06090190 CITY OF CUPERTINO
BUItO1NGDIVISION PERMIT -�CLINTRAC''LORINFb"RMATI %,
:ON
BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT"°'06090190
20800 HOMESTEAD RD 4 2
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
NE: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
goo LICENSED CONTRACT'OR'S DECLARATION
Job Description
i u I lumby affirm Nat 1 am focused under provivons of Cha acr 9(mmmcnaing
with Section 7000)of Division 3 of the B.amcba and Prof.m.Cade,and my license is
a�a lm f ilfota a deifem. .3 Lea $I .2 REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
''y L"`° � t comaaoa, (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
Or i�p� Dam —
ARCHTIECsS DECLARATION
i C< I understand my plans shall W used as public records
1yU
°Qt� Licensed Pmfeasional
3 OWNER-BUILDER DECLARATION
if I hereby affirm Nm I am exempt from the Contactors License Law far the
p O following mason.(Section 7031.5.Business and Pmfessiom Cade:My dry or county
e m_ which inquires a Permit to Construct,glut.impmw,demolish,or mosir any aurum
-zr priorluiuissuutce.alsorequires he applicant forsuch permit Or file a signed summer,
ss< that heisliccnsedpurmanuotheprovisionaofCheCanCracmr'sLiacnsclaw(ChapCor9 Sq.Ft. Floor Area VaIU (brP373
(commencing with Section 7000)of Division 3 ofdm Business and Profusions Code)w
e5$ that he is exempt themfmm and the basis for the alleged esemptian.Any violation of
Section 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of pp��NN NNgtuber Occupancy Type
tint mom than saw hundred tiglian(5500} 3 2 G 0 9 U 56 . 00
I,as owner of the be sum intended
ntends with wages r their sole campewness
will mticumns and the he Comurmes Lacaed«awdmcriffiened oan[apply 7D w.anerof Required Inspections
and Pmfesslons Code:The Conuaemh Licettu Law docs int apply m a owner of q P
pmpcum who Wilds«improves thereon,and wed Em not hr work himulfor th r rade bis
owne e,.the buiprovided than such imPmwmaas am not intended aro@md for gale.If.
builder the building or impmwroatis sett withinone year of completion,the owe of
builder will have the Wrda of proving dist he did not Wild or impmw for purpose of
tile.).
❑1,as awnu of the property.am exclasiwly contracting with licensed cmnouua to
construct lie project(Sec.7014.Business cad Pmfordom Code:)The Conmcmi s U.
cense Law does not apply to a owner of property who Wilds or improves thereon.and
who contracts for such projects with a contra bor(s)licensed punuam to the Conmactoes
License Law.
❑1 am esempt under Sec. .B&P C for this reason
Owner one
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decimations:
I have and will maintain a Cordfou of Contin to self-humm for Workers Compen-
ation,as provided for by Section 37M of the labor Code.for the peaformance of the
work for which this permit is issued.
haw and will mainuin Workers Compensation Iruuaace,a mit ircd by section
3700 of the Labor Cock,for the performance of the work for which this permit is issued.
My Wurkcrs CoC muInsuuancyalicynuabcgar� 00 Sao('
Cartier. JI Poli FROM
b�RS
CERTIFIC OMPE XEMPfII N FROM WORKERS'
COMPENSATION INSURANCE
(russecfam«ed not W completed Rule,permit Is forane hundred dollars(SIM)
or less)
I cattily that in the performanec al CW work for which this Permit u issued.I shall not
employ any person in my manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT IC after making Chu Cenificale of Exemption.you should
buomc subject to the Workch Compcmation provisions of the Labor Code,you most
.J z forthwilh comply with such provisions or this Permit shell W deemed mwked.
Z O CONSTRUCTION LENDING AGENCY
(•+ I Wmby anion that them is a c«mructinn lending agency for the Performance of
W' ^ ted wish(or which this permit is issued(Sec.3091,Civ,C.)
Lender's Name
z L<ndcrs Md.
U 0 1 certify that 1 haw gad this application aril sum tha the show information is -
Come,.1 agree to comply with all city and county ordinances and sum laws relating to
DU building Construction,and hereby authorim mpteaenmtives of this city to cnur Upnn the
>.H7 ahovaea.jud tuck ropc costs
raninspection ru,which ms.
py (WC)agm to save,indemnify and keep harmless the City of Cupenino again"
F'c,IZ incoities,judcofthe granting of
expntsa which may in an,way aceac against aid City
Uz APPLICANee of UNDERSTANDS
of Nis permit.
^
APPLICANT UNDERSTANDS ANO WILL COMPLY WITH All N�P N Issued by: Date
SOURCER
_ '� � �d Re-roofs
Signso s of ApplicmVConmactor ate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle haysrdous material
se defined by the CuPenina Municipal Code.Chapter 9.12.and the Halth and Safety
cork.section 25532(a)7
❑Ya 1p"r All roofs shall be inspected prior to any roofing material being installed.
41 Will the applicant or future building occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hvardous air conutniounts a defined by the Bay Area Air Quality Management all new materials for inspection.
District?
El Year Nu
1 have mal the bvanine mmurials myvimmcnu under Chapur 6,95 of dm Calif.,
nu Halth&Safely Code,Sccu.Vi 05,25533 and 25534.1 undenund thdifthe Wilding
door not currently haw a unanl that it is my reapundbuity m notify she Occupant of de
rcquVinncns whichwhichmt enol prior m Lssam
ume aft CCftifcam a a�° Signature of Applicant Date
`+ All roof coverings to be Class "B"or better
Owner or athomxdagent ate'
CITY OF CUPERTINO
�m 10 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 # . . . : 06090190
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 21
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
SEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------- - - - ------------- ---------- ---------- ---------- ---------- --- -------
BPERMFEE VALUATION 13 , 000 . 00 201 . 96 0 . 00 201 . 96 0 . 00
BSEISMICRE VALUATION 13 , 000 . 00 1 . 30 0 . 00 1 . 30 0 . 00
--------- - ---------- - --------- - - - -------
TOTAL PERMIT 203 . 26 0 . 00 203 . 26 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-- - - ------------- -- --- --- - - - - ---------------- - -
OTHER 2370 . 50 VISA
TOTAL RECEIPT 2370 . 50
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
•
Community Development
( _ f 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: S I —3CY PERMIT #
Qtgl Ol Ul I - O(DC QZCC
OWNER'S NAME: PHONE # AM -7- I OWD
GENERAL CONTRACTOR: SPonfinQ FAX # S O- 3-
1
I am not using any subcontractors: "��./�–�— 2/
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
lei Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
4z2 dL
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: Vi !(a S¢pc�
Job Site Address: 20 Soo S-reeQ_ot 20 f C„paps ,, o dF V-39
39
Roofing Company Name:
Applicant's Signature: v' ��a� Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
_: - REROOF
y OF
CUPEkTINO PERMIT APPLICATION FORM
APN# 22-' — D"1 r0DU Date: LO I ou
Building Address: 2 O Snys�C.Z W Hor � � 2 I
Owner's Name: V �� ll� Phone#:
Contractor: �.I `��,� `nc License#: / `�
Contact:�Qr1/- `��� � Cupertino Business License #:
F Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ sphalt Shingles Qe Asphalt Shingles
SY Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Num�Ier of existing coverings LlProvide 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:
i Cl S A
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LI
Cost of Project: 12'I�-�2 Type of Construction: Occupancy group:
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 Cbeck Fee BUILDING
BUSLIC Business License BUILDING