06090182 CITY OF CUPERTINOet
BUILDING DIVISION PERMIT CQNTRAC QR INEQRMATION
BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT NO.06090182
20800 HOMESTEAD RD # 19
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 02/21/2006
NE:
SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHI ECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o o LICENSED CONTRACTOR'S DECLARATION
m I Wmby affirm mall w licensed under provisions or Chapter 9(Commencing Job Description
:ZW with Section 7r0l)of Division 3 ofthe Business and Professions Code.and my license is
,<m inmll""C'edeife 811 QCw / REROOF- TEAR OFF FLASHING, (N) 30YR DIMEN. COMP
n i Licevc crus Lic.g
:moo Dam Camraaa•�� OVER (E) 1 LAYER (N) RIDGEVENT, GUTTERS & DOWNSPO
RCH ECTSDECLARATON CLASS A.
i¢< 1 understand my plans shall W used a public records
>yV
'G Licensed Pmfessis..I
OWNER-BUILDER DECLARATION
<F I Wmby afrres mal I am exempt from On Ctintrantirs License Law for IW
p O following meson.(Section 7031.5,Business and Professme Cock:Any city air county
m g which squires.permit to construct.altar,Wpmrc,".luh,or repair any smanc ure
prior m its issuance,also requires the applicant far such Permit o filo signed smement
that W is licensed prominent to me m
provisions of the Commrs licemc Law(Chap=9 Sq.Ft. Floor Area Valuation
(commcncingwith Scction7=)of Division3ofmc Businwand Pmrmiom CWc)or $7095
,a�$ mat he is exempt Welfrom and the basis for the alleged exemption.My v;ilnim.of
Sccdon7031.5 by any applicant fon permit subjects be applicant Io..wil penalty of APN Number Occupancy Type
not m.R mN It.hundred dollars(5501).
C]i,as owner of me portion,or my employees with wages an their sale compensallon, 326091956 . E)R
will do the work.and the structure is not intended or offered for sale(See.7014,Business
and Pmfeaslom code:The Coruscates L;cense law does not apply M an owner of Required Inspections
progeny who builds in impmw lWreon,and whodnessuchwmk himselfm through his
own employees,provided mat such improrcmenu are not untanned oroffered forsalc.B.
however,the building or improvement is sold within now year of compltion,tW owner.
builder will have the Wed.of proving mat M did ret Wild or impmvo for puryose of
sal.).
❑1,as owner of IW property am exclusively contracting with licensed Contrmaors an,
construct the pmject(Sec.7014.Business and Professions Cade:)The Contractors U.
come law does mo,apply It an owner of property who Wilds or Improves memos,and
who contracts for such projects with a contraction(s)licensed pursuant he IW Cantranor's
License law.
❑1 ans exempt under Sec .B g:P C for this mason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 Wreby affirm under penalty of perjury one of the following dnclaraliom:
❑1 Wa C.m will maintain acer ificatcof consent to self-insure for Wmtee.Campen-
sation,as provided for by Section 37M of the Labor Cade,for to performance of the
work for which this permit is issued.
I have and will maintain Wei Compensation Insurance,m required by Section
3700 of the Labor Code.for On performance of the work for which Or,permit is issued. '
My Worker's Coreponnsatioranee.prier and Policy nu r
Cartier. 7 T+r r� n Policy No.: t� O4 2 am
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(thu section wed not W complcmd if the permit Is portion hundred dollars(SIM)
or loss.)
1 eenify mal in be performance of the work for which this permit is issued,1 shall not
employ any person in any manner an as in become subject to IW Worken'Compensation
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,afmr making his Certificate of Exemption,you should
become subject to the Workers Compenssdtin previsions of the Labor Cock.you most
.J vz foMwith comply with sech provisions in this permit shall W dcemcd rerckcd.
Z Q CONSTRUCTION LENDING AGENCY
[+ 1 Wmby allies ren them is a comwction lending agency for the performance of
C> the work for which this .it is Wood(See 3197.civ.C.)
A Leaders Name
7 z I<ndersAdd.
U C) I ccnify that I have mad this application and sum that the above information is
n. `^ Correct.1 agree to comply with all city and county ordinances and sum laws relating to
0U Wildingconsuunioo.and WohyaulhwucaP.Cmatives of lhisenymemerupnnthc
4[7 abovcros,judgcd properly for ie pe expeo.nses
purposes.
(We)agree to sae,indemnify and keep harmless On City of Cupertino against
i,IZ in Cr ssexpationofu.casuand expensesmit. they in any way seethe agalnstsvd City
A cPLICANT ofinegrunting 01711113 D WILL
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE
Re-roofs
Signature of ApplicaHAZARDO Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding c.Course,
9.1 orand de IHeallom mammal
u efincl Sec io IW Cupertino Municipal Cade.Chapmr 9.@,and the Health and Safety
Code,Screen us32(a)7
❑Yes All roofs shall be inspected prior to any roofing material being installed.
41 r/'Qo
Will the applicant or future bonding wen,pam um equipment or dences which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvardoua air cpnuminanu as defiwd by the Bay Area Air Quality Management all new materials for inspection.
Distinct? .�CG
Oyer /f No
Iharcread Codc,Sections
nM5.25533 and
253 underChapmdholifthe Wilding
nice HcolthkSakryOn W ncdom 25 H.lrr533 ercon,4.1undcrnmd.95.fOfft Wilding
dam not currently Ww 3 meant,that it u my responsibility M notify the occupant of the
requisconi which mustWm orm;ssnaocc ora ceniRaam araeap Signature of Applicant Dale
Owner or amhan'redagcm p� All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 2 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 # . . . : 06090182
SITE ADDRESS . . : 20800 HOMESTEAD RD # 19
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
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
4 --° r y Cupertino CA 95014
�` Telephone(408) 777-3228
CITY OF Fax(408)777-3333
:UPEkTINO
Building Department
JOB ADDRESS: S PERMIT #
Qlg1 01 LIP I — O(ol 0
OWNER'S NAME:Fmmemeus PHONE # 4M-25-7— 10(40
GENERAL CONTRACTOR: ULkS FAX # S O'7 3"
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An LC.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: _ Zo soo f { o w�e 5 re.seC 2d C,IoA vT,,;o
Roofing Company Name: I�U�o 5 Fso �*y 7t3
Applicant's Signature: U �—� Date: /���
Greg Casteel /
Building Official
Revised 11/2/04
CITE' OF CUPERTINO aDcq �Z
- REROOF
• CUPEKTINO PERMIT APPLICA'T'ION FORM
APN# 32C.p-09_OrL-)La Date: 'lI 20 I o ^
Building Address: 2cv cl �meC+t ^ 6 � 4- I q W
Owner's Name: lk a� �fJ�i �1GLi` � Phone
Contractor: A1 •I� � �g�•y� License#:
Contact: , n ly 11,/ Cupertino Business License #:
Iv 1 IL- �w✓�
Type of Roof Covering:
Existing: Proposed:,
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
�❑ ood Shingles �[yy (+!,, ❑ Wood Shingles
ther(Specify) New fl S1 1�� other(specify) V11� IU V�• �t G'lIG ` U3�
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ Tobe Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:• \ t P(� \S�l 10 � Odpaet
Residential Commercial ❑ C�1hIV1 �5..� OQ A
Fire Zone: Yes Q No 81— t Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project:-$-,l o 5 Type of Construction: Occupancy grou _4
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