04090021 CITY OF CUPERTINO ' `- a
BUILDING DIVISION PERMIT CONTiUCTORINFORMATIO N:;¢
--
. BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT NO,04090021
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS PROPFRTTFR INC 99 nuARTR AVE
E:
SANITARY NO. CONTROL NO.
(510) 793-976Q
ARCHITECTrEJ,GINEEI
10 79 -
ARCHf1ECfyEtIGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 E 0 0
+�io0 LICENSED CONTRACTOR'S DECLARATION
I M1emby affirm Nal l em IimnseO under provisions of Chopmr Y(commencing Job Description
win 7gX))of Division3of NC Businesan Profusions Codc.end myliccnu is
Coml
or Li nano 81z3�y T/O EXISTING SHAKES-INSTALL NEW
D vv{ in fid Clus �Lk.p
nFn Dam 30 YR ASPHALT ROOF
pRCHITELTSDEC RATION
ersund my plaits shall W used u pre is records
DyU
3 u•� Licensed Pmfcssional
aG OWNER-BUILDER DECLARATION
yip 1 hereby affirm mal 1 am exempt from On Comracmrs License Law for the
¢p 0 following reason.(Scetion 7131.5,Business and Profession;Cc&:Any city or county
K S ff which require a permit m e.,.eller.improve,demolish.or repair any strucmre
-;N poor to its iYuarm,also mOuima the applicant for such Permit to file a signed summers
s shat he h licensed pursuant la the previsions of the Contractor's Liana.law(Chaplcr 9 Sq. Ft. Floor Area Valu
2ytl�3g475
ac (commencing with Section 7")of Division Sof the Business and Professions Code)or .
y _ Nm be,is exempt therefrom and the basis for the alleged eumpuan.Any violation of
Section 7031.5 by any applicant for a Permit su y,eca the applicant o a civil penalty of APN Number Occupancy Type
not mom Our five hundred douses($500).
❑I.ssownuafthe propeny,mmy cmploycu with wagessdmir sole compensation, v 326090556 ' 00
will do Orwork.and me structure is not intended or named forage(Su"]toll.Business Re uired In eCt10Ds
and Professions Code:The Conuarmr's License law dose Out apply to an owner of q P 2�
propenywho builds orimprovu thereon,and who does such work himself or through his
awn employee, or offered for sale.IL
however,the building or improvement is sold within one year of completion.Ne owner-
build.,will have the Widen of proving mat W did not Wild or improae for purpose of ♦\/�+/
sale.).
❑1,as owner of the propeny,em exclusively convening with licensed mntracmrs to
construct the pmjca(Sec.7004.Business and Profusions Code:)The Con mmear's Li"
=rise law does not apply to an owner of property who Wilds or improves Iheroon,and,
who contracts for such projects with a comracros(s)licensed pursuant in the CommctoYs D `�
License Law. V
❑l am exempt undo Svc. ,B&P C for Nis ream;
Owner Dare
WORKER'S COMPENSATION DECLARATION
1 hereby offum under penalty of perjury one of the following decimations:
l have and will maintain a Certificate of Consent m self-in.sum for Worker'sCompen-
sation,as provided for by Section 3700 of the labor Code.for Ne performance of the
work for which this permit is issued.
0 I have and will maintain Workeh Compensation Lison;..,ss required by Section
37W of On labor Code.for the pu formanec of the work for which Nis permit is issued.
My orkers C.impetus 0 Its am ciumI and Polirynumner ac:
Pat �
s
CERTIFICATE OF EXEMMONFROM WORKERS'
COMPENSATION INSURANCE
(Thu seeNm recd not W eomple¢d if dm permil is forum hundred dollars(Slip)
or mss)
I certify Nat in the performance of the work for which this Permit is issued,)shall not
employ any person in any manner an as to become subject a the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Cenifieam of Exemption,you should
become subject to Ne Worker's Compeesation provisimu of On labor Cram.you moa
.J'Z, foMwlth comply win such provisions or Nis permit shall W dimmed revoked.
Z O CONSTRUCTION LENDING AGENCY
F. I hereby anm Out acre iso construction lending agency for the Performance of
!Y 7
one work for which thin permit u issued(Sec.3097,Co.C.)
Q Isndcr'. Namc
4. Lenders Address
U
C) I 1 ranee that 1 have read this application and sin a Nn dm above information is
(y U concis 1 agree to comply with all city and mums ordinances of and some laws relating e
OfJ abovengconstroaioaend hereby euthonpurporcsenutives of this city to enter upon the
r above-mentioned to raft for inspection
itify an purposes
(s ju agree to save,indemnify and keep harmless the City of Cupertino against
FoeZ incoiduuence f u,msuang expenses which may in any wayaccrue agaiwuid City
t..3z in coluequencc of NC Stunting of his permit.
^ APPLICANT UN TANDS AND WILL COMPLY WITH ALL NON Issued by: Dale
50 CE TIONS.
Re-roofs
rgnuum ofAppl¢aHAZARDOUS MATERIALS DISCLOSURE oto Type of Roof
Will ft applicant or future Wilding decorous mom or handle bmudous material
as defined by Ile Cupertino Municipal Code.Chapter 9.12.and the Huln and Safety
Cadr.Section z5533(a)? kk..,,�� All roofs shall be inspected prior to any roofing material being installed.
❑ye yp nu
Will the applicant or future building occupant use equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove
emit havardous air contaminants as defined by rte Bay Area Air Quality Management all new materials for inspection.
District?
p Yes xll
Ihave&Safet nehvardne m 505,25533mmcnu under d:mmd P95 ut
NC Califor-
nue no, &Safny Cook.Scene. and 25534. undcrsuntl Nat iflW WilJin .0
does not cunni] a tenon,nut it is my malmin I diPF
el moceuporofmrequircmc us"WmelpriortoismonmofaceOcmpan.r. Signature of Applicant ate
caner or aumorix as.nt Dam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
1• 3 of 5 PERMIT RECEIPT OPERATOR: suem
COPY # 1
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 32609056.00
DATE ISSUED. . . . . . . : 09/07/2004
RECEIPT #. . . . . . . . . : 26941
REFERENCE ID # . . . : 04090021
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 7
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
i
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
10-'E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
BPERMFEE VALUATION 13, 000.00 201.96 0.00 201.96 0.00
BSEISMICRE VALUATION 13, 000.00 1.30 0.00 1.30 0.00
TOTAL PERMIT 203.26 0.00 203 .26 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
- p REROOF /
CUPERTINO PERMIT APPLICATION FORM
+PN# 3� D �7 C� Date 7 0
Building Address: (/C�
2U O o T Cti a"A 1^ f [ « son #: c "s
Owner's Name: Phone#:
(�,✓, x:f� PU � .vFP,I ko S3o�
Contractor: Phone#: icense #:
Contact: Phone#: Cupertino Business License#:
[1/Ih2l� ��, 5 Sro 1►�{ X18 Dci
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ,2r;' Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
ob Description:
r qW ��,ST 5 �I�es ,>,sra u ee� 7 ib os
i ai3 INsrv,�,c A-mej 3v eAt aS9tiiCT" of
Have
❑ Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Plarim e t. if
there are any res ,ons:
Cosu-p c t e of Constructs Occupancy gr 7
`1"7-s.
Qty. if
App 1 ab e` 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
i Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
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: �f o^�c�2v s r f 0f eA rrj C
Job Site Address: 20(500 STe4/G� C�P�/iT""y
Roofing Company Name: JJge '� uob�'^�7 / !AI-c-
A plicant's Signature: % Date: � a
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
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