06090168 7PROMETHEUS/VILLA
CUPERTINO --"*^�
G DIVISION PERMIT �X-ONTRACTOR INFO MA'�ION :
ESS: DUBOIS ROOFING INC PERMIT No. 06090168
HOMESTEAD RD 1
: PERvU7 ISSUE DATE
SERRA 99 DUARTE AVE 09/21/2006
E: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
as LICENSED CONTRACTOR'S DECLARATION
ZI bunchy lice
by am.Nal 1 wonnsed under prom visiaof Claim.,9(comma ming Job Description
'< in ullrumath Section doffaCtLifianJofNcBusinessandPrafcuiunsCodc.endmyliccnscu REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
' o Darc.C. C39 �^�rg12 3�`'J OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
CTS DECIATATION CLASS A. CARPORTS 1
IundcnuidmyplansahallWuud.publicrccnssu , 82, 83 TEAR OFF SHK (N) COM
yU
Licensed Professional
'h3
Oat 1 0. ompu from
DECLARATION
s C 1 Wrehy¢(Sat Net 11. exempt(rum dm Contras Co License Law for de
o O which re re.on.Permit
y o LA Business and Pnit demolish.
h.or Any city Of county
$txi which to i sea a c.ahr m cnnswm,slur,intron h permit t ore pair any structure
ui< met In
licensdpuruantto tetW applicant for suehpermiumfilnce Laedsuumcm
Natal is licensed pursuant to Nc Provisions of the Conuxtor'a Licens law(Chapter 9 Sq.Ft. Floor Area Valuation
i-
i (commencing with Saturn 7")of Divuion 3 of that,Business and Pmfesdom Coon)or $14306
$ Ne u at hexempttherefrom and therefroand Ne buts for the alleged ezereption.Any violation of
Section 7031.7 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more that rive hundred dollars WWI,
1,uowner ofthe propructre Is wploycs withwagesu Nefrsok c044.Bu limn,
will pothcwones and these ComuantkundWe awdoffered suapply.in an,Business
32699056 . 819
and Proretiom Code:The csther om.Licess¢law dart Out apply to an owner of Required InspeCtlODs
property who WiRb improvmch impr,andwho damauehended mselfor through his
own employes,provided that such improvements is sold
ase not ear-f-orarread for sale.If,
however.the Wilding a,imt Of P.A.is cold within true year ar cmp.far the owmr-
builder will have tk Wmcn of proving that W did twt Wild m improve(tor puryae of
uk.).
0 1,as owner a(Ne property,am exclmively camuctint with licensed contraction W
construct the pmjem(See.7004,Business and Profession Cade:)The Contractor's Li.
come Law dos not apply ut an owner of property,who Wilds at improves theme.and
who amusem far such pmjeN with aeon raccuu(s)Basted pursuant in the contractors
License Law. -
❑ 1 am tempt under Sec .B k P C for this revan
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby atom under pcoaltY of perjury are of the following decimations,
I have and will maintain aCuufism of Consent to self-insum for Waimea Campen-
ation,.provided for by Section 37M of the labor Crei for Ne performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as,required by Section
J OOmf Nc Lahar Code.for Ne performame of Ne wakfor whicM1 itis permit.issued.
My WmkehC.Compenauon Insurances 'm and Policy,number are:
Came.. Ja ArT`!_I'VRAYL Policy No.: Wro(4—
CERTIFICATEOFEXEMPTIONFROMO ER
COMPENSATION INSURANCE
Tlbuseetion reed not W cmnPlemd if Ne rennin is format hundred dollars(SIM)
nr lea)
I certify that in to performance of the work for which this permit is issued,1 mail not
employ any person in any manner an u an become subject in theWorkers Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If.after making Nu CeniOcae of Exemption.you should
become subject in the Worker's Compensation provisions of the Tabor Cast.you must
0O f0mWllh comply with such Provisions or Nmiu
is perhall W deemed mwked.
Z ` CONSTRUCTION LENDING AGENCY
F 1 hounhy anirm Nat No us construction leading a
{eq far0e perfermmec of
de wurk for which Nis permit is.sued(Sec.7091 Civ.C.7
W�Q Lcs Nam
z
Latices
u
s Addre
1 certify than 1 have read this application and sum that the show information u
fy E^
coma,I agree N comply with all city and county ominaras and sum laws relating to
0 U building conswetion,and hereby authorim reptesemadvor of this city to ema Orton the
ah.vt
en,
i^,0 imili memianm Pm.cost fa d caporces with may
(WO)agree to save,indemnify and keep harmless dm City of Cupertino against
.f'.�r/7 Iiacomminution fthncosuand nidus pe which may in any way acemc against said City
Uz APPLI ANT of then RSTAN or Nu permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC�O GNS. //�
�`�U(it _�' Re-roofs
Sitnarure of Appli HAZARDOUS MATERIALS DISCLOSURE uor ak Type of Roof
Will de¢prisms,tar(tau ni Wilding arupaptatort m hatblc huaNe.damacrid
Safety
.defined io 0e Cupertino Municipal Code.Chapter 9.1J,eM the HcaIN and Safety
cads.Section 2557](a)? All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yea I�yO
If a roof is installed without first obtaining an agree to remove
emit hvallom air contaminants inspection,I a
Will the applicant m future Wilding occupant use equipment or devices which P g '
mimnts u dcfiad by 0e Bay Area Air Quality Management all new materials for inspection.
District?
❑yes >CNa
Ihave rcad thic
uwretryiaChaPtarfi.95al Ne Glgnu HcslthhSafmyCodc,Satsnd21534.Imd he building
dots oatcrmndY law a mount.N.it is myonspomihilitY to Of,thOcOPOnt
�� O6
of Nc
requireich myst t prior to issuance Ofa Cau&aeof` apOi Signature of Applicant Date
Owner`ar,a,n`mria,<d sem '� AI Date. All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 8 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 # . . . : 06090168
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 1
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PROMETHEUS/VILLA SERRA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO,
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
*E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- ---- --- - --- - -------- - --- -- - ---- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 15, 000 . 00 223 . 56 0 . 00 223 . 56 0 . 00
BSEISMICRE VALUATION 15, 000 . 00 1 . 50 0 . 00 1 . 50 0 . 00
---- ------ ---------- - --- ------ ----------
TOTAL PERMIT 225 . 06 0 . 00 225 . 06 0 . 00
VOICE ID DESCRIPTION. VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
:01 Community Development
,•['+*,#A„ 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
:UPEkTINO
BuildingDepartment
JOB ADDRESS: . S PERMIT #
Qtgl OI LQ 1 — O(0a 0
OWNER'S NAME: PHONE # 4M-25-7— 10(00
GENERAL CONTRACTOR: S FAX # rj O— 7 3—
�f t _
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete 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
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 perm t issuance, you must agree to comply with 1.997 U BC 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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum.of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: Zo Soo 40 w , 5-re-,Lot 20 C„pa�T v, o Sckj$' 1 .'39
Roofing Company Name: (2o'
Applicant's Signature: �� Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
4 lk REROOF
. CUPEkTiNO PERMIT APPLICATION FORM
APN# 3^ , 0
9_OFU Date: IOU OIW n
Building Addrreesss ✓ry ,n S Rd + I
Owner's Name: ,. Phone#:
in � k -1,077- !D100
Contractor: VLAIs ky'-y Cl. License#:
Contact: s nLIr� ��' 1yi 1_��� 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 [+�/1 ❑ Wood Shingles /�'f,�,,{
B Other(Specify) N�'Tlt-1S�'` q�Other(Specify) QVe ICN S1� e
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: rio(M\A&�M \ t P
Residential Commercial 'nsw❑ p Yl ;,CO(z rl
new
+f'2V11rr*F
Fire Zone: Yes ❑ No 0— 1 t 532-163 Confirmed with Planning Dept. if P
there are any restrictions: LJ
Cost of ProjectO� Type of Construction: Occupancy grown
1�
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
•