06090181 CITY OF CUPERTINO
BtILDING DIVISION PERMIT -COIF„TjUQTQR.INF0RMAT�II0N -;
BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT No.06090181
20800 HOMESTEAD RD # 33
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
E; SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITECDENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i0o LICENSED CONTRACTOR'S DECLARATION lob Description%mC I hereby affirm Jul 1 am licensed moacr provisions of Chapter 9(commencing
:iW with Secrceand1U)mfLC_-on]ofJteBusircvand Professions Code.aMmyliccnxis REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
'<> in full force and effcce/rJ C St 3oa
;q= LICC.Clas 1.J7 Lie.g _I OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
Lf� Date A ConARCHITECTS DECLARATION LARATION CLASS A.
i m< I undersand my plans shall he used a public meet&
)yU
u In Licensed Professional
'ct3 OWNER-BUILDER DECLARATION
P 1 hereby affirm that I am exempt from Ne Conoacmfs License Law for the
a O following mason.(Section T0]1.5,Business and Professions CWe:My city or county
i m which requires a permit to co omict,after.improve,dcmolsh,or repair any same.
pd.,to its issuance,also mq.iris the applicant for such permit to file asigneJsu¢ment
<
Out be is licensed pudammtothe puovisioesofthe ContmselcusLim.Law(Chapter 9 Sq.Ft.Floor Area Valuation
e�ct (commend,with Seefion?000)of Division]of the Bosineawd Profusions Cods)Or $7095
Jus he u exemtherefrom add therefroand Ne hoer for Ne vlegcd exemption.Any violation of
Section]0]1.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollars(5500).
❑I.uownerof the Propmy,or my wploym viN waguadre'v seld campewtian,
will eco Jae work.and the suuctum in Out intended or offered for sale(Sum.71344,Business Required Inspections
and Professions Cade:The Conuxemr's Liana,Law don not apply N an owner of q P
property who busIda or improms Nercnn,and whodossuchwork hicu lfor though his
own employees,provided thaaach improvements are notinuo ded oroRcted forsale If.
however.Ne building or improvement is mid within one year of completion.Ne owner-
builder will have Jon bustles of proving dart he did not Wild or improve far putpo¢or
sale.).
Ej Las owner of the property,am eulunwiI,.meaning with licensed cenoacmrs m
Construct the project(Sec.7044,Business and Profusions Code:)The Contractor's Li-
cense saw don not apply an an owner of property who builds or improver themon,and
who commout for such projects with a eon ramrods)licensed pursuant N the Control
License Law.
1 not concept under Sec .B&P C for this;ream.
Owner Dam
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑I ham and will maintain aCeri fiuCement of Cem t to self-imam for Worker'sCompen-
salfon,uprovided for by Section 3700 of the tabor Cade.for the Performance of Jte
work for which this panel is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
]'100 of the Labor Cade,far Ne performance of the work for which this permit is Iaued.
My Worker's Com pews/oy Wurana casim and Policy num/per ate: �,,a_
Camer:J Tj;'; rVa, Policy No.: (0(0,5 goo y 0 4-
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thu scCo.need nmbcco n imcd if the permit is forone hundmG dollars(SIM)
or less)
1 certify that in the perfmonanec of the work for which this permit u issued,l shall am
Critic;any person in any mannerso a in become subject to the Workers Compensation
Laws of Caliurna.Dao
Applicant
NOTICE TO APPLICANT:If.after making Our CedificalC of Exemption,you should
become subject to the Wmiters Compensation provisions of the Libor Code,you most
O foMwith comply with such provisions or this period shall he rimmed revoked.
Z h CONSfRUCf10N LENDING AGENCY
re+ I hereby affirm that there is a coauuuNnn lending agency for the perfudomm or
a the work fur which this Permit is issued(Sec.3097,Civ.C.)
fA� Lender's Name
.7 z Lembe.Address
V Q 1 crnffy Na 1 have read No application and sec a that the shore information u
correct.I agree to comply with all city and county ordinances and state laws relating to
oU building Construction,and hereby authome repmcroldu Of this City to enter upon the
erty
�I3] above-mcntiuncdps.Cost for travertine expenses
topewhich ma
F jy s.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
y incoitiu,judgmcnheStainingof this esmit. mayinany way attme agaiast said City
U A APPLICANT
UNDERSTANDS
of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-p0� Issued by: Date
SOURCEREGU .
9 4 D Re-roofs
Signore of ApplicanUConmactw Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thee Cupertiwfuturebuildinge.Chaptemoorandth Heardoamaterial
u defined m the Cupertino Municipal Cade.Chapter 9.13,and Nc Hu1N anti Safety
Cole,$c 35532(a)?
41 ❑y. All roofs shall be inspected prior to any roofing material being installed.
Yn flCk(
Will the applicant or future building occupant tax equipment or Jcviees which If a roof is installed without first obtaining an inspection,I agree to remove
emit ho.odou air cansminans u dcfxd by the Bay Am.Air otiosity Management all new materials for inspection.
DiJict?
❑Ycs
Ihave&Safet Nehaardmumatedaismquiremensundercliman Ourific Wilding `--•,• Q�
ria Hca1N&Sa(my Cale,Sections 15505.25533 and 25534.1 to dry
Wilding �/
don not currently ve a tenant pert it i my mapofa Cedy m m of
Ne aceupent.f Jte
oyuiremm-atlWmmpdtrmissmartatrecenifeetemrtiv>,wy./6 Signature of Applicant Date
.Owner.1 mthori,.edagent /D�C-� All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 1 of 10 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32609056 . 00
DATE ISSUED. . . . . . . : 09/21/2006
RECEIPT # . . . . . . . . . : 36146
REFERENCE ID # . . - : 06090181
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 33
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
AREE 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
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 Torte Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: S PERMIT #
otpl of LQ I — cto1 0
OWNER'S NAME: PHONE # -7— 0(0P
GENERAL CONTRACTOR: SQmfirP FAX # rj 0—'7
1
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: �(o�'IGe s V, I(a S¢fr ,
Job Site Address: Zo SoO 4o,-"r_ S reQo� 2d { C„pRn t „;C,
Roofing Company Name: (r 4 7�J c
Applicant's Signature: ��z Date:
. Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO ��
SUKI_ REROOF O(ou o I Q V
• CRY Of
CUPEkT(NO PERMIT APPLICATION FORM
APN# 324&-Og_Or:w Date: 0 20 I lV
�' ^
Building Address: ' ^vbCEJ^ �S Rd4- 33
Owner's Name: !�/ D � Phone #:
Contractor: 1 P` A ;)0°IS Poohm k fct License#:01230 L
Contact: vnV -V— D_A)C;6I Cupertino Business License
#:
�1
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
:❑ �Wood Shingles [� 1,� ❑ Wood Shingles 't,,,�
Other(Specify) WW�fIgSly1 3 �Other(Specify) �V I5_in.
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: r�',n�\(� &% \ 1 P
( Qi1�1Sfi1 10 � Q V
Residential Commercial ❑ ��� (1IQ A
Fire Zone: Yes ❑ No 8� — t' Confirmed with Planning D_pt. if
there are any restrictions: E
Cost of Project:1 0n5 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
•