06090180 CITY OF CUPERTINO
BUILDING DIVISION PERMIT -�CONTRIUC-TQ�41NFOP,,MATfQN%
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OIL ILDING ADDRESS: DUBOIS ROOFING INC PERMIT No,06090180
20800 HOMESTEAD RD 7
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
HE
_ SANITARY NO. CONTROL NO.
(510) 793-9760
A0.CHRECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oZ' LICENSED CONTRACTOR'S DECLARATION lob Description
:m= P
V I th ion 70 )of tha,1 am licensed under and
Professions
of Chapter 9(commencing
is
;n ullto=mdCffecDivision3oltheBuainmandProfusionsCoJc.anOmylicertmis REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
;�= LkenmCass C Lk. SrZ3o�1
.0 Dam Contractor ���_ OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
sty ARCHTECI-SDECLARATION CLASS A.z I undcrwnd my plans shall W used u public racomb
u.ayV
°0 Licensed Pm(cuional
OWNER-BUILDER DECLARATION
E 1 besehy alum The,I am Gumpo,foodfrom tW Conracroh Licensee law for IW
00 following neamn.(Section 7031.3.Business and Pretnded Calc:Any city or county
3$ which requites a permit to construct,alter,improve,demolish,or repair any aloe sum
_i< prior or its issuance.also docures the applicant for such permit to file a signed statement
shat he 6 licensed purmam I.the providou of the Conusmmue r's l3Law(Chapter 9 Sq.Ft. Floor Area Valuation
e0 (commencing wish Section 7000)of Division 3 of Ne Business and Professions Code)or $^7 0 9 CJ
1�2 Na,he u exempt therefrom and the bur for the alleged exemption.Any violation of Y
Section 7031.7 by any applicant for a permit subjem dw appfican,to a civil penalty of APN Number Occupancy Type
Om mac dun fisc hundred dollars(SSW). P Y YP
0 1.u owner of she property,or my employees wish wages as their auto ciac'n ation,
will do the wort and On surcmre is;not intended or offered for We(Sec.7016,Business 32699956 . E)
and Pmfeasion,cost The Conumei License Law coda act apply in an owner of Required Inspections
property who Wild,or improves thdrmn,and whodosssuchworkbimselfor through his
ownemployces,provided that such improvements are not intended oro@red for We.If. -
however.the Wilding or improvement is mid within orm year of completion.due owner-
bu;lder,will ban the Warden of proving ths,he did net Wild or improve for purpose of
vkJ.
❑1,an owner of the property,am exclusively contracting with licensed commissions no
construct the pmjm(Sec.7044.Business mid Professions Code:)The ContraemYs U.
cense law doss not apply in an owner of property who builds or improves thereon,and.
who conracu for such pmjeent with a condacmr(s)licensed pursuant to the Contractor's
License law.
0 lamasoun'tnder See ,B$PCfm Oi wawn
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby arae under Penalty of perjury one of IW following declarations:
1 ham and will maintain a Certificate of consent to self insure for Worke/a Compare
action,an provided for by Section 3700 of the labor Coe.for the performance of the
work for which this p<nnf is issued.
Than and will minimum WorkcYs Compensation Iuurmce,as requimd by Section
J700 of the labor Code,for the peif...of the work far which thus permit is issued. '
My Workete.comrp m ati(g_q lw artim and Pudic,,number M Boy
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(fir mmim need no,he completed if IW permit is Intent,hundred dollars($100)
Icss.)
I certify Nat in the performance of Oc work for which this permit is issued,I shall not
employ any person in any manner.ss m become subject to Ne Waste.Cnmpeuation
Laws of California.Date
Applicant
NOTICE TO APPLICANT.If.after making this Cenificmc of Exemption,you should
became subject in the Workers,Compensation previsions of tW labor Code.you most
.J O foMwith comply with such pmu visiaor this permit shall in,dmmcd revoked.
Zy CONSTRUCTION LENDING AGENCY
[-. I hereby strum that them is a construction lending agency for the performance of
03 use work for which this permit in is and(Sec.3041.C;v.C.)
aQ Lender's Name
.7 z Lender's Address
U O I emtify Na,I ban read this application and sum this the above information Is
D, correct.I agree to comply with all city and county ominanLa and mm laws relating to
�O Wildingeonauuetiun.and hemby outhorimmpresentatives of this city to enter upnn the
almvcmcmiuncd property fond c portion whichpurposes.
F y (We)agree to saw,indemnify and li harmless Ne City of Cupertino agamn
In in
dnu,casuintl expcnsumit. may in anY way accrue agains,sdd Ci,y
C1 z in cosrscgwnee of the granting of This petrol,.
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH AL/LNN-PO Issued by: Date
SOURCEREGULATI
Ob
Signature of ApplicanVRe-roofs
HAZARDOUS
bilin
MATERIALS DISCLOSURE Type of Roof
W;11 the applicant ar future Wilding acupan,smre m Mndlc hmardou material
u dc0ncd by the Cupertino Municipal Code,Chapter 9.13.and the Health and Safety
Code.odes 25532f.)1T ...,,, All roofs shall be inspected prior to any roofing material being installed.
u/nO
WJI the applicant or future building occupant use ego;prom,or device,which If a roof is installed without first obtaining an inspection,I agree to remove
emit haoamou air conuminanu u dcOncd by the Bay Arta Air Quality Muugcmcm all new materials for inspection.
District?
0Yes ZNo
Iban mail Ncbvamou materials mgairtmmm34.1u. .d.93 ofdeWilding
n;es nt c&sareyyCedd,hawa avouhat it
my anJusi4.t understands occ Pmrm or the
Jou m,currently M1an•tenant that iu u my responsibilitY w notify Jm occupant al the
require menu wh' ust , met prim m issuance of a CeniOem,of Occupant Signature of Applicant Date
Owner oraathoriaedagen Data All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 10 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 # . . . : 06090180
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 7
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 BAL
- - - - -- -- - - - - ----------- ---------- ---------- -- -------- ----- - - - -- ------- ---
BPERMFEE VALUATION 8 , 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00
BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
- - -------- -- -------- ----- -- --- ----------
TOTAL PERMIT 148 . 76 0 . 00 148 . 76 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- - - - ---- - -------- ------------ -------- ----------
OTHER 1989 . 00 VISA
TOTAL RECEIPT 1989 . 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
�UPEI�TINO
Building Department
JOB ADDRESS: S PERMIT #
O(p17g01101 — Otol79�,i
OWNER'S NAME: PHONE # ACe-257- 10( 0
GENERAL CONTRACTOR: $ Qcnfi rP -FA"-EE O--7 $-
1
I am not using any subcontractors: `I`.! — / Ti
Signature Date
Please check applicable subcontractors and complete the following information:
66 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 Y4 " 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: Tf o�,Ido s / vl l(2
Job Site Address: Zo 800 H-ow�
Roofing Company Name:
�T)j/�(2 �'S t F 7 fJ C_
Applicant's Signature: `L%G���� Date: /e7�_
• Greg Casteel /
Building Official
Revised 11/2/04
CITY OF CUPERTINO O(QOQ 0 ( vo
REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# 321p-09_Dt)lV^ Date: 120 0 vI
n
I
Building Address: n � -� Rd + C1lV
Owner's Name: f / ' Phone#:F s �
Contractor: Vv11c;)0,1S Ppc 11Y� MCI. License#:01
1�+'
Contact: K L y_V_ UU�•` 1 Cupertino Bus License #:
12-U5K Type of 7Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Cl Wood Shakes ❑ Wood Shakes
❑ �Wood Shingles [[y� !,, r1n ❑ Wood Shingles r���,,,,{
B Other(Specify) (�eWfl(As •�1 n E✓Other(Specify) VVQ CW Iowe ru:�_
Number of existing coverings ❑ Provide I.C.B.O. Report N t—y
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: r"orm\A& \ I rltpn U0tTT,3-;:zAUP
(oVerSfi ndvoe\ert n&N ers
Residential Commercial ❑ -(Z)COa A
Fire Zone: Yes ❑ No a� t Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: ry O� 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