06090188 CITY OF CUPERTINO
BVI LDINC DIVISION PERMIT CONTR'ACTORI,NIFORMATIO
BUILDING ADDRESS: DUB S ROOFING INC PERMIT NO. 06090185
20800 HOMESTEAD RD 9
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
HE SANITARY NO. CONTROL N0.
(510) 793-9760
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
100 LICENSED CONTRACTOR'S DECLARATION Job Descriptionus 1 be cby alft.that 1 am licensed make provisions of Chaper 9(commencing
wits Scott..7g )af Division 3 ofthe Business and Professions CoM.and my liccnu is
o. m full r%C aha Cryo, '� ��.j, 3o REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
spto Uccnm Cl Lic.N
St:� Dam Convenor '�� y (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
CHTf be
DECLARATION CARPORTS 13 16 17 TEAR OFF SHAKES, NEW COMP.
i C 1 undcraand my pans shall W mud a public records r r
:EU
o t; Licensed Pnsfeaianal
3OWNER-BUILDER DECLARATION
1 acre"vRrm
that 1 am exempt from dw Contractors License Law far the
p o following reasontwu
.(Section 7131.5.Busiend Professions Cale:Any city or county
:CC
which requires a permit to connect.alter,improve,demolish,or moor any structure
prior Or its issuance,also requires the applicant for such Vomit on Bre a signed statement
cedar lois licensed pursuant to the provisions of to Canuacwr's License law(Chapter Sq.Ft. Floor Area Valuation
L�S (eommnrcing with Section 7000)of Division 3 of the Business and Professions Code)or $19620
Nat he u uempt tkmfmm and the balm for the alleged ca repoOn.Any violation of
Section 7031.5 by arty applicant for a permit wbjCw the apPliCUL 10 a civil penalty of APN Number OccupancyType
nut mart than five hundred dollars(S-100). YP
❑I.aowwr of Ne pmpeny,ar my wploYcu wits wagua Nov talc compensaton,
99
will do due work.and the structure isnot intended oroffesadfor stle(Sw.7Wd.Business Required actions
end Professions Cadntru
e:The COemra Licnne w e Ladoes cot apply m m Owner of 9 P
property who Wilds.imperms Ncmagand whomsesuchwork hisyselfor through his
own employes,provided that such Improvements oR not intended aroffcred for sale If.
however,the Wilding or improvement is Mid within ane year of compleuan.We Owner-
builder will have the border of proving that le did not Wild or improve for purpose of
ala.).
❑I.as owner of the progeny,am uclusively convecting with licensed convuwrs or
mtutmct the project(Sec.70a4.Business and Pmfetions Cade:)the Commutators U.
caves law does not apply to m owner of property who Wide at improves thermn,Md.
who contracts for such pmjec%with a eontrmror(s)licensed personal In one Contractors
License GO,.
1 an uempl undo Sec ,B&P C for thla mama
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 bcmby aRim under penalty of perjury aro of de following declaatiotc
I ham and will maintain aCmtificvw of Consent to self-Insure for Workch Compen-
sation,a provided for by Section 3700 of to L aor Code,for the perfonnan.of one
work for which this permit is issued.
have and will maintain Workers Compensation Insurance,a required by Section
3700 of the Ube,Code,for Ne petfarmancc of the work for which this permit is issued '
My WOrkersT pewuanl arrestee caniu end Policynum�cr eg:P aO zzo
Canicr._TT Ta•••'eC_J�'aA+�/1 PoluY (✓DIS C..a/
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This unian wed nothe compimed if tW permit is forone hundred dollar($10G)
or loss.)
I certify that in the,perfamtucc a the,woh for which this permit u issued.I shall not
employ any perms in any manner m u to tactician subject to face Workers'Compensation
Laws of California.Dew
Applicant
NOTICE TO APPLICANT.If,after making this Ccrtficaw of Eaemption,you should
became subject w the Wmkers Compeaseuon provisions of the ISWr Cade,You meet
.JO forthwith comply with such provisions or Nit is permshall W doomed rcvakcd.
Zy CONSTRUCTION LENDING AGENCY
F" IWmby affirm that,Nem is a conswctinn lending agency for one perfmor.of
W 7 the work for which the Permit u issued(Sec.3097,Civ,C.)
1 Q Landers Nam,
Z LcrWch AONess
U 0 1 cenify that 1 have lead Nis application end state Nat the above information is
it, f-' correct,l agree to comply with all city and county ordinances and sum laws relating to
0V building consuuction,and hereby authorim mpreunutivos of this city to enter upon Na
. C t aWvomcntiuncd proes. Mlrty for inspection purposes.
(We)agree to ave,indemnify and keep harmless the City or Cupemno against
U to in COMCCU cgmcnuecasuantl capersms which may in my way accrue agvnstsaid City
U z in eansegwnce Of the granting of this pmnit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH RCE RE ALL NO POI Issued by: Date
SOU
�1 O Re-roofs
Signature Of ApplicamU onuactar Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applranl or forum building.,.Pant smle or batch,hammers material
as defined by the Cupertino Municipal Code.Chapter 9.12,ab th Health and Safety
Cala,section 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
❑Toa
Will Ne applicant or future Wilding oecupam uM equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
emir haardous sir contaminate as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
C YesNu
I have mail Ne haundma materials mquimmenu unrer Chapter 6.95 ofthc Calircr-
alas nolN&Safety�ede,Soctoruonshelita my hosnd2ibilay5534.1 undersand te..P Wilding
rasa not c.mcnty haw CO�CICatyy¢nano tut it. 55 3 ad 2 ibility un notify Nc o¢upmt of,
require menuw et prior w issuawc of a Ccrufrcaw of Occu m
�"� Signature of Applicant Date
Owner or authorncd agent All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 8 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 # . . . : 06090188
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 9
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 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
i � / Cupertino CA 95014
' 'y Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building Department
JOB ADDRESS: $ PERMIT #
o(gl 01 (g) - 0(DCX1 Ql
OWNER'S NAME: PHONE # 4M-25-7— 0(O(7
GENERAL CONTRACTOR: VUW$ QMfj FAX # 5 O— 3-
1
I am not using any subcontractors: ";//°G -- . 2/
LIC
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 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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: �fbe.l�evs / Viva
Job Site Address: Zo SOo 20 C„putt w o da S' 1 39
Roofing Company Name:
Applicant's Signature: �--� Date:
. Greg Casteel
Building Official
Revised 11/2/0.1
CITE' OF CUPERTINO
MVP
ROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 32.1D-- On 05' nDate: cl ZO I OW
Building Address: 2 O SriW
omestpcd
9-d4— n'
"i
Owner's Nam Q V �S-1V ���� Phon`e#�
Contractor: b.1 S %n 1\,C,1�e7t License#: ,Z
Contact:A ayt- A)U)0O�S 5����1`I �'f � Cupertino Business License
#:
1�t Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
sphalt Shingles E�Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Num er of existing coverings ❑ Provide i.C.B.O. Report
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off P licy:
• Job Description:' 1' �� ( `J r . ►fl
i o ,,. r r s 1 A
Residential Commercial a$(PD ': Y Pff SWa $IY)SO11
Fire Zone: Yes ❑ No Confirmed with Planning Dot. if
there are any restrictions: LJ
Cost of Project:$ In 1�^ Type of Construction: Occupancy group:
'I byIQU R-:
Qty. if
Applicable Fee ID Fee Descri tion 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
O