06060185 CITY OF CUPERTINO ax
BL%LDIN'G DIVISION PERMIT +CONT.RACIQRINI
BUILDING ADDRESS: MA OTO PETER PERMIT N0.06060185
10560 S FOOTHILL BLVD
OWNER'S NAME: PERMIT ISSUE DATE
MATSUMOTO PETER 06/20/2006
NE: SANITARY NO, CONTROL NO.
ARCH=IENGINEER: BUILDING PERMIT INFO
BILDO ELECT PLUMB MECH
tI
u o p LICENSED CONTRACTOR'S DECLARATION
m 1 hereby affirm Nat I am licensed under provisions of Chapter 9(Commencing Job Description
iNSCcllon]BfSB.f DiWmm�3afNO BusiM..�nd Prm&ai mCodA.aMmyliccamis
+�
into,
REMOVED SHAKES - INSTALL OSB 7/16 50 YEAR ELK
;M= Lioma Lm.. z?
;- �camracmr � CLASS A
C ARCHrIECrSDECLA A ON 1000FlA1� ROYAL KNIGHT ROOFING INC PAID FOR BL 6/20/06
a understood my plana Mail be used n puhlic nu mus
G Licensed Professional
OWNER-BUILDER DECLARATION
y I hereby IMM that 1 em excmpt from the Contractors License law for the
O O following random.(Section IID 1.1,Business and Pmfcssians Code:My city or county
ZOO
9 which requiros a permit to Construct,albs.borrow,dcmolsn,or repair my structure
-m prior.its issuance.also requires the applicant forsuch permiva file asigned statement
< that he is licensed punuantlo Nc pmviabom of the Contractor's license Law(Chapter 9 Sq.Ft,Floor Area Valuation
Y O (commencing with Section 7000)of0ivWon3offtInstruments!Prafessiona Code)or $14000
9 that he is Astoria tia tiro n and Ne bas for the alleged csempdon.My violation of
Section 7031-5 by any applicants for a permit sub*11 Use applicant to A Civil PmAftY orAPN Number Occupancy Type
not mom titan In hundred da1Ws(55001
❑1,a owner of the property,or my employees with wage As their ick compensation,
will do the work,and the structure 6 not bterbed or offered ranale(Sm.TOM.Bunneu Required Inspections
and Protestant Cada:The outracmfe LiCenY Law docs act apply m!n Maur of 9 P
propertywhm builW mrimpsowa Ncrecn,and who dmenen wart himAelfm WoaNhs
owmemplmyem,provbedNatsuchImp..utaeotim mm@redfwsale,If.
however,the building or Improvement is sold within ane Kar ofompledon.the owner-
builder will have the burden of proving Nm he did not build a improve for purpose of
ale.).
❑1,as owner of the property,am exclusively conaadng with licensed Conaacras to
Comtauct the project(Sec.7044.Business and Pnefeolms Code:)The Comranofs Li-
cense law does oat apply to An owner of property who bulbs or improves ft..and,
whoonuac4 far ouch pmjeas with a eanvawr0)Ilunmd pmvwsam heth COnuactors
Deme Law.
O lnmaemptunder See .B&PCfmrthiareoon
Owner Data
WORKERS COMPENSATION DECLARATION
1 herby anno under penalty of perjury me of the following declatNma
1 how and will maintain A Cenifiem of Consent to self-insum far wmkels[ompcn-
ation,An provided for by Section 3700 of the Labor Code,for the performance or the
work for which this permit is hued.
0 1 haw and will maintain Workers Compensation Inmtrana,As required by Section
3700.f NC Labor Code.for ft performance,ofthe were for which this permit is lased. .
My Wor�C[ Com Permanent ran ..cr and Policy nnu�Au��msan,art:
CartieOtFA TE F KD PolicyNo.:600 96 9
CERTIFICATE OF EXEMPTION FROM WORRIERS'
COMPENSATION INSURANCE
(This action need not bC completed U f Permit Is far one hundred d.nass($100)
ar lea)
1 certify dict in the performance of the work fm which this Permit is bound.I awl Am
employ any person in any manner an As to become subject to the Workers'Compenwion
Laws of Cali(mmta.Data
Applicant
NOTICE TO APPLICANT:IL after making Nu Certificate of Exemption,you Almond
become abject to Ne Workees Compensation variations of time labor Cade,you muse
0 O forthwith comply wife such provisions m Nu permit shall be deemed re aked.
tiCONSTRUCTION LENDING AGENCY
F-t Thereby arrim that thea is a construction lending agency far the performance of
tYiNe work fur which this permit 4 issued(So.3097,Cl,C.)
94 0 Laadefa Name
7 Z Lendee3Addrea
U O 1 certify No 1 have read this Application and sum that the above inflammation is
1..V correct.I agree to Comply with all city and county ordinances and sum laws aiming Ice
OU building comuuctim,and hereby Ruthann mpmsemmiws of this city to enter upon the
I31 ahow-mentioned property for inspection purposes.
G3. (We)agree m ave,indemnify and keep harmless the City of Cupertino against
C") liabilities.judgments,toss and expenses which may in any way arm against said City
(„)7in c.susa— ofthegratingof Ns permit. / / 9
r� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date !JY
OUR
610 06 Re-roofs
Signature of AppBanuConuacmr Da
HAZARDO ATERIALS DISCLOSURE Type of Roof
Will tie applimnt m fat building mceupamsmre a handle heardum roam"
as defined by the Cuperdem Municipal Cade.Chapter 9.11,and the Heahh and Sally
Code,Section 11533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes pwlo
Will the applicant Or future building occupant um,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emir hra ndnns air omaminrsta a infaN by Oe Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea P140
I ban mad the hsssednmmateriW requirements under Chmmr6.95 ofthA Califor-
nia Healed&SAIeryCmde,Sectims 25105,25533 mm25534.1 understand thmtfthe building �ar/�!�� 2�
dura not curently haw a moan.that It s my msponsthility in notify than notseupant or the
mi nuwn
be pWarm mart3rcuPan Signature of Applicant Date
Owner oramh.dud agent DJO All roof coverings to be Class"B"or better
aClOF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
GVUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
10,T610 Sr FeorfflLL iSLYO. 0 0 00 1
OWNER'S NAME: Fx7jFg M,477swmord PHO #V091241— 7/6 a
GENERAL CONTRACTOR: pNCiCj1H7- N
OOF 6 FAX # qv? ,2gS—1 QYS
I am not using any subcontractorsl: zi , Z O 10,g
Signafure Date
Please check applicable subcontractors and complete 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35705018 . 00
DATE ISSUED. . . . . . . : 06/20/2006
RECEIPT # . . . . . . . . . : 34954
REFERENCE ID # . . . : 06060185
SITE ADDRESS . . . . . : 10560 S FOOTHILL BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : MATSUMOTO PETER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BOB EFANTINO
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : MATSUMOTO PETER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
OEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 14 , 000 . 00 212 . 76 0 . 00 212 . 76 0 . 00
BSEISMICRE VALUATION 14 , 000 . 00 1 .40 0 . 00 1 .40 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 319 . 16 0 . 00 319 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 319 . 16 VISA
TOTAL RECEIPT 319 . 16
•
CITY OF`CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 35-7
^ J G
0 , -. DI Date: Z O
Building Address: l! (J 1 —
Owner's Name: Phone#: 2 51- 963)1
409 :241- 7/60—
Co actor:
License#:
G DOE a c C-37_,qqS_711
Co ct: Cupertino Business License #:
ARVOV 2-.2-1-570-
Type
2 —5 0-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
ja Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 2S ❑ Provide I.C.B.O. Report#
JR To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
KsmDOHD S A Es NS'TA L_ DSS %' 50 JIR E<K C,/ASS
Residential S Commercial ❑
Fire Zone: Yes ❑ No p�- Confirmed with Planning Dept. if
there are any restrictions: LJ
�ost of Project: Type of Ctruotion: Occup, gr :
000 ��
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) h1-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: / ATAR MATSIM40TO
Job Site Address: IO-56o F9o7w1LL t5L.YD,
Roofing Company Name: RoML 10N/6NT KgoF/N6 CO, ZNC,
Applicants Signature: Date:
• Greg Casteel r
Building Official
Revised 11/2/04