06090186 CITY OF CUPERTINO a rl�t'ssa*aq
BUILDING DIVISION PERMIT CONTRACTQR IIVI'OLtMATIO
BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT No. 06090186
20800 HOMESTEAD
OWNER'S NAME: PERMR ISSUE DAM
PROMETHEUS VILLA SERRA 99 DUARTE AVE ocj/21 /2nnr
10 NE: SANITARY NO. CONTROL NO,
(510) 793-9760
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i00 LICENSED CONTRACr0R3 DECLARATION Ib Description
w F I Imrcby affirm that I am licenced umleislo
r pmvns O
of Chapter 9(commencing
'<W wiNSccdon70f10)of DiWion3o(t Bairmumd Profcssioa Codc,a mylicc=is
;�I full force
Z p REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
)q: Lieerm!9 Lie.a (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
Np Dow Como.ur
•"� ARCHf CTSDECLARA N CARPORTS 7 & 8 TEAR OFF SHAKES
i z< I understood my plans shall be used as public mcorda , NEW COMP.
)yU
fit; Lwanud Professional
3 OWNER-BUILDER DECLARATION
1 hereby afford that 1 am exempt from the Canvanars License Law for me
A Cfollowing mason.(Section 703 I.J.Business and Protesdoa Cock:Any city or county
fwhich requires a Permit to exa uuc
rt,alter,improve,&..fish.nr repair any swnum
-iw, prior to its issuance,also requires lW applicant for such Permit to file a signed statement
<
the.W is licensed pursuant to the pmvislom of the Conuxwh U..Law(Chapter 9 Sq. Ft.Floor Area Valuation
r $ (commencing with Saction 7000)of Division 3 of the Business and Professions Conic) `18(]2
_ Wl he u exempt therefrom and me basis for me alleged s c mption.My violation of
Stiction 7031.5 by airy applicant to a permit subjects Ne ppliant to a coil pcdairy of APN Number Occupancy Type
.or mart than five hundred dollars(5500).
❑1.six owner of the Property,ar my wployxs to wages a their in compensation,
will do the week.and mestrunert is sur intended or aRertd nor ak(Sm.704 a,Bud. ;260900
Required Inspections
and Professions Cade,:The Capitulates License law does not apply to an owner of q P
property who Wildscrinprova themes.and who dusumch work himselfmthmugh his
ownemployess,provided that such improvements see not intended oroRern l forsale If.
however,Ne building or improvement is sold within one year of completion,the owner.
builder will have thte hunden of proving Nor he did oar Wild or improve for Impose of
sato.).
❑1,as owner of the property,am exclusively contracting with licensed aurrtmmrs in
construct,the project(See.7044,Baines,and Profassina Cade:)The Contramara u.
cense law dos oar apply w an owner of property who Winds or improves Nemen.and. .
who contracts for such projens with a conmclnr(s)licensed pursuant in,the Contractors
Lieena law.
1 am exempt under sac. .B&P C for Nu moon
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby affirm under pea11Y of perjury one at Ne following Melaratiaa:
1 bare and will msinuin a Canon am of Coacnt w self-inium for Workers Compem
cation,a provided for by Section 3700 of the Inbar Cade,far me performance of the
work for which this permit is issued.
,21 have and will..Irwin Warkers Compensation Insurance,a rtquined by Section
3700 of t is labor
er.STA�Caode,far Ne perfmmunceof the wok for which Nu
.I,u issue
MyWorrsCampew6Iw... andPolier
Card
Poirt .
0Y zztyNo �
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Thlssecdon need not h completed lithe Permit is future,hundred dNlam(SIM)
or leas)
I cenifv Net in Ne performance of the work for which this Permit is issued.I shall not
cmPloy any person in any manner w as w become subject to dte Wotton'Compenution
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
became subject m the Workers Compensation provisions of We Labor Code,you muse
,J z forthwith comply With inch provisions or this permit shall W decreed mwked.
Za CONSTRUCTION LENDING AGENCY
r
[-t I hereby
FC heriNmemiaac3nlendingagency for Performance of
Nwork for whichNis Permit u ived(Sec. 097,
Civ.C.)
D.1 0 fenders Name
az Lcneers Margie,
U Q I cavity that 1 have read this application and sum that Ne above information is
ly F^ correct.I agree to comply with all city and county ordinances and sure laws relating to
0 U building constitution,and hereby authorize represcnwtiva of this city to enter upon the
a ahave-mendanc ena,C t for inspection purposes.
(We)agree to ave,indemnify and keep harmless me City of Cupurtino!galat
UeylZ liabilities,Judgments,Cuts and expenses which they in anyway accrue against said City
(„)z, A APPLICANT
of me griming of this permit.
^ APPLICANT UN ER NDS AND WILL COMPLY WITH ALL NON- DINT Issued by: Date
SOURCE *42-
�
��� / Z�/s Re-roofs
Sigamrt of AppliraHAZARDO eve
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or(utero Wilding occupant sort or Nrkle haardaa mamriL
a defined by the Cupertino Municipal Code,Chapter 9.12,and the Hcalth and Safety
Cade,Scedon 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑re
Will the applicant or future building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hxvardna air conuminanat W dcfined by use Bay Area Air Quality Maagcmenl all new materials for inspection.
D's icl7
❑Yes gVo
1 hags mal the hnaedrrusmnerials mquirememu under Chapter 6.95 of Ne Cslifor-
ria Health 4:Safcty Codc,Sccdaa 25505,25533 and 25534.1 underswmd Nos if the Wilding
does no currently hoe a..4 tha its my responsibility m notify the oce.Pant of the
m4timmcnw which Ito met prior to issuance of a CerdOcam of Occu l/046 Signature of Applicant Date
Owner or authorimd agent D All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 6 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 # . . . : 06090186
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 5
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 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
liiiw
ay Community Development
, J 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
4UPEkTINO
Building De artment
JOB ADDRESS: $ —39 PERMIT #
. 01,g X01 LQ I - OLOC
OWNER'S NAME: PHONE # 460-25-7— I0I40
GENERAL CONTRACTOR: DAW S Ppofi mt FAX # S Q-- 3—
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
7.. 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 nailinspection 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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: j ro i _� VI l(GL Sst!/'c
Job Site Address: 20 8OOST/eQa� 20 C paw r w o �J�$' 1 .-39
Roofing Company Name:: 00(2,0;S l �'(r C_
Applicant's Signature: `L%��— Date: ��
• Greg Casteel /
Building Official
Revised 11/2/04
CITY OF CUPERTINO rU( n�M
REROOF lu
• CUPEkTINO PERMIT APPLICATION FORM
APN# 32p_ On,_0'D n Date: n so ou
Building Address: 2 0 800 "O� 5
Owner's Name: V g Phone#,:
Contractor: �.I \S^ 111License#:
Contact:, nQr� VubbS 51��,� `"����� Cupertino Business License�`-�#:
1�1 Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 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 Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off P hcy:
• Job Description:-M'' I 1 tnsmjl
ns 1 A
,C11 DjXNN
Residential Commercial
Fire Zone: Yes ❑ No �-' Confirmed with Planning Dot. if
there are any restrictions: L
Cost of Project I Q �, ^ Type of Construction: Occupancy group:
I ¢—�
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