06090171 CITY OF CUPERTINO
BUILDI.c DIVISION PERMIT COT, I1VF„ORMATION. `.�
BUILDING ADDRESS: DUBOIS ROOFING INC PERMITNo.06090171
20800 HOMESTEAD RD # 13
OWNER'S NAME: PERMIT ISSUE DATE
ANk PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
NE: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ow Z' LICENSED CONTRACTOR'S DECLARATION Job Description
i u C 1 hereby alrum Wt I un licensed unit,provisions of Chip.,9(cnmmcrcing
:Zw wim11form70th))ofDivixion3ofthcBuainrvandProfcuiumCOdc,andmyliccnsois REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
s« in full Tara arm effm S[^L 3Dy
;�� Lim.�M, G39 ue.g 1
Contractor OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
i F❑ Dae +�.—rn/
HrtECTSDECLARATION
>wU IundersmndmyplansshellheuscJupuhlicmcorJa CLASS A. CARPORTS 23 & 24 TEAR OFF SHK, (N) COM
,6
0y
Licensed Professional
aS Oat IFM CUILDER mDECLARATION
C I heehy.(Sere that 1 1. .umpt fared r Co tiorst o :Any c taw for the
O C following moon. emit t IIB Ls,Business and Pmfcsdou Cod,:Any city or county
fm urea which requires a permit noi.i.di t pplic imprnvu demolish,nr repair any mucruire
statement-a:e %at heiucensed e,almmto the thovisiocant for mchpermiuonkne,Lawdsuremcm
cx Nashcisliccnudpursuant taNcpmvixio�uoflhcConuv:mrSlJccvcfAw(Chapter 9 Sq.Ft.Floor Area Valuation
(commencing with Sauor 70DG)of Division 3 of the Business and Prof,ssinns Code)ur $12706
that he W exempt therefrom and me bub for de alleged exemption.Any violation of
Seedon7031.3 by my applicantfor.permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more man five hundred dollars(SKID).
❑i.u owner of the pmpmy,a mY ermployeu with wagn u Neer sale campcwdan,
3260995600
will do the work,and dinmumme uwlamended or.ffmcd for We(Sue.T044,Boman - eCIIODS Insd Required and Professions Code:The Conusmr's Littmdocs not Law donot apply m an owner of 9 P
pmperty who builds c r im proms thereon,and who does such work birwl f or Nmugh his
awn employees,provided Nat men improvements sue not intended oroReed formic If.
however.Ne building or improvement is sold within one year of completion,me owner-
builder will nese mu burden of proving Chet he did mat Wild or improve for purpose of
sale.).
❑1,as Owner of du propenY•am reclusively counseling with Bathed eanostors to
commucs the pmjea(Sec.7044,Business and Professions Cade:)M Conusta's Li-
mme law doe not apply b an owner of property who builds m impmmu du em,and
who contracts for such projects with acontranor(s)Beamed pursuant m Ne Conmatc oes
Limmue Law.
❑Iamexempitemkt See ,B&PCfm Niseaon
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby alarm under penalty of perjury,one of the following dnelarations:
1 ham and will maintain a Certificate of Cowmt N calf-inure for Workers Compcm
mart,as provided for by Section 3700 of Ne Labor Code.for du perfarmamtt of Ne
wort for which this permit is issued.
I have and will maintain WOrkera Competuakit Ismamcc,as tcquired by Section
3'100 of the labs Code,for Ne pertarmmce of the work for which this permit is issued.
My Workers omPsamtion Ins/sya�Zttlgire and policy number am:
Cama ' [^w'�l Policy No.:_��/
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITU seen.need nothecamplced if the permit Is Toone hundred dollen($100)
less.)
1 cenify that in W performance of the work for which this funnnit W i umad,I shall not
employ any person in my manrerso As Or become subject to tie Worluni Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
became subject to the Worker's Compensation provisions of me tabu Code,you most
.J O forthwith comply with such provisions or Nu Permit shall W domed rooked.
z'-' CONSTRUCTION LENDING AGENCY
A
F+w` k for by which thi Nils Neeuaconswcti097,C, agency for du perturmantt of
z 1 the work for which this Permit is uucd(Sec.J09I,Civ.C.)
IL1�
Lender's AName
M
nde `
M z Lets Address
U C) 1 certify mat 1 ban reed this application and sure Nu the ahem information is
Uy F^ correct.)agree to comply with all city and county ordinances and state laws misting to
0U building construction,and hereby amhorim mpfesentaums of this city to enter upon the
ahovememioned pmpc costs
for inspection whichpurposes.
y (We)agree to save,indemnify and keep harmless me City of Cupertino against
Z incomesrensce f riserols,gsumdof%isper it. may in any way some agaiutsaid City
U z A APPLICANT
of the gaming of Nis permit.
�--' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P INT Issued by: Date
SOURCER S.
/ 06 Re-roofs
Sigensum of ApplicanitConlsacmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant Or future building occupmtmom a handle harardou material
u&Imed by de Cull.Municipal Code,Chapter 9.11.and the Health and Safety
Code,Section 25532(a)+
❑Yu What) All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Its
Ih&Salcl Neharallous,2550525533tus and rcme 5534.1 rChamer demordthatifbe Wilding •-'r V! - / /`�
dixscatcur Safayhama WOOL
it is my
undotify muiflh,Wilding
docs not currently naw a¢nano mat it h my rmpansihility to notify the meupant of Ne
mquimmcnts�n9ttat xmcLIanormissaanecofacerdn,aeora- ry. Signature of Applicant Date
� 1
Dwnerorauthorirdagent J5,uo All roof coverings to be Class"B"or better
CITY OF CUPERTINO
1 of 10 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32609056 . 00
DATE ISSUED. . . . . . . : 09/21/2006
RECEIPT # . . . . . . . . . : 36145
REFERENCE ID # . . . : 06090171
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 13
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
SEE 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
t,.
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
:UPERTINO
Building Department
JOB ADDRESS: S PERMIT #
owcAOI LO I — OIoC 0
OWNER'S NAME: PHONE # AM-257— I 0(d0
GENERAL CONTRACTOR: VUW$ FAX # 5 O-'7 3-
I
I am not using any subcontractors: _' —._��. 2/
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
z
Owner/Contractor Signature /06Date
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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: �(o c De u s / V, I(a Sel/��
Job Site Address: Zo 800 40"A,r S-re_,_o'L 2d C,, GA'I'T,' o '&ckj$' 1 .-39
Roofing Company Name:
'I���o
Applicant's Signature: Date:
Greg Casteel —`7—
Building Official
Revised 11/2/04
CITY OF CUPERTINO NOVI I
«C . REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# 321.p-OQ_O� v J'
� 2Q I oIV/^
Building Address: 2�-1� ^^ 'l, G+ � r� J 4- 1 -3
Owner's Name: � � 'QJ Phone
Contractor: ,P' Avlttic Pocfi m Mc• License#:01 1�-304
Contact: Cupertino Business License #:
Mptrk_ Dj)�6kS 5to-- 4_C,(a� 2L l
Lt-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ fWood Shingles [y ` y� ❑ Wood Shingles ,r,,,� ('+ ,�,^�
� Other(Specify) NL�IN s11�r 1,,,� E7�Other(Specify) VGf 1 D� )e 1 w�
Number of existing coverings eJ ❑ 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:
JCAM-)0111-AU )LAI
t vetob 2Xisfi tion: r od I a ;J � t (i Verst, P
r
Residential Commercial QYl , C1a _
new
Fire Zone: Yes [3 No 8� 23r'2-4 Confirmed with Planning Det. if P
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy grow
0. �.
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