06090172 CITY OF CUPERTINO
BUILDING DIVISION PERMIT t CONTRAGTOR�INFORMATION"
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BUILDING ADDRESS: D ROOFING INC PERMIT NO.06090172
20800 HOMESTEAD RD 17
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
NE: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHrtER/ENGiNEER:
BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 0 0 0
.00 LICENSED CONTRACTOR'S DECLARATION Ib Description
i U C 1 Mm Nam O 1
thereby affirm l licensed under provisions of Chapter 9(commencing P
U wiNllforenrade)of eet.rsion3ofdicBusincssand Profcu�isunsCode,and myliccnxu REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
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infalleass lid eflccs _ 9 �(Z3ay
a}az Data-Class C.." - OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
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Data- 4P_/ft Conuxror
CHTECTSDECLARATION CLASS A. CARPORTS 35 & 36 TEAR OFF SHK (N) COM
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i¢< 1 vadersnd my plans shall be used as Public records r
1yU
°a Lwevcd Pmfesaioml
3 OWNER-BUILDER DECLARATION
I I hereby affirm that I am exempt from the Convenors License Law for the
p O following reason.(Section 7031.5,Business and Profamund;Code:Any cityar county
Sm Pi which requires a Pe snit to construct.altar,improve,demolish.or repair any structure
-mi primm its issuane..a6orequirusMapplicant fortieth pc meilofnitsi,ecdsatamem
Sq.Ft. Floor Area Valuation
that he is licensed purmantla the Provisions of the Cmmucmri License law(Ctupmr9
y~$ (commencing with Section 7")of Division 3ofdoe Business tied professionsCodc)or $12706
re3 F Nat he u exempt therefrom and th,basis fee the alleged exemption Any violation of
Section 7031.5 by arty applicem for a permit subjects the appOcans to a civil penalty of APN Number Occupancy Type
out mare then five hundred dailan(5500). P Y YP
❑I,as now of thin property,tar my emplmyces with wage as their mid compensation,
will do Ne wartand the swmu,is not awarded or offered toad.(Sce.' .Business
and Profession Cade:The Convectors License Law dam not apply in an ownu of Required Inspections
Property who buildsorimpmvn theme,and who domauch work hirmalforthrough his
own employees,provided that such improvements are not intended oroffered fmsale.If.
however.the building or improvement is bald within one year of cmnpleuon,dee ownm-
builder will have the burden of Proving wt ho did not build or improve far puryose or
sale.).
❑1,an ower of the propeny,am exclusively convening with licensed mnvanms In
construct the project(Sec.70",Business and Professions Code:)The Coovaemrs U. _
Co.law docs not aPP1y to an owner of property who builds or impmves thereon slid
who contracts for such pmjccm wide a conuacmr(s)licensed pursuant in the Contractors
Limited Law.
I t o exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby a?on under Penalty of pmjmy arc of dta fallowing declarations:
1 hsm and will maintain a CeAftcem of cement m mlf-insure for workers Compen-
more,as pmvidcd for by Section 3700 of the labor Code,for Ne perfomori¢of the
work for which this permit is issued.
&4 have and will maintain Workers Compensation Imumnce,as required by Section
37W of the labor Code,far dee performance of the work far which this permit is issued
My Workers Compensation[nsumncepnicr andPolicyNo.:
nUs g��� L.
Clrrier. A�L/ATEOF
F/l Polity No.: 0 b
CERTIFl CO OFSATIONINSFROM WORKERS
COMPENSATION INSURANCE
(This scetim need not be completed if the permit is formic hundred dollar(5100)
less.)
I certify,that in the performance of the work for which Nis permit is bound,I shall not
employ any penin in say manner art as in become subject to dee Workes'Clare m ori
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after mating this Certificate of Exemption.you should
lacerate subject to the Worlem's Compmtsetion provisions of the labor Code,you mull
.JO forthwith comply with such provision m Nu permfl
it ail W deemW revalued.
Z` CONSTRUCTION LENDING AGENCY
[-a I har whip thi Wt dirt is s ed(Sec.
lending agency Car the performame of
0: tiro work fur which this permit is issued(Sec.J09],Civ.CJ
`0 Lcndim sName
Addir
� z Lenders Address
U 0 1 certify that 1 have mad this application and sum Nat the abova information is
HCorton.1 agree to comply with all city and county aNinanees and ea a laws adating to
V building construction.and hereby authorimmprescnulivrs of this city to enter upon the
LU ahovcmc peignaned property farimpection-hath es.
C4 (We)agree to save,indemnify and keep harmless the City of Cupertino against
Z incoiuuuience cru f ft graving of dus eannit. mey in any wry accrue against said City
C)z inconuqucnce UNDERSTANDS
thiND WILL
Issued by: Date
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON- DINT
SOURCEREG
Re-roofs
bigmlare ofAppGnn Xis uxmr Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or far.Wilding occupant atom or handle haurdous material
u defined by dta Cupertino Municipal Code.Chapter 9.11.and the Heald,and Safety
Code,Sc�dYrtn 25532(a)± / All roofs shall be inspected prior to any roofing material being installed.
41 Yns
Will the applicant ar rumrt building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Cook havardnm air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District] ���///
❑Yes 'On
I have real the haua mor materials mquiremcnu under Chapter 6.95 of the Calife,
nu Health&Seely Cade,Scctions 25505.25533 and 25534.I understand that ifthe building 0 v/
docs not Currently melpdormLutly have a moans res
that it u my responsibility to the artery occupant the
a (!
mquiimenu uem'eofaCertificataa(Oc wy Signature of Applicant Dat
Owner or amhrtnzcd.,at / / �3 m All roof coverings[o be Class"B"or better
CITY OF CUPERTINO
�m 2 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 # . . . : 06090172
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 17
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
OEE 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 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
•CUPEkTINO
Building Department
JOB ADDRESS: S PERMIT #
otel of LQ I - Olooq 0
OWNER'S NAME: PHONE # Aj$-25-7— tO(400
GENERAL CONTRACTOR: $ FAX # 5 O— 3-
�6
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
•�`��s� •2 6G
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 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.
Homeowners Name: y, l(a Sefr--
Job Site Address: 20 800 ( �o wee S r/ea a� 20 C.,,pAi.T w o 81r $' 1,-39
Roofing Company Name: ���0 S
Applicant's Signature: ���—� Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITE' OF CUPERTINO O�OP011 L--
( REROOF
. CUPEkTINO PERMIT APPLICATION FORM
APN# 3?j_P_0q_05V Date: n � I oI �
Building Address: 'wry ^^ rryG+t ^ —� ti ^'1 l{J
Owner's Name: _ , 1 d J��I ILf` C 1: C� �Ph4on 1 7 0
Contractor: At °�S `y� License#: E51-7-304
Contact: � Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
:'-YO
/Wood Shingles (y !,, y� O Wood Shingles � ,,,�{
Other(Spe fy) N TIASf 1•`t {,� 6Y"Other(Spe�fy) QVG7 ►CNS1rWe rOC)�—
Number of existing coverings `J ❑ 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: \ 1 P
(71/2t� Sil ('i VerSF. roN
Residential Commercial ❑ , (1'
Fire Zone: Yes ❑ No 3 -w Confirmed with Planning DMt. if P
there are any restrictions: LJ
Cost of Project: I/i 1 O� Type of Construction: Occupancy grou
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener-gy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING