06090175 CITY OF CUPERTINO '��e+avia��
BUILDING DIVISION.
PERMIT CONTRACT0W1NF0iW, ATION_
BUILDING ADDRESS: 13013M ROOFING INC PERMIT NO.06090175
20800 HOMESTEAD RD # 27
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
NE: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
0 C� L! 0
iop LICENSED CONTRACTOR'S DECLARATION Job Description
i u 1 hereby affirm that 1 am RemainedI under provisions of Chapter 9(commencing p
with Section 70M)of Division 3 of the Business and Pr,lossiunt Code,and my license u
ifull(.aandeff«t. e� S12 py REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
`i"" " ' `th " OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
-gyp Date Contractor
3 ARCHRECTSDECLARATON CLASS A. CARPORTS 50 & 51 TEAR OFF SHK (N) COM
1 undcrmanJ my plans shall Ise used as public reeorJt a
iau
LLo
Licensed Professional
3
OWNER-BUILDERexemptDE Ce Contractor's
F 1 hereby.(fi' that I am exempt from the Cont..Cos :License Law for the
00 following reason.(Section 7(53 L5,Business and Professiom Code:Any city or county
i B f which requires a permit to cnngrVC,alter,improve,demolish,or¢pair any swcore
prior to its issuance.also reptli.sheapplieant far such permit to file,signed,aNmen
that W is licensed pursout to the provisions of the Conuazori Liec.Law,(Chap.9 Sq.Ft.Floor Area Valuation
(commencing wish Suwon 7000)of Division 3 of the Business and Professions Code)or $12706
Nat he u ther
exempt therefrom and do basis for the alleged ceempOm.Any violation of
Section 7031.3 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan flue hundred dollars(5500).
❑1,as owner of the propany,or my employees with wagca as their Is compensadon,
will do Ne work,and Ne muerme is not intended or offered ferule(Sec.70x4,Business
and Professions Code:The Convaemrs Liaise law does not apply an an owner of Required Inspections
property,who builds or improves tNsean.and who docs such work himself or through his
Own cmpbyces,provided reattach improvements art rot intended oraRened fmsahe.If,
however.Ne Wilding or improvement Is sold within one year of compleuou.the owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
tale I
❑L at owner of On property,am exclusively contracting with licensed ttnuacom m
consumm the project(Sec.7(164,Business and Professions Code:)The Conuu:bts U.
ante law docs out apply o an owner of property who builds or improves there al.and.
who contracts for such pr aecu with a eonuxmr(s)iia wd putsu"m to Ne Convanoh
License law.
❑ 1 am exempt underSec. ,B&P C(or Nis reason
Owner Date
WORKER'S COMPENSATION DECLARATION
40 1 beteby affirm under Penalty ,of perjury one of the fallowing declarations:
❑Ihaveaod will mainuina cetifca¢of Cowmmmlf-insure forworlmesc mpcn-
sation.as Provided for by Section 37M of Ne Lahar Code,for she performance of the
work for which this permit is issued.
have and will maintain Worker's Compcnvtion Insurance,as teyu;md by Section
700 of Nc labor Code.for Nc pCrpormsocc of the work for which this permit is issued
My Worked}Confessesa 1L¢w,.. Grand Policynu be tic: �/ ��s
Cartier. J ' q nrV lwglAA Policy No.: �b� �v I'm(d,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section raced not W completed lithe permit is foranc hundred dollars(5100)
or less.)
1 cenify,Out in the pCormonanec a the work for which this Permit is issued.1 shall not
employ any person in any mmrcr so.to become subject to the Workcra Compensation
Laws of California.Dam +
Applinnt
NOTICE TO APPLICANT:If,afar making this Cedifictim of Exemption.you should
become subject to the Wohcr's Compensation provisions of the labor Code,you must
,JO forthwith comply wish such provisions or Nr
is peilL shall W deemreversed,
oked.
'Z' ,
i CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm Out Nue us comvucuon kndingagcne,for aha ped..me of
C she work for which thus permit is issued(Sec.309'1,Civ.C.)
W�Q Lender's Name
r7 z Lender's Address
U0 I certify that I have mad this application and sera Out Nc above information is
LL F^ conal I agme to comply with all city and county aNlnances and state laws relating to
OU building construction.and hemby authome mprescrativa of this city to enter upon the
above mentioned pmpc costs
for inspection purposeswhich..
0. (We)agree to save,indemnify and keep harmless the City of Cupertino against
N in
fthecosuindof this cewhich maythany wayaamc agaimtsaid City
U z m eawquentt of the granting of this permit.
^ APPLICANT UNDERSrAND§AND WILL COMPLY WITH ALL NON-P INT Issued by: 2�(�
Date
SOURCE REGUL y�/
�� 0�Z��� Re-roofs
Signals.of ApplicanUContractm as
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she appneant of future Wilding ucmpant some or handle harardaus material
es deflncd by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Cole,Sccuon 35513(x)?
Ys RJ Nu
All roofs shall be inspected prior to any roofing material being installed.
41 ❑
win Nc,pPlis'a or(arum Wilding Occupant use equipment ordevices;which If a roof is installed without first obtaining an inspection,I agree to remove -
em;t hunodnas air Contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Dutrict?
pYca p1(
1 have mal Ne haudnus materials requirements under Chapter 6.95 of Nc Cs ifor.
n;a Health&Safety Cook,Sectors,25505,35533 and 35536.1 undersand Nuifthe Wilding O�
does not curamly ham a anon,Out it u my responsibility b rant
Jct occupant'.roc
myuimmcnts �y.ma,txmetpriar,m;asa,ncaaracanar+eaaaraeep Signature of Applicant Date
C
Owner ter aumarind agent DA All roof coverings to be Class "B"or better
CITY OF CUPERTINO
5 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 # . . . : 06090175
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 27
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 SAL
--- ------ - --- - - -------- --- ----- -- -- -- - ----- ---------- ------- --- - ---------
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
�UPEkTINO
Building Department
JOB ADDRESS: S -W 1 -39 PERMIT #
otgt 01 LO 1 -- O(OC R W
OWNER'S NAME: PHONE # 4M-25-7- 10(00
GENERAL CONTRACTOR: DUW$ FAX # S10- 3-
- rJl
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 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:
Job Site Address: Zo Soo 40"A,�-- S-r�o-C 20 C„pAn.r w o BJt�s, I 39
Roofing Company Name: ���0 S _Lo �v:ry 7tij
Applicant's Signature: �'� Date:
•. Greg Casteel
Building Official
Revised 11/2/04
CITE' OF CUPERTINO OVA0115
REROOF
V an
• CUPEkT(NO PERMIT APPLICATION FORM
APN# 3?_ p—0q_OIDU Date: 20 I OI n
Building Address: n cb^^ ,y_ n,�� � 4-
Owner's
2� VJ
Owner's Name: 4+/ Ch 1lJ T IV Phone#:
Contractor: Dt bo,ls Pocfi y) —1ty'�`-.�L License#:011-304
Contact: MGtl�k �la61 SM`71 Cupertino Business-1xioense #:
Type of Roof Covering: 4��✓
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ ood Shingles [[yy ❑ Wood Shingles
Other(specify) N T{QSb`nd ia,�Other(Specify)
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: V-10( p0& \ t
�N�2�Cisfi 0, �i{er'sr, P
Residential Commercial CkWyn �� 11GL A
I
lr�
Fire Zone: Yes ❑ No B-' cJ. 0 1 51 Confirmed with Planning D_pt. if P
there are any restrictions: LJ
Cost of Project:4 12:11 O' ^ Type of Construction: Occupancy grou
�Y
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
•