Safely Ca ,Sadom7550.1,15533sh 2553.IundemandthuirdM Wilding
does of corm w e komm"est It is my mipauihility to"atiry dw upent.f the
requiremcnu i m WmetprmraismanxoraCOukawofOc ,racy Signature of Applicant Date
Owmlardthavwdagrai "Y '�`� All roof coverings to be Class"B"or better
CITY OF CUPERTINO
REROOF
*CUPEf,T1No PERMIT APPLICATION
APN 3 ,L,.,�1 ���0 , � � Date: ✓>
Building Address: i1b
Owner's Name: Phone #:
veojrl 4e-,, Gf, 2oG . G ?
Contractor: Phone #: &/
Fax #:
Cupertino Business License #: Contractor License #:
22-0:2 07
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 1K Asphalt Shingles
XWood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) X Other(Specify) -7/16 1 Cj SL3
Number of existing coverings ❑ Provide I.C.B.O. Report#
To be Removed jlt�, Pro i je�lfgr. Installation Specs.
Job Description:
end 4v)dmt r-I_-1L Ue4v „A�►
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: 22A
eI Have Read, Unde a nd Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
d� REROOF
OCUPERirvO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2 f 1REROOFRES Re-roof Residential B 1SFDWLR00F
/ 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
lei 1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Community Development Department
Ar Building Division
® ` ` City of Cupertino
10300 Torre Avenue
/'� CITY 0- Telephone: (408)777-3228
L! I P E kT I N O 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.
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:
Job Site Address: ..
Roofing Company Name:
AplicanYs Signature: Date:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
® CITY OF CUPERTINO
2 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36217066 . 00
DATE ISSUED. . . . . . . : 02/13/2008
RECEIPT #. . . . . . . . . : BS000003929
REFERENCE ID # . . . : 08020079
SITE ADDRESS . . . . . : 7824 CREEKLINE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DAN LE
ADDRESS . . . . . . . . . . : 7824 CREEKLINE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4154
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : P 0 BOX 1726
CITY/STATE/ZIP LOS GATOS, CA 95031
® TELEPHONE (408)298-9399
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- --------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 7, 286. 00 0. 80 0. 00 0.80 0. 00
1REROOFRES SQ FEET 29 . 00 377 . 00 0. 00 377 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 377 . 80 0. 00 377 . 80 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 1, 523 . 80 #2587
---------------
TOTAL RECEIPT 1, 523 . 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------- ----
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF �'I
Community Development
10300 Torre Avenue
w may' Cupertino CA 95014
�
Telephone(408) 777-3228
UPEf�T
CITY TINO Fax(408)777-3333
Buildill De artment
JOB ADDRESS: n , ` PERMIT
OWNER'S NAME: O07
PHO OG_
GENERAL CONTRACTOR: FAX 4 �2 5�-
I am not using any subcontractors:. .
Signatureate
Please check a licable subcontractors and corn lete 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
2� d�
Owner/Contractor Signature ate