06090166 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRA TORJNFORMATIONN
r,a"i
9UILDINGADDRESS: DUBOIS ROOFING INC PE1tM1TNO'06090166
20800 HOMESTEAD RD
ER'S NAME: PERMIT ISSUE DATE
OWN
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 2006
NE: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i O p LICENSED CONTRACTOR'S DECLARATION Ib Description
w I bereby affirm shat I am lichand under provisionspeSCTIP
of Chapter 9(commencing
IZ� with Section 7000)of Division 3 of the Business and Professions Codc,and my license is
;z iafull force and effec s Lin Soy REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
'�c L1Cens °ss Comaac.r
o Dow ConvOVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
I ARCHITECTS DECLARATION CLASS A. CARPORTS 58&59 TEAR OFF SHK (N) COMP
i w< I understand my plana shall W used as public records z
yU
e G y Licensed Pmfossionel
OWNER-BUILDERcacropDEdo,Commences
<� ON
1 hereby mirm mt I am.Bumps from sed fess..CO Licit.taw for the
p O whichfollowing muoa(Som,t 703 1.5.Business and Professions Cade:Any city ar county
e which requires n permit re crams a alter.improve,demr it t sir repair any grucmre
i y prior m its Issuance,also reforms the Nue applicant for such permit m ices Laced smemcm
<
tat Mulicl withSawn7000)of Disioru3 of fre alfa rofina (Oupicr9 Sq.Ft. Floor Area Valuation
(commenring with Saban]000)of DivisionJof the Businessand Professiaru Code)or $on
$ that he u Mempt therefrom and she base for IW alleged exempuom Any violation of
16515
Section 703 L5 by any applimt for.permit subjects the applicant to a civil penalty of APN Number Occupancy Type
rat more than five hundred dollars(5500).
1,as owner of the pmpwsy,or my unployces wish wages a their able compensation,
will do the work and Ne mwcture is not intended or offered for safe(Sc.70,44,Business
and Profcssimu Code The Communes License law don sins apply to an ow.of Required Inspections
pmpenywho Wildawimpm tharnn,.ndWWdoessuehwrkhimselforthroughhu
awnemploe Wiprovided shmsuchimprovementsart noon or msiffced(msale IL
builder Neawth 6mces of pmentt,Out withinum)ear or completion,the ore of
safewill have she burden of proving Out W did wt Wild m improve for purpose of
sakJ.
El 1,as no,of she property,am eaelusively converting with licensed commeton m
construct she project(Sec.7064.B.inea and Professions Code:)The Contmemrs U.
come law docs not apply b.n owner of progeny who Wilds or impmvn thereon.and
who contracts for such projects wit a cortragen )licensed pursuant m ted Contrutors
License law.
❑ lameaemptunder See ,Bir PCfoshtsreamn
Ow e, Doc
WORKER'S COMPENSATION DECLARATION
1 hereby aRmsunder penalty of perjury one of Ne following dcl=donm:
1 ham and will maintain a Certificate of Consem m self-insure far .WorkeraCompen-
s.0on,as provided for by Section 3700 of the Labor Code,for the performance of she
work for which Nu p Mail is issued.
g 1 hale and will maintain Workers Compensation Insurance,.required by Section
3700 of due
eLat�Code.fen Me Of of Ne work fa/yrmwhhich Otis permit u issued.
My Cameo'..._ rM' on(TTM' Policy No.:rudifticyno 09�oQY?� b
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(TTissomen aced not W completed if We pesmis is(music hundred dollars(SIU)
sir less.)
1 certify that in the performance of the work for which this .it is issued.I spall raw
employ any peuon in any manner.as to become subject to On WorkersConformation
Laws;of California.Dau
Applicom
NOTICE TO APPLICANT:If,after making shis Certificate of Exemption,you should
become subject in the Wolace,Compensation provisions of she Lmor Code,you mug
.J O forthwith comply wit such provisions orthis Permit hall W decreed rovoked.
z CONSTRUCTION LENDING AGENCY
[-+r I hereby afirm that themes.construction lending agency Or the perf....ur
fY > the work for which tiffs permit u issued(Sec.309],Civ.C.)
LV Q Lenders Name
= z Lenders Addtea
U O 1 citify that 1 hale mad this applieuion and sou that Ne above information Is
lL t" correct.l agree to comply with all city and county ordinances and mute laws relating to
U building construction,and hereby authorize representatives or this city ins enter upon the
W above-mcntidnedgm nmpc costs
for
andexpenses
penes purposes.
(We)agree to save,indemnify and keep harmless the City of Cupemnu against
Uro incoivauence,of ents,
grsu and of this nwhich may in anyway accrue againgseid City
U z A APPLICANT
of UNDERSTANDS
of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PoINTIssued by: Date
SOURCE REGUL�. TISWS.
���2� Re-roofs
Signature or ApplicanUConuactor �—
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant or future Wilding occupant store of harmlc hseenim s material
as defined by the Cupertino Municipal Co@:Chapter 9.13.and the Health and Safety
Code.Section 25532(a)7
41 0y. )Me All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining inspection,I
Will On applicant or future Wilding octagons tau eyuipmmtwdevicns which g an agree to remove P
emir hnamnus air contaminants as defined by she Bay Area Air Quality Management all new materials for Ainspection.
Disvict7 L`''
❑Yrs NA
I have read the h—fdrws materials requirements under Chapur&95 of the Califor- /
Me Health&Safciy Cade,Sections 255)5.35533 and 25534.1 understand sh adds,Wilding DID
does not currently hast a teram,Out it u my responsibility in notify this oc upert of Nue v
requinereco hh>D metpda aneenifiaamorOccp Signature of Applicant Date
Owner or.thon7zd agent p+ DTT All roof coverings to be Class"B"or better
CITY OF CUPERTINO
6 of 10 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32609056 . 00
DATE ISSUED. . . . . . . : 09/21/2006
RECEIPT # . . . . . . . . . : 36144
REFERENCE ID # . . . : 06090166
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 30
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
WE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- ------- - -- -- ---- ---- ---- -- -- -- ---------- ---------- ---------- -- --------
BPERMFEE VALUATION 17, 000 . 00 245 . 16 0 . 00 245 : 16 0 . 00
BSEISMICRE VALUATION 17, 000 . 00 1 . 70 0 . 00 1 . 70 0 . 00
---------- -- - - ------ ----- - -- -- ----- -----
TOTAL PERMIT 246 . 86 0 . 00 246 . 86 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
•
Siam
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Bui Iding Department
JOB ADDRESS: $ "'3 PERMIT #
oteC OI LQ 1 — O(oCR Qi
OWNER'S NAME:V7rZM PHONE # 4M-Z5"]— 10(40(D
GENERAL CONTRACTOR: $ FAX # 5 O— 3—
�/J l
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
Owner/Contractor Signature I 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
I 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:
Job Site Address: 2n800 fFow�(�eSr/ oL 20 � C,,V i,r �o 8JckjS'' 1,-3
Roofing Company Name:
��o S lLcso (-r r ! 7M1j
Applicant's Signature: Date:
• Greg Casteel /
Building Official
.Revised 11/2/04
CITY OF CUPERTINO w q 01
tC - REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 324—O9_015 ^ Ifo,
� I W
Building Address: -200
ocl U/,y�y�4s�6 � � 3
Owner's Name:ID, " ��V�1�1 '�` � � Phone# a S5 OC)
10
Contractor: V A` o,ls�1 kf)c License#:0 tl 12-304
Contact: ' A��/r,{1,JV IS 5Icj-,4 qw�' Cupertino BushLicense #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
:❑Wood Shingles (y !,� ❑ Wood Shingles /���,,,,{ ,,�,,`^
1 Other(Specify) N�TIo lr� �/Other(Specify) VVGT 1� l �IIG r�
Number of existing coverings ❑ Provide I.C.B.O. Report 4
❑ To be Removed ❑ Provide Mfgr.installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: rVrM\A&_e) \ I
��i C\SP
t
�l ( 1 �f�
Residential Commercial ❑ , CIQ
Fire Zone: Yes ❑ No 8-' 58 Confirmed with Planning De if P
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy grou
515 -
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