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06090100CITY OF CUPERTINO " - L]'UILDING17IV]SION PERMIT BUILDING ADDRESS: LOS GATOS ROOFING PERMIT NO.06090100 21911 HERMOSA AV OWNER'S NAME: PERMrr LSSUEDATE FELDMAN JAN 888 FAULSTICH CT 09/14/2006 NE: SANITARY NO. CONTROL NO. (408)298-9399 ARCHITECrfENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION IOb D05CrIpI100 tamby aff ow Nal I am account under previsions of Chapter 9 (commencing FI wrN Smcuan 7gk5)af Divufon3afNC Business and ofeuiuns Code. and mylicenseB aradic, once erfe�C',gt %0 REROOF— REMOVE EXISTING SHAKE ROOF. INSTALL � L n °iss u`'A Dam Conmman ROOFERS SELECT FELT AND PRESIDENTIAL TL SHINGLE A IlE(.TS DE1 24 SQUARES. CLASS A < I untlentand my Plans shall he uxd uplaw uhlic maards Licensed Pmfaaional OWNER -BUILDER DECLARATION I kmhy alarm I em exempt from Contractor's License Law for the C C Co fallowing mason. an Pr ns Cade: Any lily or county Roman Business and Pe. ♦mi permit A ells. Improve. dear ore sig any ewctum which mtsisaneesmh moues each A also requires the the for such i to Ch emem Is issuance. re file a signed (Chapter Licenseeems,uper9 Sq. Ft. Floor Area Valuation of Nathelslianwit purhamt reale provisions tf the actor' L he MALp Me Business Code) or war9 ncal Sc 1 of r as Ne Buunessand $7644 osis f on. Anyone Wt k e esempt NCRlrem and Ua baso for the ule{ed emmptfon Any violatlan a! last ho sumpt from and APN Number Occupancy Type Sudors 7031.5 by ury sppleaut fm a permit mbjull de aPplkant be • civil Penalty of not mart than rive hundred dollars ($500). ❑ Lu owns of the properly, army cmployea wOh wages u heir mle compensedon, will to Newest, and the stroctum is not mended aranesed forule (Sec.70W,Busircas Required Inspections -1 and ProfeYlOm Code: The COMAc1 to LiCRY LAw deal not apply be m "am a! employ Wip whotlanauchwork hf. C oraelfarNrough idedprovuch Immma .we such Improvements art not oranerW formic, f. own a a, provided ou of r. however, Nebuilding orImprovementuhathe within year of mprowfrtheowes- er. Me pr O Am builder will hen the burden of pmWng that k did ret Ndlh a improve fa purpose of sale.,. ❑ I, as tweet of ca pm. 7rA.. Business si elynd! cantessi na wbh ) Tim Ccan0n"s re canswct prefect (See. 7014,serfAnd! Py ns Code:) Tim Corsuxrer'a U. L/ / 7 Q/ wito Norton, anh, come Law does not apply man owner of properly who halms at d / roue w has for each projects; aiNacamantrtglicenseri Puuamm Ne Conmmtora whence 'D Lacta License Law. ❑ I am uempt under See , B Jr P C for this mason Owns Dam WORKER'S COMPENSATION DECLARATION I hereby, &Rbc under Penalty of perjury am of Ne following dslamtioa: I have and will maintain a Catifram of Consent self-lowre fe, WariCompen- moran, As provided f" by Sudan 3700 of de Labs Code, for the performance of Ne work for which Nie permit is issued. ❑ 1 have and will maintain Washers Compensation Wurance, u mquimh by Schen 3700a(Ne lsbar Cade. fa the purfmart. of the wast for which Nu permit is ' My Wo s Compensation lamucce lunar and Policy number art: �}AB Carrier: 7 PailcyNo.: Dob '1 CRT • CATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section modest he completed flak Palmer is forme, hundred MAIN ($100) or lass.) 1 unify Not in the pulorm s e of Ne wart for which this permit is iesued. I shall not employ any Woman in my maresm As b hemmc subject to the Worker] Compensation Laws of CaliftmiA. Dam ApPlicmt NOTICE TO APPLICANT: If. AMr making this CeNOcme of Exemption. you should become subject m Ne Workers Compema0on provisions of Ne Lsbar Cade, you moa z fonhwin comply wild Men providmet or Nis permit Mall k deemed hawked. CONSTRUCTION LENDING AGENCY > 1 hereby affirm Nat Nem is a combustion lending agency for Ne Performance of .., the work for which Mus permit b ineW (Sec. 3197, Co. C.) Lenders Name Q Lcndaes Add= z Q 1 comfy Nu I haw read was application W sum Nu de above infomuuun is f" coma I agree to comply with all city and county ordinances and cue laws relating an U building construction, and hemby aurhoriw representatives or his city to cnmrupnn the shove-racruaned property for inspecuon purposes. W (Wc) agree to cave, indemnify and keep harmless Ne City of Cupertino against raj, Iimaida,judgments, core and expenses which may in any way mcom agaimtsaid City in canarqunen or Ne granting or this permit. APPLICANT UNDERST WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCFARE LA^ ^ Re -roofs ���M a7 Signor ren Ol'Applicamn0mummur Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the apPliamor future building arupantvore"handle howdowa mmanal u deRnch by the Ommame, Municipal Code. Chapter 9.12 and tie Health and Safety Code, Sada. 25532007 �y �V All roofs shall be inspected prior to any roofing material being installed. [3 you No If a roof is installed without first obtaining an inspection, I agree to remove Will am applicant car fo ure building occupant um equipment or devics which emit haurdsses air c"taminmte As denrsetl by the Bay Ams Air Quality Managcmcnt all new materials for inspection. Duraict7 '''��-���vvv ❑Yes 7y Nu ////wu���m=dalsmqulmnr Ihavemal thehmash under Ompmr6.95ofNe Califon nu Ha1NSSafetyCode,Sa-i" 25505.25533and25534. 1undcamond buifNe Wilding des not currently haw a arms, Nat It Is my responsibility in notify the weapon, of the myulmmcnu whi I must k met Prior an issumm oft CcNfmamysosa 1b, Signature of Applicant Date % 7 r "B" All roof coverings to be Class or better own" anutharbnd a t oam - !m 2 of 2 %EE ID BPERMFEE CITY OF CUPERTINO Fi*CIuFi17�[4�Fl�IS Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35716136.00 DATE ISSUED.......: 09/14/2006 RECEIPT #.........: 36041 REFERENCE ID # ...: 06090100 SITE ADDRESS ...... SUBDIVISION ....... CITY .............: IMPACT AREA ......: OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... 21911 HERMOSA AV CUPERTINO FELDMAN JAN OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: LOS GATOS ROOFING CONTRACTOR .......: RANDY BROWN LIC # 23481 COMPANY ..........: LOS GATOS ROOFING ADDRESS ..........: 888 FAULSTICH CT CITY/STATE/ZIP ...: SAN JOSE, CA 95112 TELEPHONE ........: (408)298-9399 UNIT QUANTITY AMOUNT ------------- ---------- ---------- VALUATION 8,000.00 147.96 VALUATION 8,000.00. 0.80 TOTAL PERMIT : 148.76 PD -TO -DT THIS REC NEW BAL ---------- ---------- ---------- 0.00 147.96 0.00 0.00 0.80 0.00 0.00 148.76 0.00 METHOD OF PAYMENT AMOUNT I I NUMBER ----------------- ------------ ------------------ CHECK 275.72 1794 TOTAL RECEIPT 275.72 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.progressinspection 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. 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: --\, )," M a -)i .—Job -Site -Address:- . Aplicant's Signature: Greg teel • Building Official Revised 1/30/03 Printed on Recycled Paper Date: *COF •CUPEkTINO • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # ©G o For Q6 OWNER'S NAME: PHONE # `/D 9 2.S % Z/ GENERAL CONTRACTOR-,fos FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and "comulete the following information: Owner/ Contractor Signature Date 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 Septic Tank Sheet Metal Sheet Rock Tile Owner/ Contractor Signature Date 0 � CUPERTINO APN # CITY OF CUPERTINO OUM 0100 REROOF PERMIT APPLICATION FORM S . / _ I lD — / l p BUILDING Date: Energy Building Address: �_.--- -----.--._. BIBM---- ___---_----_ a)911 H errno5a BUILDING Owner's Name: �. . Business License BUILDING Phone'#: Jam 4e Id 01 p e25 2 / 3 Contractor: Phone #: 0 License #: gQ��O Contact: ��- Phone #: Cupertino Business Licen a #: Sa,09e_� 358 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) zi Other (Specify) Number of existing, coverings I ❑ Provide I.C.B.O. Repod# To be Removed Provide Mfgr. Installation Specs. I Have Read, Understand and Will Co ly With Cu ertino's Tear Off Policy: Jo Desc •ption: ,- � f Residential Commercial E] /�1c�+ 'Y-4 SQOr�cl Fire Zone: Yes ❑ NoZ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project Type oConstructi Occupancy group: y oIng �9 Qty. if Applicable Fee ID Fre. Dperrintinn BPERWEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING �_.--- -----.--._. BIBM---- ___---_----_ ---BiJfbDING-- _.._ BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING