06090163 CITY OFCUPERTINO +
BUT'—'DING DIVISION PERMIT �-CONTRAC-T,O I(`FORMATION '
Pc s c4'L+t.%Ar.7nA_ �m.? 7m%x
BUILDING ADDRESS: D ROOFING INC PERMIT NO.O6O9O163
20800 HOMESTEAD RD 14
OWNER'S NAME: PERMIT ISSUE D
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09A721/2006
NE: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHn-ECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
:pp LICENSED CONTRACTOR'S DECLARATION Job Description
U C 1 Mreby affirm Nal 1 am licensed under provisions of Chapter 9(commencing
with Sued..70M)of Division 3.f the Business and Pmfcsaiime Cede.and my license is
ecce nm0fareead ifcct./ 8tZ -3py REROOF- TEAR OFF FLASHING, (N) 3OYR DIMEN. COMP
OVER (E 1 LAYER N RIDGEVENT, GUTTERS & DOWNSPO
i F� Dam Contrumr =4 ) ( )
ARCHITECTS DECLARATION CLASS A. CARPORTS 25 , 26 , 27 TEAR OFF SHK, (N) CO
U 1 ungersaind my plans shall be used as public reenacts
°u.p� Licensed Prefessinnal
OWNER-BUILDER DECLARATION
iZ I hereby air'.that I me exempt farm NC.."
cores CancmLi
rs cense law far the
a O following reason.(Section 7031.5,Business and Professions Colo:My city or county
5 m which requires,a permit to convect a@q improve,demolish.or repair any structure
-iy prior m its issuance,also acquires the applicant forsuch permit to file a signed statement
C that he is licensed pmmantm the pmvisiins of the Contractor's License law(Chapmr9 Sq.Fe Floor Area Valuation
�5 (commencing with Section 7000)of Division 3 of the Business and Professions,Codc)or $`18115
Q that he is exempt themfrom and this basis far dm alleged emmpdan.An,violation of
Section 70313 by any applicant for a permit subjects the applieum to a civil penalty of APN Number Occupancy Type
not more than five hundmd dollars(SSW).
0 1,as owner*fine property,or my employees with wages as,their sole compensation,
will do the wart tang dmavuemen u notthmnded or offend forsaie(See.70th,Business
and Pmresoona Cade:The Contractors License law doe o01 apply to an owner of Required Inspections
propcny who buildsurimpmvuthnrmn,and who doessuch work himself or duough his
awn employers,provided Out such improverw me...I inn-Med aroRered for sales If,
however,one building or improvement is mid within d m year of comptetion,the owser-
builder will Nap also human of proving that he did not build or improve for purpose of
sal..).
0 1,as owner of the propeny,em exclusively contracting with licemed mnuacmrs to
caminrcl the pmjca(Sec.70".Business and Pro&ss an,Cade:)The Contactors(;-
cone law does not apply to an owner of property who builds or improve Merton,and
who contracts for such projects with a conmctoHO licensed pursuant to dm Contractor's
Lii taw.
❑lam eempl major See .B B PC forNis reama
Owner Date
WORKERS COMPENSATION DECLARATION
40 1 hereby affirm under pettalty of perjury arc or the following disdaatiare:
0 I have and will maintain acerufitvm of cement to self-imam for Worlsescompcn-
satioa,as provided for by Loan 37W of the labor Cade,for one performance of the
work for which this permit is issued.
g1 have and will maintain Worleeri Compensation Insurance,as acquired by Section
37W of that,labor Cade,for the performance of jet was for which this permit is isi '
My Work�e+rs Compemadt-lmu�ta�t artier and Poli.: bca�6�8�sa�aa O�
Cartier. JTZ'�Q f ai`rs� Polity No.: 9 K/-f
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not be completed lithe permit Is forone hundred dollen($100)
or leas)
1 ecoiry that in the perfmmarme of the work for which this permit Is issued.I shall not
employ any person in any manner m as to become subject to Ne Wmhrs Compensation
Lswa of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certincam of Exemption,you should
become subject to the Worker's Compensation provisions of Bet labor Code,you must
.JO faMwhh comply with such provinces or Nve
is permit slim[he doomed neked.
P'y CONSTRUC ION LENDING AGENCY
PI hereby affirm that then is a construction lending agency for the performance of
Cls dae wurk far which the pearch u issued(Sec.3097,Civ.C.)
W� Lena,',Name
a z Lenders Address
U0 1 certify that I have read the application and some that the abase information is .
Lt. P correct.I agree in comply with all city and county ordinances and mate laws meting to
O U building consuuetion,and hereby matron,representatives of this city to enter upon the
C ahuvctic.Judgmpropcny forinspection purposes.
(We)agmc m ave,indcmni fy and keep harmless he City of Cupertino agaimt
I 6i
UlyiZ in
ofthecoming expenses thismiichmey in any way accrue againstaid City
U z A APPLICANT
aoftheRSTAg SNisprmil.
'--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REEQU TIONS.
�r��-s— 9/z, 06 Re-roofs
signawm of ApplicaMCamactor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or futmm building occupant mors or handle havardoe material
as defined by dm Cupertino Municipal Code.Chapter 9.13.and slit Health and Safety
Cade.Section 35533(x)?
❑Ye ax. All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
W511 No applicant or future building occupant mm equipment or devices which g agree to remove P
emit havardnus air containments as defined by the Bay Area Air Quality Management all new materials for inspection.
Disrict7 JJ'
0Ye pnu
Ihave W Ne haardian materials requirements under Chapter 6.95 of the Califon
not Health h SafcsyCode,Sections 35505.25533 and 75534.1 understood!Na if the Wilding
dors 11aI cumcntly have a tenant Nat it is on,resFeasibility m nadl'y the acap.,of N.
mquimmcntawhichmtry metpdormiuummofa Cemricamof Occupancy. Signature Of ApplicantDatC
Owner orauthorn..dagent �� Date All roof coverings to be Class "B"or better
CITY OF CUPERTINO
TOP 3 of 10 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: B1k: Lot :
APN . . . . . . . . : 32609056 . 00
DATE ISSUED. . . . . . . : 09/21/2006
RECEIPT # . . . • . . • • • : 36144
REFERENCE ID # . . . : 06090163
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 14
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER PROMETHEUS/VILLA SERRA
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
SEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - -------- - - ----------- ---------- ------ ---- ---------- ---------- ----------
BPERMFEE VALUATION 19, 000 . 00 266 . 76 0 . 00 266 . 76 0 . 00
BSEISMICRE VALUATION 19, 000 . 00 1 . 90 0 . 00 1 . 90 0 . 00
------ ---------- ---------- ----------
TOTAL PERMIT 268. 66 0 . 00 268 . 66 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
•
..�„ Community Development
e 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Bui Iding De artment
JOB ADDRESS: S PERMIT #
otal olLeI - WC9Q
OWNER'S NAME:VrunethBiq PHONE # AM-05-j- 10(00
GENERAL CONTRACTOR: $ FAX # rj 0—19 5—
t
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
66 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
2 6G
Owner/Contractor Signature Date
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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: V'AG, S�clY�
Job Site Address: 20 80c, ac kJ$' 1 "39
Roofing Company Name:
Applicant's Signature: Date:
• Greg Casteel /
Building Official
Revised 11/2/04
CITY OF CUPERTINO 0�oq o o
l " REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 32�09_CFW I
Date: n1 0-o I ou
Building Address: -200000
^0 ^^ 4- I�'
Owner's Name: r �. ,,1 �J� ,` fit 1 Pl� Phon �f3
Contractor: VU400Is Poo(�M {
i1� )C,. License 011-30 y
Contact: K pLV_k UU`6tt S G,to-�14-q�p� Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Cl Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles �y 1,� y� ❑ Wood Shingles
B' Other(specify) NeW CIS1 1•IH,"Other(Specify) �11Gt I�S1
Number of existing coverings eJ ❑ Provide LC.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: rBYYYJVIP/ ei�\ \ 1 t P
t7�EY S11ri Ver'SF,
Residential Commercial ❑ , (11Cz
Fire Zone: Yes ❑ No 9�' ,J511.U121 Confirmed with Planning P
Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy groin_
181115
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
•