06090179 CITY OF CUPERTINOs BUILDING DIVISION PERMIT B,kWNTTRAC�TORANF�ORMATION
BUILDING ADDRESS: DUB IS ROOFING INC PERMIT NO.06090179
20800 HOMESTEAD RD # 24
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
NE: SANITARY NO, CONTROL NO.
(510) 793-9760
ARCHMCT/ENGTNEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�0, LICENSED CONTRACTOR'S DECLARATION Ib Description
i V Ej1 creby antero Nat 1 am licensed under provisions O0SCr1 of Chapter 9(mmmctoing P
with Section]qIU)of Division J mflW BusirLic,mv and Professions Code.aMymy Ikense u
? y in full fortedeffec✓ IF $(23a r REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
License,.: { OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
Dam ARCH ELTSOECLARATION CLASS A. CARPORTS 47 T/O OFF SHK (N) COMP
i I undersand my plans shall W used u public records r
)yU
`0t; LicensedPmfessional
OWNER"BUILDER DECLARATION
1 he."alRrm
than 1 am exempt(scum Ne Communes License Law for IW
p o following moon.(Section 7531.3,Bum.and Professions Code:Any city or county
<m fL which requires a Permit to construct,aher.improve.demolW,or room any suucwm
prior b its issuarxx,also inquires the applicant for such permit to Bk a signed gammem
< thatWisliecnudpurwanuotWProvisionsoftheConuacmrslJansclaw(ChaPm9 Sq.Ft.Floor Area Valuation
`�$ loss
with Section 7000)of Division J of the Business and Professions Code)or $on
-. t he I$exempt therefrom and Nb
e uis for the alleged exemption.Any violation of
10171
Section 7031.3 by any applicant for a permit subjects thc Applicant o a civil penalty of APN Number Occupancy Type
nut mom than five hundred dollars ISM P Y YP
❑1,u owner of ted property,o mY emPloyas with wage u they sole compewtion,
will do the work.and rite saueturt ismatinanded eroffcred forsalc(Sec.7054,Busircv 32699956 . R_
and Professions Code:The Comaeara License Law does rot apply in an owner of Required Inspections
property who Wildsoimprovextherean,and who d«asuch work bimulfer through hu
own employe s.provided that such improvements art not Intended"offered for sae.If.
however,Ne building or improvement is sold within one year of oompleuom,the owner-
builder will have the harden of proving that W did not Wild or improve for purpose of
We I
❑1,as owner of are progeny,am exclusively contracting with licensed contractors to
construct the project(Sec.7(A4,Business and Profession s Cade:)The Contractor's Li. _
ceue Law does or apply to an owns of property who Wilds or improves thereon,and.
who contracts for such projects with acomamor(s)Remand pursoam m rim Conuacmrs
License Law.
❑l am exempt under Sec .B&P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I homey affirm under pe.ahy of perjury one of the following declarmious:
1 ham and will mainain sCerufscate of Co..,to self-imurt for Workers Campen-
sation,as provided for by Section 3700 of the LSW,Cade,far dee perfomanm of the
work for which this permit is issued.
neve and will maintain Workers Corepemnkm Iusuinnce,as required by Schon
3700 of the laWr Code,for the perfarmmcc of the work for which this Permit is issued.
My Worker's Comamandom InnsurmettQtrier and P
rlPr` ley nu ry�Q (�
Cartier. JT4'i•G f V� IvaPolicy No.: s/�o7 Beef7 aIy�
^��
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Must account road not W completed if the Permit Is forme hundred dmlaa(SIM)
or leu)
1 certify dot in the performance of the wort for which this Permit is issued.1 shall not
employ any person in any manner so as to Weome subject w led Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after mating this Certificate of Esempitm,you should
Wrome subjeet to the Worker's Compo cation provisions or the labor Code,you mug
0 O foMwith comply with such provisions or this Permit shall W deemed nevekcd.
z " CONSTRUCTION LENDING AGENCY
[+� Ihereby am.that them I.a cormuucutat lendingfordo rformance of
FL
the work for which thus . leg` p`
�W Q Lender's Name .it u issued(Stt.J097,Civ.C.)
Z)z Lender,Address
U C) I certify that I have road this applicamb and sum Nat Ne aWve information is
Ii. f" come(.I agree to comply with all city and county ordinances and sale laws relating to
UU building convection,and Wmb1golu ire mpmecmgivcs of Nis city m enter upon the
0. anikiesndouWprogeny for cpectione.purposes,
(We).gore to save,indemnify and keep hamdns,the City of Cupertino against
nl"'wh in consequude or theeostsandofteosamit. may in any wayattmc againstsaid City
U,Z in consequence of the Earning of This permit.
^ APPLICANT UNDERSTANpJAND WILL COMPLY WITH ALL NON-POI Issued by: Date
SOURCE REGULA'ns])/9!/
��G�^ —S— �(a
Re-roofs
Sgnuure of ApphanUConracmr 0�
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ted app ocarl or forum Wilding eceupant,mm or handle ha:edous rte mdal
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Cause.Seetion 255320)7
❑Ya All roofs shall be inspected prior to any roofing material being installed.
41 �u
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit h.mrdo e,air contaminants as defined by Ne Bay Area Air Quality Management all new materials for inspection.
DistrlcR
❑Ye A11C
1 have rad the hvardtws materials requirements umdef Clupmr G93 of rite Califor.
nu Hcahh&Safety Coda.soon.73505,MS33 rW 13534.Iundersond duaifde Wilding
dons not currently have.mnane that it is my responsibility w notify rite oceupmt of the /
mgrimmcntswhkhmu ctpriormissummofaCouficamafOccup Signature of Applicant Date
Owner.1.rmaram age.[ „� All roof coverings to be Class "B"or better
CITY OF CUPERTINO
Om 9 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 # . . . : 06090179
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 24
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
•EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - --- ----- - -------- ---- ---------- ---------- ------ ---- -- -------- ----------
BPERMFEE VALUATION 11, 000 . 00 180 . 36 0 . 00 180 . 36 0 . 00
BSEISMICRE VALUATION 11, 000 . 00 1 . 10 0 . 00 1 . 10 0 . 00
---- - ----- ---------- - --------- ----------
TOTAL PERMIT 181 . 46 0 . 00 181 . 46 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
�UPERTINO
Building Department
JOB ADDRESS: S I — PERMIT #
0121701 lIQ I — OloC7a®.
OWNER'S NAME: PHONE # 4M�25-- )0(00
GENERAL CONTRACTOR: SQmfi nq FAX #
6
I am not using any subcontractors: 2%
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
[!jPainting/ 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 m;mmum 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: �f o wl�e s V, I(C, SRjr-,
Job Site Address: Zo Boo H-o"A e_ S-rea of (Lo
Roofing Company Name: 001_2�0'S � r�r , 7hj
Applicant's Signature: v �� Date:
• Greg Casteel /
Building Official
Revised 11/2/04
' CITY OF CUPERTINO moll Cl
M REROOF
• CUPERTINO PERMIT APPLICATION FORM ff nn
APN# 3�oq—o,J10 Date: 20 I o W
Building Address: '200600
200 00 �rreS 9-6 n' L
Owner's Name: �� � ! V'1 I In ry Phonek#:,`^m' ),otp
Contractor: V1 t/et`IS License#:
Contact: , A�r' �{'}� Cupertino Business License #:
iv LTJ 12-CF51
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 , { ^^�
t Other(specify) N�TIQS�•� .9lOther(Specify) qhx1�5�1��
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: VWM\A&_ey\ \ t P
Residential Commercial ❑ c) yn C�(Z
Fire Zone: Yes ❑ No 19-1 41 Confirmed with Planning1Dept. if P
there are any restrictions: LJ
Cost of Project I ul �1 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