08030044 CITY OF CUP RTINO
BUILDING DIVIISiON PERNIIT sXQM R . QRINk,10AA TI9g,--�
eulLgjN6Q64 RDE FOE DR DIAZ ROOFING PERMIT08030044
WNER'S NAME: PERMIT ISSUE DATE
TOM PETERSON 4652 SHETLAND WAY 03/10/2008
NE: SANITARY NO, CONTROL NO.
(925) 565-0960
ARCHITELTIENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
0 0 0 0
406 LICENSED CONRACIDR'S DECLARATION Job Description
. 1 hereby u!" i is 1 am IRrrvd un&r pdProons of Cholla 9(commense is
=�uF$ Ith Secoon70110)of Oividon 3oftim Budaw and Professional Cam,aM mylicen¢u RE—ROOF T/0 SHAKE& INSTL 1/20SB,CLS A 29SQ
�=N in
Z full Iorano _
Li
9 Dam Con
ARCHTfECI'SD ON
1 vomnund my pima still be wed u per record.
3 U
vera Licensed Partial anal
OWNER-BUILDER DECLARATION
C a s I hereby a(flmt that 1 I Bussu from the Comrade.o e:My Law for the
C m O following Pero. (anion 7U3 I3,Bllilnea aid rvA,demolish.
e Professions Code:My rity of manly
IRE! which its Isu l permit m ctmamq aline improve,&mol W,m mphir any structure
thaw b its u,sed pursuant n to the the applie of for inch permit m rtla ne Law(summit
C (com is lift wittSition mine of Division
3the eBumm/t Lianse6w(Chaamr9 Sq.Ft.FIOOr Area Valuation
�'5 that he iscgwiUfStt0ornaditbasisfroftheBedAssmtorofevioaCo&)or $14000
3 9 that Ise u eumPt themrrom and 0e Eub for the Alleged«emp0on Any violation of
that Section 70313 by any Applicant for a permit objects the applicant m a civil Penalty of �,ppt Number Occupancy Type
net mart thou fl.hundred&Ilan3001,(5 3 5 9 2 5 0 3 3 17 V'
❑l,uowrerof Uepmprny.wmynoployenwiNmr-iuU irmlc=M=Um.
will rthewmk,me TheCureunotmunenswagereds apply
An
ewer of
and Ra Whotw Com:The CrmncmY, d.lon law doer oaks appy lf rt note of Required Inspections
Property whobuildoorire doom achImr andwho doeawhwink Nmul(m thmugb his
Own ever.me uiproM&cthin each Improvements Anchor earofcmoneyed forum.if.
builder.Neav Use
within owyew ofmproefortheower-
buil&r Will have tic btWm of proving that he did set build or Improve far purpose of
um.).
❑1,As..of the P,oPRny.Am exclusively conu sum,with Iia•••d mnuanan to
mnawct the pmjea(Sec.load.Bt rinew and Pmfesons CodemF
)The Comecon',L
mine law doer not appy m a owns of Property who bund,a improves thereon,ad
who anuacu for such projects with.coma mr(O licensed pursuant to the Conummh
License law.
❑I Am comp,under See .B l PC for this won
Due
WORKER'S COMPENSATION DECLARATION
1 bereby alfim under penalty of papery orc of the following dalerWons
elaw W will for by
n•Cion 37M of me Lace,
Comprn-
worn,u providhi for mi Secures 3]00 of tic labor Code,ran the,perfahmarm a!the
work far winch this permit is issued.
I have and will ma mor WorYeYs Compensation Insurance,As required by Sectio
3700 of the Labor Co&,for the performance of the work for which this permit a lama.
My
GrWieCau..on er ad Policnumber m:
Polley ^4
.
TPCFlAEOEK PfION FROM W K
COMPENSATION INSURANCE
('rbu.seplo need Out be campicad Bthe permit is form hundred colon(1100)
or mal
1 certify eau,in the perf....err tie work Ise which this permit u luued,label Out
employ any person In my manner&u to become subject to the Worker'Cotpena gam
4wt of CAifomaa Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnirtca:of Faemption,You shouse
becmn,subject W the Worker's Compemdtio pmvitiona of the labor Codn.you mus
O O forthwith comply with such provisions or this permit"I he dcaned mvvkM
'Z' CONsTEvcnON LENDING AGENCY
[.n► I hereby aRirm that thew las construction lending.,mc,far the erfahmana of
�i > tie work for which this Permit Is Wood(Sec.3097,Civ.C.) '
Wh Q Lendeh Name
.7 z Lender's Address
U O 1 cenify that 1 have teed this application and rum tial the,bow,information is
Ly ^ coma a m I Agree cwnply With All city and county ardlnanwa and rule Iews staring in
O SV': building construction,and hereby Authwaw mPmmnudwa of this city m cmerupon the
LL7 alrow-madioed property for inspection purposes,
(We)agree m save,indemnify and kap homeless the City of Cupertino Agenda
o-„ y IlablliUu,jWgmcm.cmis ad caKwau which may in my WAY see=Agalnn aid City
() in cut
"'A""
permit. 10— 6n
v1• AP LICA UNDERSTA D AND WILL COM Y rTH ALL ON-P INT Issued by: Date I^
O CER UbsAT1(
Re-roofs
Si rf ApplicaUCo r Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building oesupanl sore orlundle hat ndeu mamyial
&Bond by the Cupcnim Municipal Cade.Chapter 9.13,ad the Health ad Safety
Sectiony5332(a)? / All roofs shall be inspected prior to any roofing material being installed.
Will the Appncat or mom building wTupanl Rin equipment or melees which If a roof is installed without first obtaining an inspection,,I agree to remove
it huarmu at conummunu As&tired by the Bay Arta Air Quality Management all new materials for inspection.
District?
❑yes r
I have read are huatdmu mseriait requimmcnuunder Chapter 495o1'the Calif.,.
ria Healthk SafwyCodc,sections 25305,35533 m .I uMcrsuM ducir to Wil 'ng
dors t c nUY naw a sees Il'u my ma rwhi0y b mofy the we pmt n Ne
roans n whom mus be 1Pd. An nancifof Cersmr,mataeaP Signature of Applicant Date
owner thoNed.g est D. All roof coverings to be Class'Ra'or better
® CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35925033 . 00
DATE ISSUED. . . . . . . : 03/10/2008
RECEIPT # . . . . . . . . . : BS000004115
REFERENCE ID # . . . : 08030044
SITE ADDRESS . . . . . : 7604 DE FOE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TOM PETERSON
ADDRESS . . . . . . . . . . : 7604 DE FOE DR
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4307
RECEIVED FROM . . . . : RODOLFO N DIAZ
CONTRACTOR . . . . . . . : RODOLFO DIAZ LIC # 26457
COMPANY . . . . . . . . . . : DIAZ ROOFING
ADDRESS . . . . . . . . . . : 4652 SHETLAND WAY
CITY/STATE/ZIP . . . : ANTIOCH, CA 94531
• TELEPHONE . . . . . . . . : (925) 565-0960
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 14, 000. 00 1 .40 0. 00 1.40 0. 00
1REROOFRES SQ FEET 29. 00 377 . 00 0. 00 377 . 00 0. 00
---------- ---------- ---------- ----
TOTAL PERMIT 378 .40 0. 00 378 .40 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ------7-------- --------------------
CHECK 378 .40 #4655
---------------
TOTAL RECEIPT 378 .40
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
0�o3OOLH
CITY OF CUPERTINO
G C� REROOF
OCUPERTINO PERMIT APPLICATION
APN# �� Date:
c3bo b�
Building Address:
Owner's Name: �q //Ge, r� Phone#: //ZcYf
Contractor: t►fi2 y' Phone #: 9z95 3S41—/ 9
Fax #: s
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asp�halt Shingles ❑ Asphalt Shingles
r�Wood Shakes ❑ Wood Shakes
❑ Wood Shingles mod Shingles
❑ Other(Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
w'To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: TFaIr a 6v)ary tZO5
\` 4aA li�z�w\ CUnA -t:kAxnjle X55 A ,
Residential Commercial
Fire Zone: Yes ❑ No ,L Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
I Have Rea , Understand and Will Co y ith Cupertino's Tear-Off Policy:
• - M
Signa r
CITY OF CUPERTINO
adm`" REROOF
CUPEkT
OINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
�9 1REROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
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) fob .ra ()
r
Job Site Address: ��C� CP_ rl)
Roofing Company Name:
Applicant's Signature:' Date:
Greg Casteel w�r
0 -
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
RUPEkTINO
Building Department
JOB ADDRESS: PERMIT#
`? 6O`t r Dr 0S03a0Lc �
OWNER'S NAME: I nit e--A,4--'c-n PHONE # 2-7-: 6f = O 97d
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontract and complete the followinginformation:
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
a �
Owner/Contractor Signature Date