06090185 CITY QF CUPERTINO
BUILDING DIVISION PERMIT sC O NTRACTORqNFORMATION -:-
Zr
BUILDING ADDRESS: . DUBOIS ROOFING INC PERMITNO.06090185
20800 HOMESTEAD RD # 38
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS VILLA SERRA 99 DUARTE AVE 09/21 /9,006
NE:
SANITARY NO, CONTROL NO.
(510) 793-9760
ARCH1TECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
iop LICENSED CONTRACTOR'S DECLARATION lob Description
I hereby affirm Nat I am licensed under provisions of Chapter 9(commencing
:U with Section 7001 of Division of the fitowese and Profession Code.and my Imnsls
inmllfnaAnd ertaGsF O REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
s z Licensea {... I Lk.9
-ro Doc 9 +a a+�—conumor (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
3f ARCHITECTS DECLARATION CARPORTS 78 & 79 TEAR OFF SHAKES, NEW COMP.
i m 1 undersunJ my plans shall be used As public records
5yU
u.l;; Licensed Professional
OWNER-BUILDER DECLARATION
I bcrehy,alEnn that I am exempt from the Canvactora Lineae Law for the
CC following mason.(section 71131.5,Badness and Professions Cook:My city or county
i m ff which requites a portrait to moslrun,alter,impreve,dcmalish.nn¢pair any emctvm
cxi prior m its mention,site mquios the applicant far such permit In ftk a signed sukmem
s that he alittnudpursuant toden provisiaruafdoCoamer'sUccraseLaw(Chapter 9 Sq.Ft.Floor Area Valuation
r t] (commencingwiltSalion7000)ofDivision3efNeBusinusandProfessionsCode)ser $18020
that M st exempt therefrom and ban India for the alleged exemption Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars(5500}
❑1.as,owner of the property,or my employees with wages As their sok compensation,
will do the mkn and the srecture is an[invaded or offered for aala(See.7044,Business 32609856 .
and Professions Code:The Contractors Liatue Law don not apply an an owner of Required Inspections
property who Wilds or improve themon,and whodoessuchavad himselfor through his
own employees.provided thatsuch improvements art am,intended unaltered inane,it.
however,the building or improvement is mid within one year of completion,the owner.
huilder will have the burden of moving that W did rot Wild or improve for purport of
Asia.).
❑1.As owner of the property.am exclusively contracting with licensed mnuxmn an
construct the projea(Sec.7014.Business and Prefessiam Code)The Contractors Li-
cenu Law don not apply at an owner of property who W ilus or Improvea thereon.And,
who contracts for such projects with a cormscul licensed aterna eat m the Contractors
License.Uaw.
❑ Imtemno ounderSee ,B&PCfmthiareamn
Owner Deo
WORKERS COMPENSATION DECLARATION
I hereby afirm under peniltY of perjury oro of the following declaramou:
1 have and will mainuin a Certificate of Consent be self-imam for Worhh Compcn.
rather,as provided for by Section 3700 of the Labor Cade.for the perfmmaboe of the
work for which this permit is issued.
I have and will mainuin Workers Comemsation Immanence,As required by Section -
3700ofthclal,w Coast.for the peRormanee of the work for which this permit as issued. '
My Workers Correa atio 1�¢'sy'ur�� a Gamier and Policy number am:
Carrier.S;r ; fl= Policy No.:
CERTIFICATE OF EXEMPTION FROM CRILKERIPS
COMPENSATION INSURANCE
(the acctim bond ret W completed if ale permit is far..hundmddoll.(5100)
or ins)
1 certify that in the performance of the wart for which this permit u issued.l shall raw
employ any person in any mannerm as to became subject to the Words''Compensation
Laws of California.Dec
Applicant
NOTICE TO APPLICANT:if,after making this Ccnifrcae of Exemption.you should
become mbject to tW Worker's Compmtution poviamas of the labor Code,you must
.J O foMwith comply with such previsims 01 this permit shall W doomed¢raked.
C. CONSTRUCTION LENDING AGENCY
CC. I hmby.film dot them is a cmA maim landing agcmy far the perfermmxaof
'> tW wan fur whim this perch at issued(Sec.3097,Civ,Q
6W. 0 tenders Name .
0. z Lender.Md.
V Q 1 cenify that I have mad this application and sate but Ne above informatiur is
Ly torten.1 agree to comply with all city and county ordinances and sou laws relating to
U Wilding consurection,and hereby mint mpresemativn of this city to enter upon the
r 0. shoat-me judgments.
udgm propc costs
for inspection purposes.
t-^ (We)agree cave,indemnify and kcep barmkss the City of Cupertino again.
LO)UZ in consequence
cat the gra Andexpensesdes;permit. may In illy Way aeCrlM agalnSl old City
C)z inconsequence of the granting of the permit
'—' APPLICANT UNDER ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sOURCER L S. P/,/0�
Signatum of ApplicenvContlacor --Dt— Re-roofs
HAZARDOUS MATERIALS DISCLOSU RE Type of Roof
Will the applicant W fuom building uccupmi sore or handle barallous material
u defaml by the Cometh-Municipal Cade,Chapter 9.11,and the Health and Safety
Cada,Section255320)? All roofs shall be inspected prior to any roofing material being installed.
Ynp
Will the applicant o fuwm Willing occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huminn air contaminants as;dclined by the Bay AMA Air Quality Management all new materials for inspection.
DcmIcL?
❑Yes Gmu
1 have mad the by adaus materials requirements under Chapel 6.95 afthe Califon
ria Health&Safcy Cade,Sadao]3505,25533 and 25534.1 understand due trite Wilding gL
docs not cmmall,hoc a kraut that it ls my Inponsibility m notify the occupant of the V
myuiremcnts whmh nmtpdor to'..once of.Gerlk. Signature of Applicant ate
Owner or autham<d agent ata.
t-/ aAll roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 5 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 # . . . : 06090185
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 38
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 19, 000 . 00 266 . 76 0 . 00 266 . 76 0 . 00
BSEISMICRE VALUATION 19, 000 . 00 1 . 90 0 . 00 1 . 90 0 . 00
---- ------ --- - ------- ---------- ----------
TOTAL PERMIT 268 . 66 0 . 00 268 . 66 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
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT f ,
Otet 01LOI — OtoM®
OWNER'S NAME:9 PHONE # 4M-25-7— 10(0(D
GENERAL CONTRACTOR: g FAX # 5 O— 3"
l
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 fust 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: �(o c_I�ovs / Vi1(a
Job Site Address: Zo Soo k f o w e S ren o� R 0 G,Py� r w o �J S' ,—39
Roofing Company Name:
Applicant's Signature: � Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
' - REROOF
• CUPEI�TINO PERMIT APPLICATION FORM
APN# 32W Dq05U Date: LO I ou
Building Address: 20800 "OnIe .ta,-d 9-d
4- 38
Owner's Name: sV�W t tl�����j�����11 Imo{ I one 4
Contractor: DLAb6l S In `1`nc, License#: �12
Contact:, nQr�- )Ub&Z_ ` `T�� Cupertino Business License
#:
I�t Type of Roof Covering: 1
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ �4sphalt Shingles QyAsphalt Shingles
5� Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Num er of existing coverings ElProvide I.C.B.O. Report 4
To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off P lic
• Job Description:-Wr- 'e ' ' ^7 t 0,5Z. In
i rl ,^� � s A
Residential Commercial 1a1' $ hl,,a�.�.; r v1 T ,In�'I
Fire Zone: Yes ❑ No Confirmed witb Planning Dept. if
there are any restrictions: LI
Cost of Project: IQ 1 O Type of Construction: Occupancy group:
VV �lq RA
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