06090184 CITY OF CUPERTINO 7
9UILDINO DIVISION PERMIT CONTRAGTORAINFOT2MATION
BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT No.06090184
20800 HOMESTEAD RD 4 10
OWNER'S NAME: FERIAn ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
NE: SANITARY N0, CONTROL NO.
(510) 793-9760
ARCHITECT/ENGINEER: BUILDING PERNIMINFO
BLDG ELECT PLUMB MECH
I� 0
:aa LICENSED CONTRACTOR'S DECLARATION
reF 1 Itemby affirm 1 am liecacd ander prm
a. ans of Chapter 9(commenemg lob Description
rm N
;zw with Section 70M)of Division 3 of dte Business and Profesiom Can.and my liccnscu
License and If T(7 3a" l REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
y i Licenm�Can g
SFO Date canmanar _ (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
ARCHITECTS DECLARATION
i < I understand my plans shall he used a public acares
)yU
e Wo G Licensed Pmfcssional
5 OWNER-BUILDER DECORATION
N 1 bemby affirm that I am exempt from On Canulctofs Liecnac Law for are
a o following mason.(Sectio"70 LS,Business and Professor.Cole:Any city ar coumy
<m which requires a Permit m arrtavui alto,,improve,demolish,nr¢pair any nature
uzi Prior N its ads.rate.the applicant for such permil to file a signed statement
xgo
Out bell licensed purauamtoftprovisiaesafOnColoss ilicemelaw(Chopw9 Sq.Ft.Floor Area Valu4adV213
el— (commencing with Section 7000)of Divuian 3 of On Business and profession Calls)Mr
9 Nat he is exempt Noefrom and the buts for the alleged exemption Any violaulon of
Section 7031.5 by any applicantfor a permit subjects the applicam an a civil penalty of AP Number Occupancy Type
Men mom Nan An hundred dallars 0,5(()). 32 6 0905G . 00
❑Luowneraf the property,omy wployces wishwageaathe'v sole eompenatian,
will dolework.And Cali:: heCoseunor's Liam
Law
os sad.(Seenot
71 an came,of Required Inspections
and Proery h bis Code:The ns therst,Liceme taw don not apply lf r u awrter is q P
progeny who builds of d tatmch improvements
m r and wW AM not
work himxelfar Nrougb his
owncer.the Wilding
prmach improsoldwharcnot ear ded ofeoraBerW for owls If.
however.Nc Wildhe tru improvement u sold within ane year of improv W the esus of
builder will have tite Wrdcn of proving Nu he did not build or improv for purpose of
rale.).
❑1,as owner of to prepcny,am exclusively contracting wit licensed mnuacmrs to
construct the project(Sec.7044.Bosinoss and Professions Code:)The Connectors U.
aesa law don not apply N an owner of progeny who builds or improves Nerea ,And.
who contracts fm such projects wit a comractor(s)licensed pursuam an the Contractors
License Law.
❑I am excrope underSa. .B d:P c far Nu mason
Owner Dam
WORKER5 COMPENSATION DECLARATION
1 hereby diurnal under peri of perjury ene of the following dalarmiom: -
I ha,c and will methods a Cuditesm of Contra in self-insure(or Workers Coni
odor,As provided for by Section 3700 of the Labor Code.for Ne performance of On
walk for which Nu permit in Based.
1 base and will maintain Workers Compensation Insunnce,in required by Section
37W of Ne Labor Code.for Nc performance.(the work for which this permit u issued.
My Workers ComPenoay['p,n�insuran/5e artin and Policy n robe mare:
Carrier. �a f��.rV 1k1 w! Polity No, L Q,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu xction need sat he completed fide permit is fora.hundreddalt.(3100)
or 1.)
1 certify Nos in the performance of the vMh for which Be,Permit is imund,I shall not
employ any person in any manner no as to beam,subject an On Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making Nu Ccnificate of Exemption,you should
beenme subject a use Workers Compensation provisions of the labor Code,you mum
.J O farl comply with such provisions or this Permitnball be deemed acnial.
z 4CONSTRUCTION LENDING AGENCY
[—i l hereby affirm Nat Nero sea concerned..lending agency for Ne perfurmaae of
I%> to work for which On permit is issued(Sec.3097,Civ.C.)
UA
Q Lenders Name
z Lender's Address
V 0 1 cenify Nm I ban mW Nis application aml sum Nat she eWn mimmatiun is
ly F-' correct.1 agree to comply wit all city and county ordinances and sum laws slating N
0building eonsauai.n,and he¢byaNhmne¢Pmsenutircaof Nis city m emernpnn the
ahovomemiuned nu.cos lar expera ca
is purposes.
F 0. (We)agree to save,indemnify and kap humless the City of Cupcnina against
h liab ncet,alma of tha granting
tsind of this'which may in any way accnte against ssid City
V z incansCAN'T of UNDERSTANDS
of Nu permit
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -POINT Issued by: Date
SOURCE REGLIIAIIONS. 6
Re-roofs
SignatureSignatureof AppliaHAZAR acuor / Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the c CBantmlarvae Wildinge.Chapter
9.1 or handle Halt nd SaaiL
As defined by Ne Cupertino Municipal Cade.Chap¢,9.17,atM th HceIN and Salcey
Code,csfion M32ta)7 All roofs shall be inspected prior to any roofing material being installed.
Tu
40 If a roof is installed without first obtaining an inspection,I
Will she applicant or future Wilding occupant sena equipment or devices which g agree to remove P
emit havordaus air comaminsnu as defined by the Bay Arta Air Quality Management all new materials for inspection.
D n ct7 ^'/,V
❑Yes /
Iban&Safet the Wwmdnusmaterials, 5533"Malcontents,Z534.Irdersand damit,Califon
nicer notc&Safcty Cade,Snnamn Out
25533"Z534. Wnobly carp Wilding
Jots not currently hart a tenant Nat it u my map.nihiliey w nobly Ik acuDant of Ne
requirements which¢ priarmissaan .Ccrdfinna or ty.iv 0�
9 Signature of Applicant Date
owner ora.abMindagent o. All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 4 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 # . . . : 06090184
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 10
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
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- ------- -- ------------- ---------- ---------- -- -------- ---------- --- -------
BPERMFEE VALUATION 18, 000 . 00 255 . 96 0 . 00 255 . 96 0 . 00
BSEISMICRE VALUATION 18, 000 . 00 1 . 80 0 . 00 1 . 80 0 . 00
---- ------ ------- --- ---------- ----------
TOTAL PERMIT 257 . 76 0 . 00 257 . 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
•
Sa-
Community Development
10300 Torre Avenue
Cupertino CA 95014
` Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: $ PERMIT #
01'ec 101 Le I — OIOC C1
OWNER'S NAME: PHONE # 4M-?$'7- 0(60
GENERAL CONTRACTOR: S' FAX # S O" 3-
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
LiPaving
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
I 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: �i o�'I�e�s / V, I(4 SRJ,- ,
Job Site Address: Zo 8Oo 4o"-_.r_ S-rexLet 20 C,pmt w o $)61^jS' 1 39
Roofing Company Name: ,(2,,D;S `/
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
-� CITY OF CUPERTINO l�Wvw I Ca I
C REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# 3 up_, wl 01DU Date: C) ZO I Ory
Building Address: 2 O 500 HMeSte„�-.1 Pd � I Q"1
Owner's Name-
Va�1\W �f� ��f��e����1 Phone
Contractor: �.' � �� 1nC✓ Licensee
Contact: Cupertino Business License
1�► Type of Roof Covering: I
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ sphalt Shingles q�Asphalt Shingles
®' Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Num er of existing coverings ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfg. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off P hcy:
• Job Description:pill- lnmn it h
Residential Commercial
Fire Zone: Yes ❑ No SK Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project: Type of Construction: Occupancy group:
b 11213 R.A
Qty. if
Applicable Fee ID Fee Description Fee Group
I 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