04090019 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACT�QR INk'ORMATIQNN
BUILDING ADDRESS: PERMIT NO.
DUBOIS ROOFING INC 04090019
OWNER'S NAME: PERMIT ISSUE DATE
Or E:
SANITARY OL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� O l� f�
woZ, LICENSED CONTRACTOR'S DECLARATION
u h SJob Description
w 1 bcreby lfrm tn nx
uI am lieed under previsions of Chapter 9(commencing
witcedust) )of Division 3 ofthe Businesam ofessions Code,and license is
„ bmnom neercat. Qjz30`d T/O EXISTING ROOF-INSTALL NEW
Z L 2 License us 3 LM.N
—v Dox Co.,., 30 YR ASPHALT
ARCHDECFSDECCAftigION
fk 1 uojcZnd my plans shall he used as public records
JyU 6
0.� Licensed Pmfcssional ,
3 OWNER-BUILDER DECLARATION
<x 1 hereby affirm that 1 am exempt from Be Contractors License Law for the
x o O following mason.(ScNan 703 1.5,Business and Pmfce ions Code:Any city nr county
$ which requires a permit tu cnnstruts,slur,improve,demolish,nr repair any structure
prior to its ismanm.also require the applicant for such Permit to Pic a signed mabment
Nat tie u licensed pursuant to Ne pmvisiouof the Contractor's Limnse Law(chapter 9 Sq. Ft. Floor Area Valu lOR082
usx (commencing with Section 1000)of OivuionJ of the Buxiness and Profruiom Cone)ar 17
in $ Nat he is exempt therefrom and the basis for the alleged eaemption.Any violation of
Section 7031.5 by any applicant for a permitmubjecs the applicant b a civil penalty of APN Number Occupancy Type
not mom Nan five hundred dollars(5500).
❑1.as owner of the pmpmY.m my employee with wages u their selc compensation. 32609056 . 00
will do Be work.and the structure Or not intended of offered Air We(Sox.7044,Business Required Inspections
and Pmfesomm"Code:The Contractors Licenselaw does not apply ban owener of q P
propertywho buildsorimproves thecon,and who so net
work himselfedNreugu his
ownhow a ar.the e,ping or i thm wmentpmold within ne arofintended completion.
orccrcd for sale.r- j
builder the Wilding or improvementis ildeiiinane you ofImprovfortheowner-
.it),r will Kase the burden of proving Nat he did not build or imPmw for puryome of
sal[.).
❑1.iuowner of the property. Business
contracting with licensed ommentbrsi /
com,La the project apply
704,L Business and Profusions Cade:)The Cs there is nd Q
come law dao not applyje an owner ur PULLmounts who sed p rc improves Berton.and
whocontactsLaces for such projects with a conttxtot(s)licensed pursuant b Be Contractors
License law.
❑I am exempt under Sec, .B&P C for this maven
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby aff under pera ty of perjury,one of Be following declarations:
ban and will maintain a Certificate of Consent to self-insure for Worker's Compere
son,an provided for by Section 3700 of the labor Code,for rhe performance of the
work for which this permit is issued.
❑I bases and will maintain Workers Compensation Insunncc,as required by Section
3700 of Nc labor Code.far the performance of the work for which this permit is issued.
My Worker's Compensati94 Insuran1cenricrand Polieynumberare:
Carier.ST4Te FVI�(�k poli ��o�.: l/b
CERnFICATEOFEXEMMON OVF' RROM) KERS'
/ COMPENSATION INSURANCE
(Thu section need not hecomplexd if the Ie.it is!crone hundred dmllae(51(X1)
or leas.)
1 cattily Nat in tie performance of rue work for which this permit is issued.I shall not
employ any pctxn in any manner an an in become subject a the Workers'Compermuon
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Cenifiea a of Exemption,you should
bacome subject in the Worker'a Compensation provisions of the Labor Code,you must
.J'aZ roMwith comply with such provisions or this permit shall be Lremcd rooked.
Z O CONSTRUCTION LENDING AGENCY
'r^+� I hereby affirm that then is a construction lending agency for the performance of
G' the work fur which this permit is issued(Sm.3091,Civ.C.)
n]A Lcoder's Name
O. Lender's Address
L)p 1 anify that I have mad bis application and main Nat Be show infatmatiun is -
ly PCorea.I agree to comply with all city and county ondinances and mute laws relating to C•/
V building convection,and hereby authorim mpresenmives ofthis city to enter upon Bic
Uj above memiuncd property for inspection purposes.
and
pless
ty of
F' � liabiliuuWjudgromms.co u and expee)agree to saw, nses which may in any waytattmc against said City
U z in consequence of the grunting of this Pcmot.
^ APPLICANT UNDERSTA DS AND WILL COMPLY WITH ALL NON-P Issued by: Date j
SOURCE REGU 1
Re-roofs
nue App ficin Con tar s
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building Occupant store or handle hvardous mammal
an defined by Nc Cupertino Municipal Code.Chapmf 9.12,and the Hc.10 and Sol
Code.Section 25532(x)? r�.G All roofs shall be inspected prior to any roofing material being installed.
❑Y N0
Will the applicant or future building occupant rex equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
t ha>amods air conmminants u defined by the Bay Area Air Quality Management all new materials for inspection.
vin?
❑Yes I Y;IIN.
Ihaw&Set the hvamhmsmau03,2 533 and 55oci under ChapudOutr 6.95 ifNe Califon
nixsrlthASafcyy Code,Secmuco 2urit is mymounmieli.l undersUs.0,andthm ifup Wilding (/
does not currently haw a tenant Nm it is my rcsporsihility u nnuly de«cupant of On
requiremcnu whi must be met prior b issuance ofa Ccmficau�fC up Siggnitu?re Of Applicant Date
ro autbon'rc 6cmDam
All roof coverings to be Class"B" or better
CITY OF CUPERTINO
® 1 of 5 PERMIT RECEIPT OPERATOR: suem
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32609056.00
DATE ISSUED. . . . . . . : 09/07/2004
RECEIPT #. . . . . . . . . : 26941
REFERENCE ID # . . . : 04090019
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 8
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS PROPERTIES INC
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : MARK DUBOIS
CONTRACTOR . . . . . . . : DUBOIS, MARK LIC # 20514
COMPANY . . . . . . . . . . : DUBOIS ROOFING INC
ADDRESS . . . . . . . . . . : 99 DUARTE AVE
CITY/STATE/ZIP . . . : FREMONT, CA 94536
TELEPHONE . . . . . . . . : (510) 793-9760
%E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW SAL
BPERMFEE VALUATION 20, 000.00 277.56 0. 00 277.56 0.00
BSEISMICRE VALUATION 20, 000.00 2.00 0.00 2 .00 0.00
BUSLIC FLAT RATE 1.00 100.00 0.00 100.00 0.00
---------- ---------- ----------
TOTAL PERMIT 379.56 0.00 379.56 0.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
________ _____ ______ __
305 FRAME _ 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
=� CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
7N# Date: ---
3a2� b as ? U
Building Address:
Owner's Name: Phone#:
(p✓t-le'Ccvv ' 6,50- ,s
Contractor: Phone #: ""license #:
D./r i i J_C,.u. fuc Sio �� 3 �:�,GC� _ T 6 ) Z_ 30�(
Contact: Phone#: Cupertino Business License#:
El/Ih2(0 �:,P�o� S 510 .�I� _ �f80�t
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
rcl'` Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
1 To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
illb Description:
raj OFF ( -7(ls7_i 1.,Al(es ,I�s;q r c e� 7 i6 ' 0s3 IA sS /veld 30 Ye,,j aSe"c 00F
Residential ❑ Commercial boF
Fire Zone: Yes ❑ No ❑ Confirmed with Planni e t. if
there are any res tons:
Coe of Constructs Occupancy gro"
Qty. if
Applj,C'ab)6j 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
Al Telephone: (408)777-3228
TCITY OF Fax: (408)777-3333
UPEkTINO
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.
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: Yfo I/ s 17���+/ ESS 1N('
Job Site Address: 20BOO Ftp nO S(Tea oT �P'e-tT
Roofing Company Name: K�or'`�� �►JC'
A phcant's Signatlzre:`'"�' Date: 1V7O
eel /
Greg t
Building Official
Revised 1/30/03
Printed on Recycled Paper
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building Department
REROOF TEAR OFF POLICY
1. You must schedule an inspection for the tear off the day before
you wish the inspection to be made. The procedure is to call the
Building Division (408) 777-3228 between the hours of 7:30 a.m. and
4:00 p.m. to request a next-day inspection.
2. When the roof is torn off, the nails have been removed or driven in,
and all of the dry-rotted wood has been replace, you must call the
City Building Division. An inspector will be there within one hour.
There are special hours for this service: from 7:30 a.m. to 10:30 a.m.
and 1:00p.m. to 3:30 p.m., Monday through Thursday and from
7:30 a.m. to 10:30 a.m. and 1:00 p.m. to 2:30 p.m. on Friday. (Note:
Building inspectors are on lunch break from 11:30 a.m. to 12:30 p.m.
and will not be called during that time. City Hall is closed between
12:00 and 1:00 p.m. daily.)
3. If you call for a tear-off inspection and the job is not ready, you will
be charged a re-inspection fee of $176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
Greg Casteel
Building Official
Revised 8/13/04
Sias ®®
3v.
'k WWI
FF R
I Ml
�T''cbin5$'�vetpf .sd,�►/ 5-p LK �.N�`t'
lrar R�.+'lsfi� �• y".r'"9'aiyv' -�'a .'�t*" ., •_.
' `"'fffi�.urrL ��� fi OY �m� 15itffi'
Emma
r
®
dH - ® ,t
e .Y�
8 „`f4-