06090167 CITY OF CUPERTINO s
Bia'ILDING.OIViSION PERMIT CONTRACTORINF,ORMATI0PI
BUILDING ADDRESS: DUB S ROOFING INC PERMIT No.06090167
20800 HOMESTEAD RD # 39
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE Q2/21/2006
NE: SANIRY NO. CONOL NO.
(510) 793-9760 TATR
ARCHRECT/ENGINEER: BUILDING PERMIT INFO
BLDGO OELECr Pm MECH
iOp LICENSED CONTRACTOR'S DECLARATION ]Ob Description
%w I bereby affirm Nat I am iumnand under provisions of Chapter 9(mmmcneing P
:Z with Scnion J011U)of Dividon3ofthe Businessand Fromiumm Code,and my license is
in roll to=and effect, g l2 pat REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
License Class `� Lie.« OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
,F a Dam Comvwtor
'f� CHrrECrSDECA0.ATlOf CLASS A. CARPORTS 80&81 TEAR OFF SHK, (N) COMP
i e I undersand my plans shall be used az public records
>yV
'pLicensed Professional
0 5 OWNER-BUILDER OE On Cmur ION
0 I Wm&y aRrm taw 1 a.1. acai from the Causim.Co Lee..law for the
0 o following maws(Sermon]rD I.S,Business seri ProfdOmol Code:My city as county
Z" which mquisu n permit w romacronstruct,Olen.improve,do Permit
t car repair ed wurum
prior m its issuance,Olin requites tW applicant far such scuff.o Bic a signed statement
;sithat(commencingwdpursuanu0the00)ofDivision
iviav.fNeConusinesindpracennowccp¢r9 Sq.Ft.Floor Area Valuation
LI-$ that he 1.
Section 7 and
tram n3 Orthe
.gedcvnndom.Ani kCnde)uf $12706
e2 taro io u 31.5 b anmftom seri the&Pers for ffic alleged eaemplkn.Any vlolndon of
Semon J031.5 w airy applicant.(a permit wbjem the applicant m a civil penalty of APN Number Occupancy Type
trot mom thin five hundred aolWe(5500). P Y YP
I,az owner of tW proprty.m my u,ploytts with wags az thevwk campewuon,
will da she work and On monsoon k wt Mended oraneted for sale(See.71H14,Business 32609956 . 00
and Prafasions Code The toothsome.Li.Law does wt apply to an owner of Required Inspections
propeny who builds«inaMmOsmon,seri who doessach work hina l(ar through his
own employees,p wmad Nat inch improremenu are not intendW mofferad for ale If.
however,the building or improvement u sold within are year of completion,the owner
builder will haw the burden of proving Nu he did not WHO or impmw for purpose of
ask.).
O 1.as Owner of the property,am aelushely convecting with licensed contractors to
consumer the project(Sec.71114,Business aM Prallmoa Code:)Tle ConvacmYs U.
cove Law doa oat apply to an owner of property who Wilds or improves thercon.and
who convects for such projects with a cunaantor(s)littved pursuant In,due Conuacmrs
License Law.
Q lamacmplunder See ,B&PCfmthismsse.
Owner Dale
WORKERS COMPENSATION DECLARATION
1 bemby affirm under penalty,of perjury arc of the following declarations:
1 have sed will mainuin aCerdrlmm or Covent m self-insum for Work esCompen-
union,az provided for by Section 3700 of On Labor Code,for the Perfor once of the
work for which this permit is issued.
Win and will trainman Workers Cumpeasatian Insurance,as required by Section
3700 of the Labor Code,for On perfomswtt of the work for which this permits issued
My Wmkc;e;co�pevatian�f�,w artier and Policy nu be
Cartier.—1 `4'rt� rW'r' Polity No.: 6� 1
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section bond not be completed if the permit is faun hundred dollars($100)
or[cis.)
I cervi fy Nat in the performance or the work for which this permit is isaund,1 shell not
employ any person in any manner an as In become subjm to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.afmr making this CenmEcate of Eacmption.you should
become subject to 1be Worker.Compering.,pwvisia,of the UW,Cod,you mus
.JO forthwith comply with inch provision of this pctmit shall be Ommed mwaked.
rZy CONMUCrION LENDING AGENCY
[-a 1hemhy affirm than dere is a construction lending agcmy for the performan¢or
the wurk for whim this peamit is Wood(See 3097,Civ,C.)
W Lender's Narm
C.
z Lender's Address
a
U Q 1 certify that 1 he.rad thisapplication
and coup and sate that me above ins salmon to
C4 f+ Wilding
I agree to comply with all city and county rUldws of and sou laws relating w
QU Wow-romonswctkn,and hcmospecdonmmpmscnulirus of thiuily to cnmrupnn tae
.hove-mentionedproperty for ex,onson whichpurpnos.
H a. (we)agree to ase,indemnify and keep harmless the City of Caanino agvvt
Uy incoivxprene ofthecaauand espcmciwhich may in any way attntc agaiml said City
z APPLI AN-r Ofthego'TANDSng of this permit,WILL
Issued by: Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS.
Re-roofs
Signature of ApplianUConvaclo' Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or future building eccupwt score Or handle harardov material
w kri ed by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safely
Conn.Section2s532(a)T
CY. y,�4All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yes q}U
Will the applicant Of future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit bactolnus air conummanu as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Ya Agqu
I have mad the hvardousmaterials requirements under Chapter 6.95 tartan Califon
nin Health&SafclyCodc,Semam25505,25533 and 8534.1 mak aund that lithe building o r
does not entreaty h.w a tenant,Nat it is my responsibility of Ooul'y On occupant of the b
requirements which pleberect prior or issuance ora certificate of Ocap ry. Signature of Applicant ate
92���
ownerwwmaived agent All roof coverings to be Class "B"or better
CITY OF CUPERTINO
7 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 # 06090167
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 39
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 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
•
Community Development
10300 Tone Avenue
akasm--[
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building Department
JOB ADDRESS: S PERMIT #
o(,e golLei — 010CRe
OWNER'S NAME: ebneuQs PHONE # 4M-25-7- 1 0(60
GENERAL CONTRACTOR: S FAX # S 0- 3-
z�� S 1
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and.com Tete the following information
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 Date
Community Development Department
v 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
l.. 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 LC.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.
Homeowners Name:
Job Site Address: 2-0 80O 4o 20 C Pyn r,w o adq,5' 1 ,-39
nn
Roofing Company Name: _ 1CJ��o;S c�O 7� C �.
Applicant's Signature: v� �»� Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO OVg0I ( 1
. REROOF
• CUPE(�t PERMIT APPLICATION FORM
APN# 5e,? • C)g—orw Date: n l l I V W
Building Address: !!0C]lJll
�
Owner'sName-
Pho
`� @n # —7— E Q
L00� e92E�
Contractor: Vpt iS ��m , amc• License#:ob12304
Contact: , AwrJ�, UU)�6'S 12�D51 4-
Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles �y 13 Wood Shingles �,.,,�{
B Other(Specify) NeWTIAS�•I� Q,"'Other(Specify) �VGI' I�S1�� rcck
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:
Job Description:� r����X\ 1�e�cisfi � ncwr� ckm1cf-F.KU Z71
P
Residential Commercial ❑ At
Yl C�Q A
ifvn
Fire Zone: Yes E] No SO �I Confirmed with Planning Dept. if P
there are any restrictions: LJ
Cost of Prol.ect: 'Z 1�Or „ Type of Construction: Occupancy grou
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