06060206 CITY OF CUPERTINO ,�
BUILDING DIVISION PERMIT RC�FdTRAC`I°aORI�FTFORMtT{IgNb
BUILDING ADORESS: SILICON VALLEY, ROOFING PERMRN006060206
18700 HANNA DR
ER'S NAME: PERMIT OUR DATE
MIKE CHABA 2988 NEAL AVF,, 06/23 /2006
PHONE: SANITARY NO. CONTROL NO.
(408) 615-7200
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO EO mums MEOC14
30o LICENSED CONTRACTOR'S DECLARATION I IOb Description
V 1 bom N
mby affirm i am Ikenad under provisions of Chapter 9(comen
mcing P
with Section 7000)of Division 3 afthc Business and Prefomoa Cade.and my license is
efallfaroc end err b3Z38 REMOVE ROOF INSTALL .1/2 PLYWOOD. INSTALL 30LBS
Z Ucenu CI Lk.a
Conk:wr INSTALL 30 YEAR COMP CLASS A �^�
a yyo ARCHITECTS DECLARATION ��� /j as
2 I understand my plans sMell be used u public ranrds IWpi Y{�WRff{_�'@4'0Yf
W Licensed Pmfessianal
OWNER-BUILDER DECLARATION ^^l
zo 1 terehyssstuns that 1 me exempt from the Cmtanaes License Low for it �U�T�
O following reao.(Section 703 T.5,Business and Prolasom Coe:My city or county /Z
Ile Which requires a pormit to mmsteam,after.improve,demolish,Or repair any structum v
_z y prior to in issuance,also require Ne applicant Our each permit to file A signed atakmcm
F O
that heWiconedpursuootkfprovisiaaofdiContractor''s iartulaw(Chip.9 Sq.Ft.Floor Area V luau 8 00
x� (aneOdes with section 7000)or Division 3 afthe Businusand Professions Code)Or
ilf 5 g— Nat Min exempt Uncertain and the basis for the alleged exemption.Any violation of
Secdon 7031.5 by any Appliant for a permit eabjeeu W applicant Is a civil penalty of ,l�pp'7��`r Number -0c ftc!p
not more than five hundred dollars(5300). 3 /�G 9054 . 0 0
❑1,m m m of Ue pmpaty,m my wploym wlth wages m Nek mle=pewdon,
w d Prafe work,and Ue o Comm roe's Liam
La.does not
apply.70 N,Business Required Inspections
and erywh bis Casio:rM Conoecwfs License Law dm not apply lf an owner of q P
propertywbobuilWviimprovesch impr endwM dm such winkhimselfed through hu
Own emplaym,provlad prouchimproaid within
not armt.aoplud a.fm WeIL
however.the buildingmimprovementu saidwithinm yearorimroveforsheawner-
buildu will Masse Uhe WNoo of proving Nat sa did nm build or improv Car PUTau of
ssk.).
❑1,As arm of the property,am exclusively ennancting with liamsd oonuattors in
corutm n the project(Sea 7014,Business and Professions Code:)The Commences U.
tense Law dm not Apply to an owner of property who Wilds or Improves tharean.and,
who contracts for each pmjcm with a emuxethr(s)licensed puruoot be the Cantm toes
License Law.
❑1 areascmpt under See. .B k P C ferNu realm
Data
WORKER'S COMPENSATION DECLARATION
I hemby aMan under penalty of perjury arta of the following decluatimas
Q Ihaveand"lmainWoaCeN wof Camentwulf-immfw Wurke sC=m-
swim.a provided for by Sc den 37M al the labor Cade,for Na perfarmance of Ne
work for which this permit is issued.
Q 1 save and will maintain WafMes Compensation Issuance,u w4umal by Section
37W of the Labor Cak,far the perform nk.of Ne work forwhich this permit is Issued. '
My Warkeea Compensation Issuance carrier and Policy numbur are: 2
Cartier.4T-LF.re Fu N/) Policy Na.: 8�I f� I'i�
CERTIFlG7E OF IXEMP LUN FROM WORKERS'
COMPENSATION INSURANCE
Crisis Auction need not m completed time permit is forme hundred do0ars(51 W)
ar less.)
I certify Nur in the performance of the work for which this permit is issued.l"I not
employ any person In any manner an As in become subiact in the Workcrs'Compensmon
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If.after making this CnnifIcate of Exemption,you should
become Subject th the Worbeea Compensation previsions of the labor Coda you mut
.JO faMwiN comply with each provisions or Nu permit"I be dronevo
d mked.
Z CONSTRUCTION LENDING AGENCY
t—� (thereby M.gain ileatea commuctinn kndingageay for de perform.of
ai Ne wort fur which Nu permit Is usual(Sec.3097,Civ.C.)
Q Lessees Name
]Z Leaders Address
U0 I cmtify Net I haw rad We application and sum,that the above information is
fL F
correct.I as=to Comply with all city and comity ordinances and a=laws relating th
0 U Wilding consuuciioa and hemby authorim mpreusutivu of this city in enter upon Ne
W abort-momiamd property for inspeeuon purposes.
LL (We) C.to taw,indemnify and kap Moral.tee City of Cimenino agaiut
.,,
IA Ilabilitiu,Judgmeau,coati andexpensea which may in any way accrue:against said Cityin
U•77 LAof the ERNANDranfing of s permit.
WILLAPPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signature of AppllaData
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the CupootmfMuni builMunicipal
Cge.ChantstoreorAnd Health
althArdous material
deflnN by Ue Cupertino Municipal Cade.Chapter 9.11,and the Hesith and Safety
.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya P",
WIII the applicant or Iowa Wilding occupant me equipment Air mor devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit huardna Air canlamianta u deRned by din c Bay AAir Qu11ty Maagement all new materials for inspection.
DisuicA
❑Ya aft
I have:real the hvaadaamatariau requiremcrw under Chapher .95ofUeCalifor-
nis Hafih&SAfelyCode,Sutiw25505,25533 and 25534.1 understood Natif the Wilding
dm not currently hew a he000a that,It Is my mspmetbaity in notify de occupant of de
re ulremcn"which must W met prior tolsswncc ora Ccnirwak of Signature of Applicant Date
la Z p
OWne a,wthamsdagent D te All roof coverings to be Class"B"or better
aClOF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
PE�T'ANO
Fax(408)777-3333
C 1 '�1
Building Department
JOB ADDRESS: PERMIT S d 1-0
OWNER'S NAME: W, PHONE # �a I
GENERAL CONTRACTOR: Ecc FAX # P(ob• )27 O
I am not using any subcontractors:
Signature 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
23 ®�P
Owner/Contractor Signature Date
• CITY OF CUP ERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37529054 . 00
DATE ISSUED. . . . . . . : 06/23/2006
RECEIPT # . . . . . . . . . : 35007
REFERENCE ID # . . . : 06060206
SITE ADDRESS . . . . . : 18700 HANNA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MIKE CHABA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : PAUL HORSAGER
CONTRACTOR . . . . . . . : PAUL HORSAGER LIC # 23342
COMPANY . . . . . . . . . . : SILICON VALLEY ROOFING
ADDRESS . . . . . . . . . . : 2988 NEAL AVE.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
• TELEPHONE . . . . . . . . : (408) 615-7200
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 10, 000 . 00 169 . 56 0 . 00 169 . 56 0 . 00
BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 170 . 56 0 . 00 170 . 56 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 170 . 56 VISA
TOTAL RECEIPT : 170 . 56
•
CITY OF CUPERTINO
XC 17
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3- 15f 2 � u��f� I
Date: Z ��
I
Building Address: ( B 00 fAP rJ N C,_
Owner's Names - • 1 1� CAA Phone#: i YG I9^ Y�
Contractor: � License#: p 1 30
Contact. _ Cupertino 3-5 Business License #:
Type of Roof Covering:
Existing: Proposed:
W- Built-Up Roof wr�. Built-Up roof
"t
$L Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings_� ❑ Provide I.C.B.O.Report#
1k To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential JXCommercial OU
, M
Fire Zone: Yes No Er Confirmed with Planning D_pt. if
there are any restrictions: LJ
Cost of Project: Type of Construct Occupancy group:
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) 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. r' 2
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 w(i'th the above stated policy on re-roofing.
Homeowner's Name: 1` �1 V�Z � �
Job Site Address: 0
Roofing Company Name: z Cc>
Applicant's Signature: Date: I 3) o 1p
• Greg Casteel 1
Building Official
Revised 11/2/04