08010066 BUILDING DIVISION PERMIT "V� ltt'�`� t .1�, � xR,"
BUILDITy,��0 ESS: PERMIT NO.
1UDEMPSTER AVE SECURITY ROOFING INC 08010066
OWNER'S NAME: PERMIT ISSUE DATE
NYGAARD JON 0 AND MAXINE N P.O. BOX 2450 01/11/2008
NE: SANITARY NO. CONTROL NO.
(650) 595-1213
ARCHTI ECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
app LICENSED CONTRACTOR'S DECLARATION O O O O
@T thereby amen that I Am licensed under pmsiam of vichapter 9 feommanaing Job Description
x withSection701110ofDivWan3ofdheBusinwandProfeasiomCodo.a mylicense4 TEAR OFF CEMWOOD INSTALL 30 FELT UNDERLAYMENT &.
inrull force antic D�di(,I(
j�2 Licenxe Clw - Lle.g /7 4�
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Date ARCNfIECI'SDECLARATION � YR COMP 27 SQ SECURITY ROOFING PD BUS LIC,
1 W ndaanJmyplwaWlbeusedaphlicmcad (01000039686) 1/11/08
gtad In Licensed Pmfesumal '
B`y3 OWNER-BUILDER DECLARATION
<y I hereby arum that Ian u..pt Win the Contractors License law for the
0 O following mw
on.(section 103 1.5,Business and Pmfmalm oCode:Any city m county
3$ which requires A permit to construct,aIle.improve.den IlAh.a repair any Mo..
_zi• prior In its issuance,also,requires use applicant forach permit W Rle a signed statement
<
that Wislicensed purn,ammuse provisions ofthe comra lm'sUccaheLaw(Chapter 9 Sq. Ft. Floor Area Valuation
�G (commendngwith Smjon70DO)o(Mi ion3afdc B"si mdProf=iom Cade)or $9250
3 Nu k is exempt therefrom ad the bub for the alleged exempdon.Any violador of
Section 701.5 by airy appltant for a permit abjew the applicant In a civil penalty ofNumber Occupancy Type
nn,more than nw hundred dmlw(SM(S3 2 647 0 7 5 .q64
0 1,as owner of ft property,ar my employ¢with wages u their role compensation,
will do the work,and the avunum brat lnunded or offered for aale(Sec.70x4.Business
and PmfeSYam CajC TW ConuCtaA License Law dam eat apply ban Owner of Required Inspections
Property who buildsor improves there n,and whodausuch wank himse for,hrough his
awe employees,provided that such improvements an not intended"Offered foraale.If,
however,the building ar improvement Iswld whhW one year of completion,the ewm-
builder will have the Borden of proving dust K did nm bWW err inpmve fee purpose of
ale.).
❑1.as owner of the property an exclusively contracting with licensed mnuacbn W
construct the project(Sec.1014,Business and Prnfnda a Code:)Tie Contaactnfs U.
eew Law dam not apply to an owner of property who builds or lmpeoves thereon.and,
who contracts for such projects with a conteactar(U licensed pursuant to the ComrnctArs
Lleew .taw.
0 l an aerupr undue See .Is k P C for this recon
Owns Dau
WORKER'S COMPENSATION DECLARATION
I hereby amlm under penalty of perjury one of the rollowing decladions:
I have And will maintain a Ceetifinte of ComeA1 w self-insure for WoftesCamper-
'on,u provided for by Section 3700 of the Labor Code,for thA Performance of the
work for which this permit is ivuN.
0 I have and will maintain Workers Compewtion Insurance,u d
required by Sean
3700 of the labor Cade,for the performance of the work:forwhich this Permit is lured.
My Workee all InauMCC caner Nd Policy mumberare:
Cartix rr^'^' Polley NO: DO OO?-Yg'-Z
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TTbsedon and not hecomplewd if the permit Is form hundred dollen($100)
or Ma)
1 coolly the,in the afornanm of the work far which this permit is sound,I shall nut
employ any person in any mwnerw As W become subject to the Workers'Compewdan
Laws of C3]ifO.14.Dau
Applicant
NOTICE TO APPLICANT,If,after making this CeLLlOcau of Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Code,you most
O forthwith comply with such provislom or this permit Mro
Mall be donned oked.
zr� CONSTRUCTION LENDING AGENCY
[r I hereby Affirm that Nitre b a construction lending agency for rhe performance of
the woh for which thin permit b issued(Sec.3097,Civ.C.)
W�Q Lenders Name
Z)z Lenders Addrw
J O 1 certify that I have mW this application and sou that the+bow information b ..
{Ir correct 1 agree W comply with LI city and county ardlnanen end Ante laws totting to '
_Q building aonstroctien.and hereby authadm representatives or this city to eater upon the
Lid aheve-mendoned pmpcny for Inspection purpueg
(We)agree to ave,indemnity and kwp harmless she City or Cupertino against
err tt,i liabilities,jWgrecnu,casts and expo•..i which may in any way accrue against said City
V z in consequence of the grading of this permit
^' APPLICANT UNDERSTANgAANO-W1 DMFLY WITH ALL NON-POINT Issued by: Date
GULAT IN /
Re-roofs
Sigwuru of Appli.VConuacto1 Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliont or future Wilding AccuPant cam or bundle hazardous maurial
As dcBned by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safely
Code.Section 255324)T Te All roofs shall be inspected prior to any roofing material being installed.
Will the appbleamt or future building Occupant use equipment err devices which If a roof is installed without first obtaining an inspection,.I agree to remove
Ir hvaAom air ennumimnu u de0ned by de Bay Ara Air Qwliry Managcmcnt all new materials for inspection.
avictT �R�/ry�
0ym r-``a
Ihave mad the hasrdmu.=data rnlviremenu under Ch to 6.95 of the Calif..
nu Health h Safety Cade,Sections 2550.25533 oW 2594.1 unticimnd that iftho building
des rot cuo cro'haw a rte u my n ilnlity m notify thc otcupwr ar the
'm entswhichm metpiartekaaatccan Ile. err eapaney� Signature ofApplicant Date
��
Owner or Authorized atom Date All roof coverings to be Class"B"or better
'
Q. CITY OF CUPERTINO
REROOF
•CUPERTINO PERMIT APPLICATION
4/QC��D
APN# Date:
Buildmg Address:
0 5� 4.Z- t
wner's Name: Phone #:
-Z a z
Contractor: // Phone #: (05z)
u2 Fax #: (cSO SciS-ZVy'y/
Cupertino B siness Licens . Contractor License #:
Z/ y3 Z 30(1 d y�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles his Asphalt Shingles
❑ Wood Shakes /❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ems,-,-, ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
Residential Comme tial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: ..�
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
REROOF
�CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
Z1REROOFRES 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) hl-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: h 7
Job Site Address: �—
Roofing Company Name:
Applicant's Signature: Date:
. Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32647075 . 00
DATE ISSUED. . . . . . . : 01/11/2008
RECEIPT #. . . . . . . . . : BS000003669
REFERENCE ID # . . . : 08010066
SITE ADDRESS . . . . . : 10344 DEMPSTER AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NYGAARD JON 0 AND MAXINE N
ADDRESS . . . . . . . . . . : 10344 DEMPSTER AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1223
RECEIVED FROM . . . . : ROBERT DONEILO
CONTRACTOR . . . . . . . : DONEILO, ROBERT J LIC # 21432
COMPANY . . . . . . . . . . : SECURITY ROOFING INC
ADDRESS . . . . . . . . . . : P.O. BOX 2450
CITY/STATE/ZIP . . . : MENLO PARK, CA 94026
TELEPHONE . . . . . . . . : (650) 595-1213
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ------- --------
1BSEISMICR VALUATION 9, 250. 00 1.00 0. 00 1 . 00 0. 00
1REROOFRES SQ FEET 27 . 00 351. 00 0. 00 351. 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 352 . 00 0. 00 352 .00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 352 . 00 MASTER CARD
TOTAL RECEIPT 352,. 00 -
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
Community Development
10300 Torre Avenue
� Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS. _ PERMIT #
S41C c_ O( 00
OWNER'S NAME: -o ,o c 't�. PHONE # yOts 0/0-0- /3
GENERAL CONTRACTOR: FAX # (,gyp
I am not using any subcontractors: -
Signature Date
Please check applicable subcontractors 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
• —��—oeK
Owner/Contractor Signature Date