06090187 CITY OF CUPERTINO '•i � *•« '� -x "
BUILDING DIVISION PERMITGONTRACytTOR INI<'URMATION
BUILDING ADDRESS: DUB IS ROOFING INC PERMIT NO.06090187
20800 HOMESTEAD RD # 6
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
NE: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITEC 'ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
I� L E 0
i o p LICENSED CONTRACTOR'S DECLARATION - Job D05CrlpllOn
%w I h emby affirm that 1 am Beamed urocr provisions of Chapter 9(commencing
iZ`uf with Section]000)of Division 3 of lbe Business and Profcssms Code.and my license is
Liccliaa Cl°sod effec`GT+`, Lin is $t2.3o`'/ REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
�o Daw combarw: y=�_ (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
qq CHITECI'SDECLARATION CARPORTS 09 10 14 TEAR OFF SHAKES
1 a 1 1 u dernand my plans shall be used as public records s s NEW COMP.
lyU
o
Licensed Professional
g Oat lam exempt
mDECLARATION
i1 hereby affirm on 11. exempt from the COnoadwh License Law for the
O O following raaoa arch t ]031.5,Business;and Pro@salons Cade: a city m o..
<m which n,quins permit m airs the alley.improsa,demolish,Ci repair any swmum
u Z<
poor at Ire sS issuance,dparse m to the
pro inions of the Such pttnli's file se,Law(Charmeol
marromingwiitpurwan0o tha pro visions of lM Contractor's An cecc law(Chaptm9 Sq.Ft. Floor Area Valuation
$ lcommcming with Section]000)of Division J of dm Busirmvsaro Profcssiov GoCc)or
$19620
— that he u exempt therefrom and the basis for the alleged exemption.Any violation of
Section]031.5 by any applicant for a Permit ubjecs the applicant to a civil penalty Of APN Number Occupancy Type
trot more Nan five hundred dollars(5500).
D I.as owner of the property,in my amployees with wages as their sok campewdon,
will de the work.and the structure is not intended or offered for said(Sec.1044,Business 09
Required Inspections
and Profusion,Cad=The Comoduy's License Law does rot apply w C an owner of tl p
progeny who builds or improvestimm on,and whodousuchwarthimsellar through his
awn employers,provided Natsuch improvemsna ara not moderated ofated fousule U.
howeva:.the building Or impnd a ruam is sold within mm yes of completion,Ne owner.
builder will have the harden of proving that he did not build or improve for purpose of
said.).
D 1,as Owner of the propcng am exclusively contracting with licensed conwmars b
eoctroet the project(Sec.7044.Business and Professions Cade:)The Connracwr's U. .
once law eau not apply w an Dean of properly who builds or improves then,un,and.
who contracts for such projects with a eonuacwr(s)licensed pursuant to the Conuadtefs
License lsw.
D 1 am exempt under Sec. .B&P C for this reason
Owne Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under peoalry of perjury ane of the following deel"Amssaflo :
sa 1 ham aro will maintain a tion 37M of Cavern wCode.fure for arlomma Compene
work p as hick this
for mi Section 3]00 al the Labor Code.for the peRarmanca of the
work for which Nis permit is iuucd.
1 hma and will maintain Workers Compensation I....u required by Section
3700 of the LAW,Coln for dm performance of Ne work for which this pmmit is issued.
My Work is COmpevauon Ivuanee canis and Polity
Cartier. gCEZ Polity !/gam/b
CERTIFlC EXEMPTION PRORO M WORKERS'
COO MPEPE NSATION INSURANCE
(ITU acmiso need Mt be completed if the permit a faranc hundred dellars($100)
or less.)
1 certify thnt in the performance of the work for which this Permit Is issued.l shall not
employ any person in any mannerm As in became subject to the Workeri Campevation
UAws Of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject an the Worker's Compensation provisions of use UAW Code,you must
.,QM
fowith Ix, m
comply with such proved..or this permit shall deced revoked.
'ZN CONSTRUCTION LENDING AGENCY '
'r+� IMrehyalMondurdmreuacavwcdnn Imim,agcncy forthcperforexant.f
a the work for which this permit Is issued(Sec.3097/,Civ.C.)
4 Q leadcfs Name
=z lender's Add.
V C) 1 dumbly that 1 haus read this application and state that the shots information is
ty correct.I agree to comply with all city and county Ordinances and sum laws mlating in
OU building conswction,and hereby aothorio,representatives of this city to curer upon the
W abovomcntioncdprogeny forinspection whichpurposes,
f^ gy (We)agree to sate,adcmni fy and keep harmless the City of Cupertino against
Ir) in
costa And ofpemsesmit. may in any way accvc agaicl ssiO City
(„) ,'� A APPLICANT
of the gSTAN of this permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATI S
S �6i
Signature of Appbdwa onracwr ^y—D Re-roofs
HAZARDOUS MATERIALS DISCLOSURE ide Type of Roof
Will the applicam or Amon,building Occupant store or handle ha drodous material
as de0ncd by the Cupertino Municipal Code,Chapter 9.13.and the HOMO and Safety
Coda.Section zss3z(A)1 All roofs shall be inspected prior to any roofing material being installed.
Ely.
Will the applicant or future building Occupant use equipment ser devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit W ardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District]
Dyes �o
I have mad the lumAdlws materials relananunu under Chapter 6.95 fthe Calif., /f /
nice Health&Safety Code.Sections 25505.25533 and 25534.1 undersand that ifthe building ` < O!
does not currently hats a mnane that it u my m5poembility w notify the occupant of the [/ (f
myuin,mens ¢h stbumetpdorwissuanccOhCcnlOcateOfOccupan Signature of Applicant Date
Owner anaumarindagent D,m All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 7 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 # . . . : 06090187
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 6
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
IDEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- --------- ---- ------- - - - --------- --- ------- ------ ---- --------- - --- ---- ---
BPERMFEE VALUATION 20, 000 . 00 277 . 56 0 . 00 277 . 56 0 . 00
BSEISMICRE VALUATION 20, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00
---- ------ ----- - ---- ---------- - ------- --
TOTAL PERMIT 279 . 56 0 . 00 279 . 56 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
+a Cupertino CA 95014
R
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: S PERMIT #
cmp1 of Le I — Wl 0
OWNER'S NAME: PHONE # AM-Z5"j- 10(60
GENERAL CONTRACTOR: S FAX # 510—-A3"
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
2 OG
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 inspectedprior 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: �fo 'I�e�syi 1(4 Sfr-'
Job Site Address: ZO 80o f Fow�e S-re�_ot 20 f C pyi t , o �e S' —,39
Roofing Company Name:
Applicant's Signature: 72�� Date: 7�
. Greg Casteel /
Building Official
Revised 11/2/04
J CITE' OF CUPERTINO OlP(X m j
C - REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# -32-LP- Oq 05' nDate: ZO I ou
Building Address: 2 o Soo onrie � -* (^"1
Owner's Name-
�r' `tW t s Phones 4,,„ _ — ^(Q
Contractor: �•I � i�
License#:
Contact:,,Y.� VU)0&S ` _ -1Cupertino Business License
#:S'0_�1 �
t
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ �4sphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Num er of existing coverings C3Provide I.C.B.O. Report#
Tobe Removed ❑ Provide Mfgr. Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off P lie
• Job Description:-WV
cbmff i5ionaltn r S A
Residential Commercial 1arT, W4 rv'7ftjbb_s,ims�ijjrnq
Fire Zone: Yes O No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: I pl 1O Type of Construction: Occupancy group:
1 a Q
Qty. if
Applicable Fee ID Fee Description Fee Group
1 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