06090178 CITY OF CUPERTINO � .mF�'
BUILDLNGDIVISION PERMIT CONTRACTORINFORMAT"IO,N„
BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT NO.06090178
20800 HOMESTEAD RD 4 2
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
WE:
SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITECTYENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
1 O p LICENSED CONTRACTOR'S DECLARATION
Job Description
%wF 1 hereby affirm that 1 am licensed under provisions of Chapser 9(Commencing P
r;zw withSudan 7")of Division 3 ofthe Busiriess and Profesuov Cade,art my licenscis
!�N in full force and elfeao11 REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
'nZ `1CCOro°
Da¢ G3 `k'g 2 OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
❑ Conuattor
ARCHRECTSDECLARATION CLASS A. CARPORTS 42
, 43 , 44 IunderstandmyplaneshallWusedaspublicmcm,13 , 4 3 , 44 T/O OFF SHK (N) COM
lyU
e o Licensed Professional
5 OWNER-BUILDER DECLARATION
iI I herehy tlTitm that I em exempt from the Convactoes LJeenee law,for the
p O following,axon.(Section 701.5,Business and Profession.Cade:Any city ar county
3_ which requires it permit to ehruwc,alter,impmvm,&..Jim.Cor repair any wucti m
_Z< Pdmrm its issuance.alw lecturer the applicant forsuch permit to rile a signed statement
that he is licensed purmanuo use provisions of the Commeturi Liceme,law chapter Sq.FL Floor Area Valuation
«C (commencing with Section 70(X)ofDivision 3 of the Business and Professions Code)or $13371
Nat he is exempt therefrom and the bvu for the alleged exemption Any violation of
Section 7031.5 by any applicant for a permit subjcctx Nen applicant a a civil penalty of APN Number Occupancy Type
not more than five hundred dellars(SSW} P Y YP
❑Las owner Critic property.or my eruployem with wages as them mlecompeisomm.
willdothework,andthestmctumurwtinm.d ..freed Tarsale(Scc.7014,Bud«.< 32609956 . E)e
and Profeadon,Code:The Comncwrs Liccme Law does oat apply M M miner of Required Inspections
property who builds Cor improves thermon,and who daeseuch wore,himselfor through his
awn employers,provided Nat such improvements an,not intended oroRcmd fmradea.If.
however,do,Wilding or improvement is sale within one year.(Completion.the.wner-
Wilder will have the WrOm of proving that he did rmt Wim or improve far purpose of
sale.).
❑1,as miter of the PrapenY•am exclusively contracting with licsnecd Conuxwn to
Co..,the project(Sec.7(J44.Business and Prefers ms Code:)The Coamemr's U.
cove law dors not apply m in miner of property who Wilds or improves thereon,and
who contratts for such projects with a emnuumm(s)licensed pumvns m the Conuattols
License Law.
❑1 am exempt under Sec .B&P C for this mason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby arfirn under penalty of perjury Cone of the folb ing declanuov:
1 have and will maintain aCertifigLe of Canemw uhf--insure fa Workeh Compen-
sation,as provided far by Section 3700 of the Latmr Cade.for the performance of the
wort for which this permit is issued.
1 have and will maintain Worker's Compensation Insunn¢,az required by Section
37W of the LaWrCode,for Ne performance of the work for which Nis permit is issued. '
MY Wmkeex Compensation
'Ivureionce carrier and Policy number arc:
Cartier: .Jf/1•%•GIV'a�� PolicyNo.: Q0 0�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ITu mmim head not he caoplctnd tribe permit is formic hundred dollars(8100)
or less.)
1 cerufv that it the performance of the work for which this pdrnit is issued.1 shall not
employ any person in arty manner m az 10 become subject to the Worke 'Compensation
Laws of Califomia Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject in the Wmrkeri Compensation previsions of the LaWr Cade,you moa
.,z foMwith comply with such provisions or this permit shall be d¢mcd revoked.
z" CONSTRUCTION LENDING AGENCY
r
'b+ I herebywhich
thi than them is a cevwau 097,Cing agency for Ne perfunnarwc of
Uj the work for which this permit is issued(Sec.309'f,Civ.C.)
0.Q Lenders Name
D Lenders Address
V O I ttnee Nat I have sad this application end suthaz above information is
0 E^ bonding 1 agree
r m comply with all city and county ordinances andnd sum laws elating m
O V abovengconswcslon,and heebyauthove poreasnutiwes of Nis city to bmbr upon Nen
ria aWvc.mcnudgmennil talerry(an inspection which ms.
(We)agree no save,indemnify and keep harmless rhe City of Cupenmo amount
UZ in
of thecasuand expenses
To which may in anyway accmc against said City
V z in consequence al the Brentin8 of this perming
^ APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-PO NT Issued by: Date
SOURCER S.
_ � 06 Re-roofs
HAZARDOUS
Signature of Appligy
xAZARDOUS MATERccupea Cl.o ba I Type Of Roof
Will the applicant nd fMuni building C account,9.1 m handle Htudth anmateria
q dofined by the Cupertino Municipal Code,Chapter 9.12,and the Hglth and Salop
Code,Section 25532(.)?
Ely. Na All roofs shall be inspected prior to any roofing material being installed.
le
41 Will the upplicam or future building occupant use equipment of devi¢s which If a roof is installed without first obtaining an inspection,I agree to remove
emit Beard..air Mmannuanis as dcfrmd by the Bay Area Air Quality Managcmcnt all new materials for inspection.
District?
0y. IN.
1 have mail the hamrib usmaedals requirements under Chaperfi.95 ofOc Califon
nim Healdt&Safety Cedc.Secuav25M5,25533 and 25534.1 inlcomnd Oatilthe building �� A
Jaen net conically have a Leman,Nat in is my hapovihility m notify the occupant of the
mquimmcnu wnrch�r us�t Prior to iaumbdmra cadrdammr«ba by. Signature of Applicant Date
�/ q ./a9�
Owner Cor am
theorized alpha 0`� aLe All roof coverings to be Class "B"or better
CITY OF CUPERTINO
0m 8 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 # . . . : 06090178
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 22
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
SEE 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
•
M5 Community Development
e 10300 Torre Avenue
u Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building Department
JOB ADDRESS: $ —3 PERMIT #
oLgC 01 LQ 1 — OLo(7R q
OWNER'S NAME: PHONE # AM 7- I 0(,pQ
GENERAL CONTRACTOR: DUW S FAX # 5i0--7c15—CMoo
I am not using any subcontractors: 2% D
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 "1.997 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: �(o �l�e�s / V, 1(2
Job Site Address: ZO Boo 4o w�e S r/e�o( 20 C.,.,?AT-, ro 0 81r S' -39
Roofing Company Name: '����o S r 7 tS c
Applicant's Signature: � �� Date:
• Greg Casteel /
Building Official
Revised 11/2/04
CITY OF CUPERTINO 0(0 d I1 b
c4o
• CUPERTiNO PERMIT APPLICATION FORM
APN# 3-2 p-0
9_orz ll/n Date: n �l I vo
Building Address: n^ � � �Z
Owner's Name: V IL q t Phone#lQ��
Contractor: -u t-)O°IS, tyg License#:��
Contact: , n.t/rI 11✓ ` �I41Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles [y ❑ Wood Shingles �,,,,{ c�
tJther(Specify) N '�IAS�I� 9+�Other(Specify) [)VG► 1N
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: RTmA& V ffwitkofP
� sfi rl verb-, raN
Residential Commercial ❑ (1I(z
Fire Zone: Yes ❑ No 1— �l 4-3 q4 Confirmed With Planning new P
Dept . if
8
there are any restrictions: U
Cost of Project: i q I I 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
•