06090191 CITY,OF CUPERTINO a.xi t xi" '� 4 a ' �' - " ,ri,
BUILDING DIVISION PERMIT 3C ONTRA.CTOR�INFORMe�TION
BUILDING ADDRESS: DUBOIS ROOFING INC PERMITNO.06090191
20800 HOMESTEAD RD # 26
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
NE: SANITARY NO. CONTROL NO.
(510) 793-9760
ARCH3rECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
:oo LICENSED CONTRACTOR'S DECLARATION
UZ C 1 hereby affirm Out 1 am licensed under provisions of Cluplcr 9(commencing Job Description
;Zt61 with Scction]Of1U)of Dividon3of de Bmtsinessand Rafcukns Code.and mylkcnseu
infalllmacmdeffeaL/?J� g1.2 3oa1 REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
License Cl. L..� u,ar contactor (N) RIDGEVENT
a Dam , GUTTERS & SPOUTS . CLASS A.
3f RCHrMCI'SDECLARATION
5
Jm i 1 understand my plans shall W used as Public records
yU
o
Licensed Professional
5 OWNER-BUILDER DECLARATION
s0 I thereby.firm Nat 11. exempt fare the Conine Co License Law for the
O which re home. Perch i LDL;Business and Professions Code:Any city or county
which requires a Permit re consRucL this.improve h Permit i or repair any umclum
-m i pat he its lensed p rainalso requires the pre applicant for Commemit m films,le a,Law(Cha mens
Thal he u(commencing
wit pSectio iso the of Division
of Nc he Business UscmC law(Chapter 9 Sq.F[. Floor Area Valu 'Aa 3 7 3
[�m that W is exempt
with Section and
of Words n 3 de al aged evand Profusions Code)of
Net he u emmPt Nmefmm Nd Ne baso for 0e alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant o a civil penalty of3 ApN Number Occupancy Type
not more Nan Ors hundred dollars(5500). 0 056 . 0 0
❑I.uo wof Nepmperty.mmy Cmployemwithwgmu0eh.nkcomp don,
will do the work and the me=u cot NtvWed moRmed forsale(Sac.10th,Business
and Professions Costs:The Contractors License Law does nor apply ar an owner of Required Inspections
property who Wildsor improves Nereon.and who doesmeh work bimselfor through his
own employer,provided Nal such improvements me not intended ororterW for side.If. -
however,the building or improvement is mid within one year of completion.Ne owoer-
builder will have On burden of proving Nn the did Wt build or improve for purpose of
vain.).
❑1,as owner of the property,am exclusively cnmmcting with licensed contractors b
construct the project(Sec.](WI,Business and P (c3siom Code:)TU Conbacor's U.
cease Law data am apply be an owner of property who Wilds ar upro des Occei and.
who contracts for such pmjecm with a conuvctor(s)licensed pursuam ta the Contractor's
License law.
❑Lam exempt under Seco ,B tiP c far this recon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRsm uMer pcmlty of perjmy oro of de folmwing declarations:
1 hsvc and will maintain a Certificate of Consent to ulf-imam for WorlocesCompcn-
mtion,
as provided for by Section 3700 of the labor Code,for the Perform.of the
work for which this pnmit k issued.
have and will maintain Worker's Compensation Insurance,as required by Section
310Paf the Labor Code.for the performance of me wrk for which this pc man is issued. '
My Warkc C.pe ..In/yyna ca rii and Policyn
Camicn a 1 w}a of PolicyNa.: um r : 00y
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not N completed if be permit is foram hundmddallars(SIM)
or lass)
1 certify Nat in the Performance of lie work for which this Permit is issued.l shall net
employ any person in any manncrm as in become subjccuo NC Warker5 Compcmadon
Laws of Califomda.Data
Applicant
NOTICE TO APPLICANT:If,After making this Cerilicam of Exemption,you should
become subject to the Worker's Compcnsstion provisions of Ile Labor Cod,you most
faMwifh comply with such provisions or Nu permit dull be deemed masked.
'Z'O CONSTRUCTION LENDING AGENCY
r
'c+ thereby which rte Nat.it
usued(S . .0 h,agcrtey for Re perfannanco of
tie work(or which dtis permit u issued(Sec.3(191,Civ.CJ
[g1 Q Lender's Name
] z lender's Address
U 0 1 tastily Nat 1 hale read this application and sate our Ne above information is
Lt.E-' correct,l agree to comply with all city and county ordinaaces and mule laws calming to
pas building construmion,and hereby authorise repmsentafives of Nis city,.corer upon Or
LA ahavo-memmned pmpc sr'for impeetion purpose:.
Fy (We)agree to save.indemnify and keep humlras Nc City of Cupertino agaiml
'h Ii micialuesi or ta,0.costs and expcnsunot, may in any way theme against said City
U z in canseglmnee of the gaming of this permit.
'-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT' Issued by: Date
SOURCE 1 ph /
�� tf a Re-roofs
Signature of ApplianuContrmtor Da1e��
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Jac applicant or future building Cempanl some or handle muardous material
as defined by de Cupertino Municipal Codc.Chapter 9.13.and the Health and Safety
Cade,SCmion35533(.)?
❑Yes 9r
All roofs shall be inspected prior to any roofing material being installed.
40 Will thea applicant or future Wilding occupant am If a roof is installed without first obtainingan inspection,I agree to remove -
pp 0 c equipment or Mara which P g
..it haramaus air ronuminanu u defined by Ne Bay Arra Air Quality Management all new materials for inspection.
Distrito?
❑Yu IN.
1 have mad the haurdeus materials requirements underamucr 6.95 of dlc Califor.
.is HmIO k Safmy CaM,Sections 35505,35533 and 25530.1 undanund this if the building
dam
not cwmndy haat a arrant,NL it U my responsibility to notify fteacupant of � ��
nequimmentswhie mat pdortoissuanm of.Ceru6ne afa coq. Signature of Applicant Date
-�gT�/�� All roof coverin s to be Class "B"or better
owns or mthorimd.gem � p g
CITY OF CUPERTINO
1 of 9 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32609056 . 00
DATE ISSUED.. . . . . . : 09/21/2006
RECEIPT # . . . . . . . . . : 36157
REFERENCE ID # . . . : 06090191
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 26
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
WE 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
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
r < `tJ 10300 Torre Avenue
k ` Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building Ike artrnent
JOB ADDRESS: 113IGqY PERMIT #
0WQg01 (,Q i - O(OCR C1
OWNER'S NAME: PHONE # AM�Z7— 0(00
GENERAL CONTRACTOR: DLktQ$ FAX # 510- 3—
I am not using any subcontractors: Z%IVC
Signature Date
Please check applicable subcontractors and complete the following information:
66 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 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 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: Tro ,eI- �+ V I S¢I/C�
Job Site Address: Zo SOD (-{-o 20
Roofing Company Name: 7�3
Applicant's Signature: Date:
• Greg Casteel /
Building Official
Revised 11/2/04
CITY OF CUPERTINO
REROOF
cily of
• CUPEkTINO PERMIT APPLICATION FORM
APN# -32-LP-0C1-05U
2' n_OnI U/
05t ^ Date: n �O I ou
Building Address: 2 O Qr � , ,,1 n -* ,2_L
Owner's Name: ^VFW moi'C��t� i�{�► Phone#A: (�
Contractor: �.I \S^�, 1�� License#:
Contact:MQr'/ Cupertino Business Ljiicc_eenns-e #:
F- Type of Roof Covering: 1
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ /lsphalt Shingles t�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 lic
• Job Description:-Wr- �)Q ^J t 1 , Ih
i Cl S A
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: I2 i Type of Construction: Occupancy group:
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
•