06090173 CITY OF CUPERTINO -
HUIiMING DIVISION PERMIT � t��V�l'1�L1C'T R 1Ti'O4�tYlA�.lfd _
BUILDING ADDRESS: DUBOIS ROOFING INC PERMITNO.06090173
20800 HOMESTEAD RD # 29
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 21 2006
lip NE: SANITARY NO, CONTROL NO.
(510) 793-9760
ARCHITECr2ENGiNEER: BUILDING PERMIT INFO
BLDGO O pLO MECHO
0o LICENSED CONTRACTOR'S DECLARATION Job Description u E 1 hereby affirm thm I am licensed under previsions of Chapter 9(co mmeneing
�a orceaida deffmL don3ofd Business
aPaS123O�myf is
n full REROOF- TEAR OFF FLASHING (N) 30YR DIMEN. COMP
i�? License chis G39 coal OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
:'i ti -ARCHITECTS DECLARATION CLASS A. CARPORTS 56 & 57 TEAR OFF SHK, (N) COM
i¢-t uMcrsund my plans shall m used As public records
,yU
G
r Licensed Professional
5 OWNER-BUILDER DECLARATION
I hereby alirm that I am exempt from the Contractor's License Law for the
O o following mason.(Section 7031.5,Business and Profassium Code:Any city or county
5$ which requires a permit to camstruct,&her.hnprove,demolish.or repair any structure
prior to its issuance,alsu requires the applicant(orsuch permitto file a signed statement
this he a licensed pursuant m the provisions of the Contractors Liense law(chaper9 Sq.Ft.Floor Area Valuation
u $ (commencing with Section 7000)of Division 3ofthe Business And Profession Code)tar
$12706
a, .. that he is exempt theefrom and the basis for the alleged exemum.Any violation of
Section 7031.5 by any,applicant,for a permit mbjeeu the applicants in a civil penalty of APN Number Occupancy Type
oat mom thin five handled dollus($500).
0 1,As owner of the limitary,or my employees with wages As their sale comp=nsadon,
will da doe work and the awc,ue a oat ntendd orufrerd for sale(Sec.7614,Busittea
and Pmfessons Cade:The Contrxur's License Law does not apply a an Avower of Required Inspections
property who builds m improves thereon,and who daea such work himself or through his
own cmpioy es,pmvidd that such improvements arcnot intended aroReleJ forsak.IL
hmvever,the building or improvement is sold within an year of comp1m on,d e owner.
builder will bave due burden of pmving that as:did not build or improve for peopaac of
salt.).
❑1,an owner of the pmpeny,am exclusively convecting with licensed rononcom in
construct the pmject(See.70".Business and Professions Code:)The Cootracmri V-
cense Law does not appy m an owner of pmprny who milds or improves ftr an,,nd.
who contracts for such projects with a contractor(s)licensed puraunm to de,Contractor's
Licence Law.
❑1 am exempt under See .B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 h eby aRrm under penalty of perjury on,of the following declarations:
I have and will maintain aCenifiwu of Consent o self-insum for Workces Compen-
sation,An provided for by Section 3700 of the Lobar Code,for the performance of the
work for which this permit is issued.
t 54 have and will maintain Warner's Compeaathm Insurance,An acquired by Seeman
37011 of the Mbar Code,for the pcaformanco of the work for which this permit is issued. '
Worse Compeaatio suaance artier and Policy number
`I
Cartier. �A'-r wL. Policy No.: (//OG Ann-
My 2 G,
CERTIFICATE OF EXEbIPTION FROM WORKERS'
COMPENSATION INSURANCE
(Dtaacction need not An camplced if the permit is foram,hundred dollars(SIM)
or less.)
1 certify amt in the porformaneo of the work for which this permit Is issued.1 shall not
employ any parson in any manner An As in become subject to also Worker'Compensation
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:IL after making this Cenincate of Exemption,you should
become subject m the Worscr's Compensation provisions of the Labor Cada.you most
.J z forthwith comply with such provisions or this permit shall m co=ned evoked.
'ZA CONSTRUCTION LENDING AGENCY
[-+ Ihe.hyarfurm that Jere aacomtretinn lendingagoncy for the penformamz of
C the wort for which this permit Is issued(Sec.3097,Civ,Q
LQ Q LendeYa Name
7 z Loader',Add.
U Q 1 certify that I have read this&ppli,adon and suis this the arose information is
LL f-' coraco.1 agree to comply with all city and county ordinances and state laws relating in
0 U buildingconsuuction.and hereby authorim.presenuaives of Nis city to enter upon the
r C above-cs.judned pmpcny for a pecdon purposes.
(We)agree to ave,indemnify and keep harmless the City of Cupcnino against
.F.Z incoitiequenec of the
cxpmuuwhich may in any way rectae against said City
(„),'� inconsequence of Ne gaming or this pomit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGyt��or+'
Signature of Ap'�vConaamor R �/a Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant ar future building accupan,m.m NMIc hmaudous mauriJ
As,de0ned by the Cupertino Municipal Cade.Chapter 9.12.and the Health and Safety
cad,.Section 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
40 ❑r 11"'I"
Will the applicmt or rule.building occupant use equipment ar&viceu which If a roof is installed without first obtaining an inspection,I agree to remove
emit haxardnus Air contaminants As defined by the Bay Area Ail Quality Management all new materials for inspection.
District?
I-]yes /No
I have mail the baaadues macrisis requirements under Chapter 6.95 ofthc Califor.
nia Health&Safety Cade,Scedoa 253()5,25533 and 25534.1 undersand that if the building O/
docs amt currently have a errant that it is my repomihilify to notify the occupant of the FJ
rtquimments whk m met prior m iauancc of a ConiBcae 0r tarp / Signature Of Applicant Dale
Owamo 9 2 yaw
All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 3 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 # . . . : 06090173
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 29
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
OE 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 DESCRIPTION305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
• I
Community Development
10300 Torre Avenue
£ F Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
:UPEkTINO
Building Department
JOB ADDRESS: S PERMIT #
ow0g0KQ) — 0(o(3 Q
OWNER'S NAME: PHONE #4:Y$--ZFj'j- O(00
GENERAL CONTRACTOR VubOi S Qmfi rp FAX # S O-7 5—
I am not using any subcontractors: ^//"v G 2/ q
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
EPainting/ Wallpaper
Paving
Plastering
.Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
4z•i 6L
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.
Homeowner's Name: T('o+^�'I� e�s V, l(G,
Job Site Address: Zo $oo 4o w..e 5-re4-ot (Li) C�past 90'0 1
Roofing Company Name:
0(2�0S lGcs o wit ! 7 tj G
Applicant's Signature: `'%��� Date:
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO Q(�MM12)
- ROOD`
• CUPERTINO PERMIT APPLICATION FORM
APN# 321p-0
9_D5LP Date: /1 � I ou
Building Address: n t.�C 00 L vnl ys�d � 4 :'In
Owner's Name: G;/`�`J T 'V Phone#,
Contractor: PLWO'Is F—Ocfi, a M f. License#:012:3 ,4
Contact: AO ' g5l,3_� 1 iC_✓Cl�� Cupertino BusinessLicense l�-#:
�/� K— Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
O Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
;fWood Shingles [y/1 ❑ Wood Shingles
Other(Specify) Newfl YI�YY� E✓Other(Specify) �VG7 I�SI�fG r1�3�
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: nermv&•& \ \ t t P
L Qi�1S�1 (�1 , t,
Residential Commercial ❑ n , 0�1 am N
o&tzi new
Fire Zone: Yes ❑ No 8� tj� 5-7 Confirmed with Planning Dept. if P
there are any restrictions: LJ
Cost of Project:-*) 1l DU 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
•