06050242t=
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
y ONITY2A(�''TORINF+OXtMA.T`T01V
BUILDING ADDRESS:
PERMIT NO. '
MBROWN CONSTRUCTION INC
06050242
OW
PERMIT 15511E DATE
orE:KEV-LiNSANITARY
NOQ L Nth.
ARCHITECT/ENGINEER:(408)
2150-1260
BUILDING PERMIT INPD
BILDO ELECT PLUMB MECH
r 0 0 0
LICENSED CONTRACTOR'S DECLARATION
lob Description
P
eomcneing
1 b.cby affirm that 1 Me licensed under Provisions of CMp or 9 (m
with Section 7000) of Division 3 of Ne Business cid ProfesspionsCode, and my license u
in full fume and cIT OO 'ZZ
Lima Clw Lie
Dam Connector
ATION
REMOVE APPROX 32001 CDX;, INSTALL 1/2" CDX, CLAS
I understand my plans hall he used asCHITECTS
public icrecords
M
Licensed Prufcsxi... I
OWNER -BUILDER DECLARATION
I hereby alamh that I am eaempl Imre the Cenuaetors License Law for the
1 f t s DRr
iL
following moon. (Section 7031.5, Business and Pmfrsslons Cade: My city m county
�I
�etltl
which requires a permit to cans mc, )tor. improve. demolish.. mph MY nrumum
prior to im issuance. sive requims the sPPlicam for such permit b Ne a signed atsmmnl
Lw9
ConuxtMmeve la
Sq. Ft. Floor Areaoul
�j ''q ;f Vjaluati
that he is licensed pursuant to the Provisions of the s (Chap=
(commencing with Section 7000) of Division 3 of to Business and Professions Code)or
!L.- �
dor he is eompt lkmfmm and thus bub for the alleged esempdm MY vlulal ess Of
� Illij
-A "7
�Occdpancy Type
Section 7031.5 by my applicant f. a P9111111 subjects the applkant to a civil penally of
rot mom duo five hundred dollua (5300).37b
b �3 0 0
O 1, u own« of de pmputy, o my employes with wage u their sour c.mpenodm,
Required Ins CC[IODS
will do the work and the.wcbue b notimmnsdW conRered forsale(s«. 70N. Business
and Professor, Code: The Contmatoes Liceum Law dean not apply m an Chains of
9 P
property who build, or i m proves thermn, and who does s«h work himself car through his
owoemplayrq provided thusuch Improvements arc not invaded on@red fmole, if,
however, the building or improvement Is sold within one year of cempletog,. the ownan-
builder. w01 have the burden of proving that he did am build or Improve fm purpose of
sale).
❑ 1, as owrcs of the property, am exclusively o nuactng with Iicanod conuanngi to
Wr,nlKl to pmj= (See. 7044, Business and Profansions Code) The Conb eS U -
cense taw does not apply to an owner of property who Wim, or improv thmeon. and,
who contracts for such pmjeets with a eonuactort) Removed regional to the Contractor's
Lime Law.
Q I am exempt under Sea . B A P C for this recon
0. Dam
WORKER'S COMPENSATION DECLARATION
I hereby alarm ander penally of perjury arc of tha following declarhanm
have and will maintain a Cartifiese of Consent to self -insure fm Worker's Coropen-
on, a provided four by Section 3700 of the Labor Cade. for to performance of the
work for which this Ismail is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Smimn
3700 of the Lab. Code, for the performance of the work forwhich this permit I. Issued.
My Worker pe on In�s3dan^« noian and Policy numb" are:
;
Cancer. T `-� Policy No.: /
CERTIFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mus section need not he completed site permb Isfarone hundred Collins (1100)
or Le.a)
I ceNfy tut in the just .... of Nc we& fo which this permit is Issued. I shall am
employ any person In my mucern as m become subject to the Workers' Compcnutom
Iowa of C.Itfoorm. Data
Applicant
NOTICE TO APPLICANT. If, after making this OeniOcam of Exemption, you should
became subject W the Workers Compensation provisions of the Labor Code, you must
faMvrith comply with such provision or this permit hall W d«med mooted.
CONSTRUCTION LENDING AGENCY
1 Wintry alarm Wt there is a cmur.-tion Lending agency for the perfomance of
the work for which Nis permit Is issued (S«. 3097, Civ. C.)
Lenders Name
Lander'. Md=
1 tmnify that I have Pad this application and sum ton the above infuriating, is
correct 1 agree in comply with all city and county aNinarhaa and nam how, relating m
Wilding convection, and hereby athorire me m monativ origin city to color upon dm
above-mantioned property (a inspection purposes.
(We) agree to on, indemnify and keep harmless the City of Cupertino against
liabilities. judgments, costs ad expenses which may in any way me= against said City
in conoqucthce of the ZWOOS of this permit.
APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON -POINT
Issued by:9 Date 3. -ae
SOU REG ONS. /
1 <i
Re -roofs
Type of Roof
Sigrompe of ApplicanUClindagelear Dam
HAZARDOUS MATERIALS DISCLOSURE
Will to applicant. future Wilding occupant store or handle hanardous maturing
as defined by to Curmon m Municipal Cade. Chapter 9.12. and the Health and Safety
Com. Section 23532()7
All roofs shall be inspected to any roofing material being installed.
❑ Yu
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or f um Wilding Occupant use equipment or devises which
t haardmon Bir cMtsmir, U a defined by the Bay Arse Air Quality Management
all new materials for inspection.
let?
❑ Y« u
e rdou mamdalsmquirements underChapmrd.95oftheCelifor-
I have read Nhaa
nlaliuW$Safe Code, Sect.0 23505,25533md25534.1undemundthnifte Wilding
doss not cu nt Ma a tensor. It is my responsibility to noury the occupnl or de
requlremen w c prienoiuuanceofaCcrificamof0ccopnry. 00
Signature of Applicant Date
All roof coverings to be Class "B" or better
'�
Owner or as grind agem Dat
E
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
22-L,i�C'
PERMIT
P0 Sd24
OWNER'S NAME: u lilt ow- 4
PHONE
GENERAL CONTRACTOR:
FAX #
TKc
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
Owner/Contractor Signature
Lb ate O�
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
8 ZZ
Septic Tank
Sheet Metal
Sheet Rock
We 4.
Owner/Contractor Signature
Lb ate O�
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT
OEE ID
BPERMFEE
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32639039.00
DATE ISSUED.......: 05/30/2006
RECEIPT #.........: 34610'
REFERENCE ID # ...: 06050242
SITE ADDRESS .....: 22025 CREEKSIDE CT
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: KEVIN THOMPSON
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: MBROWN CONSTRUCTION
CONTRACTOR .......: CHRIS BROWN LIC # 25108
COMPANY ..........: MBROWN CONSTRUCTION, INC
ADDRESS ..........: 702 S. DANIEL WAY
CITY/STATE/ZIP ...: SAN JOSE, CA 95128
TELEPHONE ........: (408)260-1260
UNIT
-------------
VALUATION
VALUATION
TOTAL PERMIT
METHOD OF PAYMENT
-----------------
OTHER
TOTAL RECEIPT :
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
7,000.00
---- - -----
137,.16
----------
0.00
----------
137.16
----------
0.00
7,000.00
0.70
0.00
0.70
0.00
----------
137.86
----------
0.00
----------
137.86
----------
0.00
AMOUNT
------------
137.86
137.86
NUMBER
------------------
AMEX
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• 'I,C1 0
CITY e
CUPERTINO
C1
J
ou06 bN' L
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
n D� (�
APN #�^ , _ , 3q -69
`T -1
Bld-9 Permit Fees
Date: �v O&
t(/
Buildin Address:
Energy
202
BSEISMICRE
Owner's Name-
BUILDING
BSEISMICOM
Phone #-
(eU(',i T60
V), �u►-�
Plan Check Fee
S
BUSLIC
Business License
ire r
License #:b? ZZ
Contact:
Cupertino Buusin es4icense #:
✓(�-
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
Asphalt Shingles
X
Wood Shakes
Wood Shakes
(� Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings
❑ Other (Specify)
❑ Provide I.C.B.O. Report #
KTo be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply W' u
ertino's Tear -Off Policy:
Job D scription: i
2
L" CD
.
Residential V y Commercial ❑
Fire Zone: Yes ❑ No ®
Confirmed with Planning Det. if
there are anrestrictions: LJ
Cost of Project: Type of Construc
' n:
Occupant roup:
(T7 -d
Qty. if
Applicable
Fee ID
Zj
Fee Description
Fee Group
BPERMFEE
Bld-9 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 thr above stated policy on re -roofing.
Homeowner's Name:
job Site Address:
Roofing Company Name:
Applicant's Signature:
• Greg Casteel
Building Official
ZZOZS
Cab YlJ' A -
Revised 11/2/04
Date: 5- 1 �V/° 6
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