06090169 CITY OF CUPERTINO 's« + t1.ak >« ' e.* 'sasrsw .. `sgrr�z`
BUILDING DIVISION PERMIT vCOrrr.RaGTnR.INFORMATI0,1V
BUILDING ADDRESS: DUBOIS ROOFING INC PERMITNO.06090169
20800 HOMESTEAD
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS VILLA SERRA 99 DUARTE AVE
E: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHRECf/ENGINEER: BUILDING PERMIT INFO.
BLDGELECT PLUMB MECH
o o LICENSED CONTRACTOR'S DECLARATION D D !�
mC 1 hereby affirm Net 1 am liccrucd under provisions of Chapter 9(commencing Job Description
l i W with 1"..7QMl)1 Division Sof the Business and Pr.fessiu s Code,and my license is
Tr Ilfmmmd.ff1M est p,,eg 12. oY REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
a,o Dam Combustor OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
W ARCHDECTS DECLAR ION
W6 Iunderstand myplans shall Ito used aspublic records CLASS A. CARPORTS 5 & 6 TEAR OFF SHK, (N) COMP
a
e0 Licensed Professional
3 OWNER-BUILDER DECLARATION
Z<C I hereby.Barn on I a1.exempt from me Contractor's License Law for the
o O which ng mama ermit t R13 LA Business and Praos,d moll Code:Any city.r county
,m which require a pernit m mnsW.L elms,im'mus,demolish,or repeir any structure
u x i 'dor to its imusac,also raquima dm applicant far such Permit o filea signed stammem
aSG that heis licensed Possum,to Umpmviskasofthe Co.uusurslJccose Lao,(Chvptm9 Sq.Ft. Floor Area Valuation
it—$ (commencing with Section 7000)of Division 3ofthe Bananas and Professions;Code)or $12706
`<—
that he Is exempt theacfmm and om baso for she alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom tun Bus bandied dollars(5500). P Y YP
0 1,u owner of the property,or my employees with wages as their sole compensation,
will do Ne work,and Ne nwctuac is not intended or Offered for sok(Sus.1044,Business 32699056 . 8-8
and Prefe(yaN Code:The Continuities License Law does ant apply in an Owner of Required Inspections
property who builds or mr owismercon,and whadoessuch.,it himself.,through his
own empla,mia,provided that such improsemci s ate not use n0ed or offered fm sale If. -
howevm,me Wilding or imprownerm is said within as pass of completion.me mvner-
builder will love the WrAen of proving that W did not Wild or improve for purpose of
sale.).
0 1,as owner of the property am exchiswely contracting with licensed contractors a
...same,the project(Sec.7004,Business and Prefesaons Cade:)The Contractors U
cc=Law docs not apply to an owner of property who Wilds or imposes thereon,and,
who concocts far such pmjccu with acontractor(s)licensed pursuant to the Corma tar's
Liceve law.
0 1 am exempt under Sec ,B Al P C for this annual
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury as of to following declarmons:
I ham and will maintain a Certificate of Coment to ul6insum far Warkefs Compero
smirn,as provided far by Sedan 3]00 of me,labor Code,far me performance of the
work for which this Permit is issued.
a:I have and will maintain Workefs Compensation Insuana,m acquired by Section
37W of dm Labor Codc,for me pcdonamcc of the work for which mu Permit is issued. '
My Worker's Campnmul9¢�In�suranee cartim and Policy nu rare:
Cartier.ST•gTe CII SIJ Policy O
CERTIFICATE PE SATION ON FROM WORKERS'
COMPENSATION INSURANCE
(Thu acorn mcd not becmnplead if the Permit is farm hunmeddoBars(SIM)
or less.)
I certify mat in the Perfammcc of me work for which this permit is issued.I shall net
employ any person in any mannrso a to become subject to the Workcri Compamadon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,afar making this Goodman,of Exemption.you should
become subjw to the Worier's Compensation provisions of the Labn Code you muss
.J z forthwith comply wins such PmHsimo"is Permit shall he deemed rawai d.
zO CONSTRUCTION LENDING AGENCY
[-+ I hmehy affirm that mere is a conswctinn kirdingagemy fm the Perfmanumma
C' me walk far which thin Permit is aimed(Sec.3097.Civ.C.)
A Lcoder's Name
CL
.7 z Lemices Address
U Q 1 cuufy that l have orad this application and some mus des idew information u
Ls.f-' carte.,.l agree to comply with all city and county onfinances and auto laws relating to
0 V building construction,and hereby auahorirn mprecmadws of this city to enter u'an the
4 m.vomcmloned Pmpeny fm mn'ceda.I1.1'.1.
(We)agree to save,indemnify and kap harmless me City of Cupertino against
Urn in
jadgmcnsecranand expenxa which they in any My action againslsaid City
U,'� hn conscgaac.f me granting of anis permit
APPLICANT
E REGUNDEER�TRSNTyyNANDS AND WILL COMPLY WITH ALL NON- INT Issued by: Date
SOURC �a�/!il /a/7,I/ Re-roofs
Signature of Applicant/Contractor
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building acupent Marc or handle limitations national
u @fined by Its Cupertino Municipal Cade.Chapter 9.13,aM tbe Health and Safety
Code.Secta.25533(a)P
40 ❑tins 1541All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding Occupant use equipment ordeviccs which If a roof is installed without first obtaining an inspection,I agree to remove
.mil harardnus air contaminants as defines by the Bay Am.Air Quality Management all new materials for inspection.
District?
O Yes
Ihaw&Safmad t tachc.Sociss2SM5,als re33and2nu.1u 6.95 Wilding
riasno, Sad,howe,Savonshat I,i2S5JJand2J5J4.l in..ofndthmifup Wilding
•--/,` _L /a'
docsno,cu�nty hale,avant Wtisu so Feasibility Certificate
ertia notify the occupant of we CZ
myuiremcnn wh' mel pnanoissuana oft Cutif a¢of Oct Signature of Applicant Date
Owner orauthorized agent m, All roof coverings to be Class °B"or better
CITY OF CUPERTINO
9 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 # . . . : 06090169
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 4
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
IWE 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
•
.s Community Development
ff 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPE�TINO
Building Department
JOB ADDRESS: S PERMIT #
oigl bllaI - woc
OWNER'S NAME: PHONE # 4M-25-7- I UP Q
GENERAL CONTRACTOR: DjtU S FAX # S O- S"
l
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 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 Y4 " 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+�'I�e s / V l(4
Job Site Address: Zo Boo H owve S-re[a.ot 20
Roofing Company Name: 7�
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
s REROOF
. CUPEkTINO PERMIT APPLICATION FORM
APN# 321p 09—OrOL Date: 20 1 o VJ
^
Building Address: n V 00 eSieCId
F-4� 4- L+
Owner's Name:�� �. ./ V ��t 1 ;�� C [�Jn Phone—sltl-1— ID�O0.
Contractor: Vt/10'ls RC` t T1`(/ License 4: 012304
'v`
Contact: � . � ` ya Cupertino Business License #:
12-0551
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Wo6Y
od Shingles �y ❑ Wood Shingles t,,,D 1�
; Other(Specify) NeW'��yash►rx� �Other(Specify) Q, �ncv�Q
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ Tobe Removed ❑ Provide Mfg,.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: CAMP
t
Residential Commercial ,
mKI
Fire Zone: Yes No 91- 5.t l0 Confirmed with Planning D_pt. if P
there are any restrictions: E
Cost of Project: I ail O' w Type of Construction: Occupancy groujj_ I
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