06090177 CITY OF CUPERTINO °* °—7---77777777777--=77777-&r ` ,eel
BUILDING D[via10N PERMIT J%td TR ACTOR4KFQRMATI0 �h
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BUILDING ADDRESS: DUBCIS ROOFING INC FERML'T NO. 06090177
20800 HOMESTEAD RD 44 1
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 2006
Ec SANITARY NO, CONTROL NO.
(510)793-9760
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
iOp LICENSED CONTRACTOR'S DECLARATION Job Description
i U(•j 1 Wreby affirm NOESCFIP
at 1 am licensed under provisions of Chapter 9(commencing
N Section 70W)of Division J of Ne Business and I'micaiaa Code.AM my liccac is
;�? li¢Iilisooclyis denec` 3S Lic.d S �'2.. 7i Okwf REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
:moo Dam Canmruar _ OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
' S
I understand my plans shall W used a public ARCHRECI'SDEON r CLASS A. CARPORTS 18 19, r
20 T/O OFF SHK (N) COM
i�< public mrnrN
lyU
°stn Liccnscd PmfcsdonAl
5 OWNER-BUILDER DECLARATION
aC I hurchy.(Suer on 1 I.S.exempt from dm Contractor'.License: Law for the
p o following reason.Permian WSJ 1. Business and Profexi0a Codc:Any an Of county
which mquima n permit re cnrmsvt1m alms,improve dcmolW,or repair any aroetum
-areprior iuissuance Alsur,toims thovisio so for Cohpermitwfilcasigned sutemcnt
that Wenchni;wit pursuer w Ne provisions of dm Conuazwhldcevc law(Chapter Sq.Ft. Floor Area Valuation
(commencing with Section]000)of Division 3o Om BusfnessoM Rafeaima Code)or $13371
'5F that he is exempt themfmm and the bait for tW Alleged exemption.Any violation of
Section 703 1.5 by Ory appliant for a Permit nbjecu Ne Applicant a a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollars(5.500}
0 I,As owner of the proputy,ar my xnployces with wags As thou sole Compensation,
will do Nc wart.and Neawmumismal intended cluttered fonalc(Sec.71)44,Business 32699956 . 0e
Required Inspections
and Profeaslons Cade:The Contmcmrs License L.A.dos nor apply w An oewner of q P
property who builds caimpmses Narrnn,and who does such work himnel f or Neagh his
own employ=,provided that such improvements Are not intended oroRered foraale.IL
however.the Wilding or improvement is sold within one you of completion.the owner.
builder,will haw du:burden of proving Nat W did not Wild or improve for purpose of
Mk.).
Q 1,as Owner of the property,am exclusively contracting with licensed convectors w
cauunet
Use project(Sec.70M.Bruce.and Proresdoru Code:)The Conuacrnr's U.
ecese Law does not apply An an owner of property wW Wilds m impmret Hereon,and
who cornets for such projects with aconlnctor(s)licensed pursuant to the Contractors
L e.Law.
O I am exempt undee Sen .B&P C for this reason
Owner Due
WORKER'S COMPENSATION DECLARATION
1 herehy affirm under penalty of perjury,One of the following declarations:
73�1
bare and will maintain a Certifiesseof Co..,w self-insure for Workers Compcn-
n,ss provided for by Section 3]00 of the Laker Code.for she performanm of um
for which Nia permit is issued.
haw and will maintain Workers Compensation Insu ..a repared by Section
of Ne Labor Code.for the performance of the work for which Nis permit is issued.Worers Compensatio°��surancartierandPalicyn Wrare: �-sebber. J`��`G r�ra'•TJ` Polity No.: Oo y— {/v
CERTIFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sccuon need not be completed ifft Permit is faros hundred doBan(SIM)
or las.)
1 cent ry that in dm perfmmanec of the work for which this Permit is issued.1 shall not
employ
any person in any manner,so As to become Arturo m the Workers'Compensation
Lawsof Cahromia Dam
Applicant
NOTICE TO APPLICANT.If,after making this Couricam of Exemption,you should
become subject to the Workers Compensation provision of Nc Iaher Codc you most
•JO f.m.idm comply with such provisions or this pdeemed moo
crmin shall W ted.
'Z`• CONSTRUCTION LENDING AGENCY
M
1.4 k for
owhicheby thi Nar Neve issued(Sec.i0lending agcnry for time perfurmantt of
LQ Le work fur which this permit is issued(Sec.J097.CO,C.)
LQ
Lender's ANone
dd
.7 z Lenders Address
U C) I certify that 1 haw mad this application and sum that the above informatiun is
,y F correct.l agree to comply with all city and county ordinances and state laws minting to
(]U Wilding construction,and hereby autborin represemamiw or this City to enter upon the
. a Above me judgm property for inspection purposes
(We)agree to save,indemnify and keep harmless the City Of Cupertino against
in,ciux tacru mento casuand expenses rnit. may in any way urnm agaiatxid City
U z APPLLIC NT UNDERSTANDS AND WILL COMPLY WITH AL NON-POINT Issued by: Date
SOURCE REGULATE
• A== _ //b Re-roofs CT
Signature of ApplicaNConvactor am
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de applicant or future Wilding attupantswre or handle har stme;material
a defined by he Cupertino Municipal Code.Chapter 9.12.and the Hcalth and Safety
Code,Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea
ns a
41 Will the applicam or future building Occupam vu equipment or dIf a roof is installed without first obtaining an inspection,I gree to remove '
emit ha=dous air contaminants As defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes "M.
Ihawmed NehaaeNans 25505.2553req.imrne 55M.IrClupmrd.95 Ortho Wilding
does nosh&SafnyCoM,Scmm�. 2, 50.ifemy 3aW25S3C.l uMcuund thataicup Wilding
does not curtcnmly:h!5.1.temnL Nam it u my n..f.hilisy i,notify the occupant or Nc
myui¢mcnidet prior ma ixaan¢nn eenifiaam Oraeap Signature of Applicant Date
Owner or authorised agent D, All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 7 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 # . . . : 06090177
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD .# 11
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 14 , 000 . 00 212 . 76 0 . 00 212 . 76 0 . 00
BSEISMICRE VALUATION 14 , 000 . 00 1 . 40 0 . 00 1 . 40 0 . 00
-- - ------- - --------- -- -------- ----------
TOTAL PERMIT 214 . 16 0 . 00 214 . 16 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
Gs Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
:UPEI�TINO
Building Department
JOB ADDRESS: S "' PERMIT #
0191 01 LiQ l - 0(0C 0
OWNER'S NAME:Ozmemews PHONE # A8-25"]— 1 0(00
GENERAL CONTRACTOR: S FAX # S 0' 3-
t
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin information:.
EF—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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An LC.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: Tf oma_ G�s V1 <<a 5Qjr-�
Job Site Address: 2_080o 4o wvnne S--eQaC (Lo 1,-39
Roofing Company Name: DU(2.0;S �sOt 7
Applicant's Signature: Date: �6
• Greg Casteel /
Building Official
Revised 11/2/04
CITY OF CUPERTINO agOq b I it
C _ REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 3?_t�09_o5Lv Date: O, 20 I oIV!
^
Building Address: ��., 0D ^ _� 9-64- 1 '
Owner's Name: ' ��f Phone# 6 Sr OC)
Contractor: 1;), A}C.,t ,1S Po�m g c. License #: 0 G ���04
Contact: `/I l/V 1 Cupertino Business License #:
M�1�k I�,11GDI 2OV51
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ ood Shingles (y `^ ❑ Wood Shingles
B- O[her(Specify) NTIASf I•I 9,'_0ther(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 1rCY \A&eA \no,31 k P
r, \es*
Residential Commercial p , CI(�
Fire Zone: Yes ❑ No 0--- �$ Ci 1 Confirmed with Planning Dept. if P
there are any restrictions: U
Cost of Project: I 13-71 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
•