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04090020 CITY OF CUPERTINO � d 'BUILdINC DIVISION PERMIT GONTRACTgR INFbRMATION y; BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT No.04090020 OWNER'S NAME: PERMITISSUEDATE PRO E: SANITARY N O AOL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO SLOG ELECT PLUMB MECH 0 0 0 0 LOo LICENSED CONTRACTOR'S DECLARATION Job Description wp 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing P <W wish Section]QM]1 sf DivisiOnJof the Busine and Profession Com.endm license�./is LfeneCli t£ffeda� u al T/O EXISTING ROOF-INSTALL NEW �y z License m CSD Date canuacwr30 YR ASPHALT ROOF H C.s / QQ ARCDECLARATI N 2, 1 understand my plans shall he used as public recmo n J Licensed Pralfcausill5locca' 5 OWNER-BUILDER DECLARATION p 1 hereby affirm that I am exempt from ft Contractor's License Law for the Q o following mason.(Section 7031.5,Business and professions Code:Any city or rounty I $ which requires a permit to construct,alter,improve,demolish,or repair any suuava _ _mi prior in ib issuance.also oqumS the applicant for Such permit to rile a signed smmment FSC that he is licensed pursuant to previsiom of NC Contmwr's License Law(Chapter 9 Sq.Ft. Floor Area - Valu 0 ms- (commencing with Section TOM)of Division 3 of she Business and Professions Code)or .52 that he is exempt 0emfrom and de buss for sea alleged exemption.Any violation of ' Section 7031.5 by arty ap,li..tfor a permit subjects the applicant o a civil pcn.lIy of APN Number O 'gancy Type rot more Nen five hundred dollars($500). --y ❑I,uawmrafthe PmpenY•mmY employcm with vngnsutheir sole compensation. 32609056 . 00 V will do the work and the amour isnot intended oroffued for We(Sec.7044,Bmirmss and Professional Codc:The Conuacto's License law does lot apply to an owner of Required Inspections prapeny who builds or improves thereon,and who doessuch work himself orthough his own employees,provided that such improvements are,not intended or offered for sale.IL however,the building or improvement is sold within one Year of completion.he owner. Wilder will have the Isurdrn of moving than he did nos Wild or i.,,.for purlmse of SaIcJ. ❑1.u owner of the properly,am exdmively mm oloing with licensed muerm ds 10 construct the project(Sec.7044.Business and Profusions Code:)The Connector's Li- more,law dons not apply to an owner of poPeny who Wilds or improves demon,and, who contracts for such projects with aeonuaetor(s)licensed pursuant to tem Concactoh License Law. ❑1 am exempt under Sec .0&P C for this maton Owner Dam WORKERS COMPENSATION DECLARATION I hereby affirm under pn a ty of perjury arc of the following decWations: .bars and will maintain a Certificate of Consent to self-insure for Worker's Compcn- ution,as provided for by Section 37W of the labor Code,for the performance of the work for which Nis permit is issued. 1 have and will mummers Worker's Compewtion lou arm,u reyuimd by Section 3700 of the Labor Code.for the pcfforrearm of the wark for which this Permit is issued. My Worke's Com a sation/I'ns once artim and Polity numbly Cartier: ,T / u Paliry CER/TIFICATEOF EMPTIONFROMWORKERS' COMPENSATION INSURANCE ' (This section need not W completed if the Per In is farm a hundred dollars(SIM) or kss.) 1 cerdfy that in the perfurmance of the work for which this Permit is issued,I shall not employ any person in any manner so u to bemme subject o Ne WorkersCompensation Laws of California.Date Applicant NOTICE TO APPLICANT:if,after making this CeriBcmc of Exemption,you should become subject to the Worker's Compcnsaion provisions of the Labor Code,you moa .,O forthwith comply with such provisions m Nis permit shall bo deemed awaked. Zy CONSTRUCTION LENDING AGENCY [+�+ I hereby arms that them is a constmerinn coding agency for dle performance of C the wurk for which this permit is issued(Sec.3097,Cl,C.) Cg10 Lender's Name L endcls Address D Z U p 1 mnify that 1 have mad this application and sure that the above informadun is ' Igy P correct.l agree to comply with all city and county eminences and state laws relating to C� �U building cansuuNon,and hereby authorin mposenlaloes of Nis city To Inter upon the 4 ahove-arentiunad property for inspeeuon parrposes. (We)agree to Save,indemnify and keep harmless the City If Coper iso against F" N liabilities.judgmens,eros and expcmet which may in any way accrue against Said City U 2 iW_"' the Smming of this Permit DERSTANDS AND WILL COMPLY WITH ALL N -POINT Issued by: Date ATIONS /{V/7/_f//J/ Signature p m fur are Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building mcupant store or handle hanmous material u defined by the Cupenino Municipal Code.Chapter 9,12,and the Health and Safety Code.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes FVo Will thea applicant or future building t use equipment or dcvicm whim If a roof is installed without first obtaining an inspection,I agree to remove rap 6 oceupan a Air Quality it hazardous air contaminants u defined by Nc Bay Arca Air Gualhy Managcmcnt all new materials for inspection. sena? 1'' C Yes u 1 have nerd the h=am Sus m`amdals mquimmenu under Chapmr6.95 of the Califor- ri�HHc,lth&Safe CodeSmem.25A15,25533 andZ5534.l andcrsoundmifthc 'Jote M1.ve a tenank Nat it is my msPorshility to nadfy theoceuP n thch muahmn poor miuuancc ofa Cenifaam of lkcu Signa[ a pp IC Dale owner ar aamenmsd,sent D e All roof coverings to be Class"B"or better CITY OF CUPERTINO I• 2 of 5 PERMIT RECEIPT OPERATOR: suem COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . : 32609056.00 DATE ISSUED. . . . . . . : 09/07/2004 RECEIPT 4. . . . . . . . . : 26941 REFERENCE ID # . . . : 04090020 SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 11 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 OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL BPERMFEE VALUATION 16, 000.00 234 .36 0.00 234 .36 0. 00 BSEISMICRE VALUATION 16, 000.00 1.60 0.00 1.60 0.00 __________ __________ __________ ---------- TOTAL PERMIT 235.96 0.00 235.96 0.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ________ ____________________ 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603ROOF BATTENS 604 ROOF IN-PROGRESS CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION FORINT Oy6ft26 N# 3c2c2 Q Date o Building Address: Owner's Name: Phone#: (�✓�.f� 2c> � ;u �� /k)c b_o- Sll - 500 Contractor: Phone #: license #: Contact: Phone#: Cupertino Business License #: `b0 I ') 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) ❑ Other(Specify) Number of existing coverings 1 ❑ Provide I.C.B.O.Report# ,111 To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: b Description: o6F „Ps-a-u CW -7 /6' 0s3 /Ns%act ,veld 3v yewase"c of Residential ❑ Commercial To tN�Tcl-, E>c/ST)N)c Fire Zone: Yes ❑ No ❑ Confirmed with Planni e t. if there are any res i tons: Co e of Constructs Occupancy gr 7 �yI Qty. if A 1 ab e 1 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 CITY 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. S 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 r/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: ProP2f E i­S lAx i Job Site Address: ?D 16� g(�,/ ar�Gtecz rf Roofing Company Name: A plicant's Signature: Date:Z4/0 0 V Greg teal 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 Al e OWN== g 5-g . ......... ER ex Rom a 40.wo -&02 P in!