06090174 CITY OF CUPERTINO
MUILDINO DIVISION PERMIT CO RAGTOR INF,ORMAT,IQN
BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT No.06090174
20800 HOMESTEAD RD 4 95
OWNER'S NAME: PERMR ISSUE DATE
PROMETHEUS VILLA SERRA 99 DUARTE AVE 09/21 /200r
NE:
SANITARY NO, CONTROL NO.
(510) 793-9760
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
!00 LICENSED CONTRACTOR'S DECLARATION JOb D0SCi1pI100
U F 1 kmby affirm Nat I am licensed under provisions of Chapter 9(commi
entng
`j
with Section]gMl)ar Division 3oflhc Business and Propositions Com.md my license is
std 'afu[if arccandeIT �JZ3py REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
pi Dee els G3 L s OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
O Dam Can DECL
ARCM ECrSDECLARATION CLASS A. CARPORTS 48 & 49 TEAR OFF SHK (N) COM
i < I undcrsund my plans shall he used u public records r
166
o G Licensed Professional
OWNER-BUILDER DECLARATION
I hereby fr,.Nat I am exempt from the Contractor's License Law for the
00 following comm.(Section 701.5,Sodtiess and Profession Com:Any city of county
m ff which ter,mres a permit m eosutruct,ithm.'nnpmve.demultsh,err repstr any structure
-iy prior an its issuance.W.oxuircs dmapplkant f.,such permit to frkasimcd.itemcut
Nat he is Lensed pursuant to me provisions of the Contractor's Liemse Law(Chapter 9 Sq.Ft. Floor Area Valuation
u�S (commencing with Section 7000)of Division 3 M the Business and Professiorrs Codc)or $12706
c -
that be u therefrom and therefroand Ne basis for the alleged excmpdorc Any violation of
Section 7031.5 by any applicant for a permit subjects Nc applicant to a civil Penalty of ane APN Number Occupancy Type
nor marc than five hundred dollars(55013). P Y YP
❑1.as ownu of the Property.or my employ.with wages u their mm compensation,
will der rhe work,.ad thommoum Is mtmtengcd mofferod for We(Sce.7044,Busm. 00
Required Inspections
and Professions Code:The Canuacme3 Limose e law docs not apply be in ownu of q P
property who builds oe improves Merton.and who docs such it himself m through his
own employer,provided Nat such improvements art not intended oeolTered Rosati If.
however,the Wilding or improvement is sold within can year of eumpletion,the owner.
builder will have the Wrden of proving Nat he did our Wind m improve for purpose of
sant.).
❑1.as owner of the propert,me exclusively estimating with Tissued eonvacmrs In
construct the project(Sec.7044.Business and Professions Code)The Cominerteri U.
come law dont not apply to an owner of property who Wilds or improves Merton,and
who contracts for such pmjccu with a corionamr(s)licensed pursuant to the Convector's
License taw.
❑Iamexempturder Sec ,B&I'Cfmthismason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of me following declarations:
I have and will maintain a CertiGnto of Comeau.relGimum far Warkcrs Comper.
sation,as Provided for by Section 3700 of me lahm Code.for the performance of the
work for which this Permit u issued.
1 hale and will maintain Workers Compensation lanmancx,u required by Section
3700 oldm Labor Cade,for the performance often work for which this permit is inmd. '
My W.r%ee C on Igsurs a pmier and Policy nu Wr} QO
Carrier. Tat //t�•.-YY.•aNV.-dd/s/ P.lidyNo.: 6
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Mismardon need rot he completed if Ne permit u rare=hundred dollars(SI013)
Or Ices.)
1 certify mat in dee Performance of Nc work for which this permit is isvmd.1 shall not
employ any Penin in any manner so U m become subject to the Workers'Cord i malion
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,if mating this Cenificare of Exemption.you should
become subject in Ne Workers Compensation prevision or use Labor Code,you most
.Jz forthwith comply with such provisinm or NU Permit shall he decreed mwkcd.
'Z O CONSTRUCTION LENDING AGENCY
[-r Iherchy affirm door then us comuucom.lendingagency for the perfo....of
IX
the work for which this permit is issued(Sec.3097,Civ,C.)
W�Q Lenders Name
D z Lenders Address
O Q 1 certify Nat 1 hese read this application and earn that the aWve information is
U.— Cortcct.l ague to comply with all City and county ondinemca and sate laws relating t.
0O building convection.and hereby authurim representatives of this city to enter upon Ne ( �/t (/� /�/////�
d aWvomcmidged property for..,int es purpose. �/
(We)agree to save.indemnity and keep harmless the City o(Cupe into against
F t,iZ in COnscipaCac OftheStanding eapemn which may toany wayamue against seid City
U z A APPLICANT
of NeStanding of this permit
^ APPLICANr UNDERSr]gD5 AND WILL COMPLY WITH ALL N/O/ryPOINT Issued by: Date
sou RCE RFbtfCR1'fOgVl'��. 9/ /
�L�66 Re-roofs
$IL.LaK of Applicanuutentrietor
HAZARDDOUOD De
HAZAS MATERIALS DISCLOSURE Type of Roof
Willy t e Cupun m(Muni Municipal
Cg e.Chapter
9.1 nand t e HeaNam material
n defined by the Cupertino Municipal Code.Uapter 9.13,and the NnIN and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu40 Y N.
Will rhe m,livaator furore Wining occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harirdom air communans u defined by the Bay Arta Air Quality Management all new materials for inspection.
District? /�
t]yes /I]N.
1 have read the h.m.materials nex,om ne aunder Cbmte,6.95 of Ne Calif.,
nice Heil"Safcty Calc.Sectio.25505,25533 and 25534.1undcrsand thaudin Wilding ef�
duce nor emosliy hose a¢pant,Nn it is my reapomibilk,m notify the occupant or the
rtyuimm W met prior to issuance of a Ccrrirwate.r c
Owner or authomsd agent Signature of Applicant Date
D All roof coverings to be Class"B"or better
m'
CITY OF CUPERTINO
�m 4 of 10 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 32609056 . 00
DATE ISSUED. . . . . . . : 09/21/2006
RECEIPT # . . . . . . . . . : 36145
REFERENCE ID # . . . : 06090174
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 25
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 DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
Community Development
y 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
•CUPERTINO
Building Department
JOB ADDRESS: S PERMIT #
Otel OI LV I - Wt Cizoc
OWNER'S NAME: PHONE # 409 7— 1 O(00
GENERAL CONTRACTOR: S FAX # S O- 3-
�� JI
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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� i o G
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
I 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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: yro",�ltw v$ / y, 1(4 siur�_
Job Site Address: 20 floc, 4owve S-ree_a.at 20 f C pn,-tT, w o $' —
Roofing Company Name: ���0 5 ( •�*(r 7�J e
Applicant's Signature: �� �� Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITE' OF CCUPERTINO uuu I ` 4
( o"t
• CUPERT(NO PERMIT APPLICATION FORM
APN# 32 _p 0
9_Dr,?L0 Date: n �J I V W
Building Address: 2 0V ,�D ^ —� 4 n'1D
Owner's Name: •�/`Q�J J�G�/� Phone!#I:
Contractor: V A�•1S p i ,yl� License#:01-2-3D4� C3D'i
Contact: , ArAvr'1' IF-o�Sf��IO�11`1">'���� Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles [� 1,� ❑ Wood Shingles 't�,�rn'
lY/Other(Specify) (� TIaSf I`� E✓O[her(Specify) �VGT ILAV S�
Number of existing coverings ❑ Provide I.C.B.O. Report 4
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: rerr v ex\ \ I P
uonrS-1 C i \er t', rJeWt
Residential Commercial ❑ 1Jwigzm 1( �
larpodZ
tear cif s kes:JnOmne
Fire Zone: Yes El No 0� 4$ ry' 4q Confirmed with Planning Det. if P
there are any restrictions: LJ
Cost of Project: O/ Type of Construction: Occupancy grow :
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERWEE 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
•