06090192 CITY OF CUPERTINOtx
BUILDI NGIIIVISION PERMIT CONTR'AGTQR IIYhOItMA.TI0O1�"
BUILDING ADDRESS: DUBOIS ROOFING INC PEaM T NO. 06090192
20800 HOMESTEAD RD 41 12.
OWNER'S NAME: PER417 ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AV
NE: SANfrARY NO, CONTROL NO.
(510).793-9760
ARCHI'IEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
apZ, LICENSED CONTRACTOR'S DECLARATION lob Description
i U�j 1 mrcbY affirm that 1 am licesmcd under provuiana of CMpmr 9(commencing
nrful5foreeanOEef(ettivision]ofdicBusinrssandRomlessioruCode.andmylzcnscu REROOF- TEAR OFF SHAKES INSTALL 7 160SB, 30YR C
License Class G S Ce.N lJ(Z 3 0 si r /
Data Conuaaoi req, �� (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
44 RCallbea-SDECLARATION CARPORTS 21 & 22 : TEAR OFF SHAKES
lundersmnd my plans ARCHrTECr dupublic menrN , NEW COMP
a.>du
o t;;
LimnwJ Profrssional
OW NER-BUILDER DECLARATION
in f 1 bcom, IT,.Nn 1 am ucmif(rvm the Committees License Law ror the
00 following mason.(Section?G3 1.5,Business and Professions Cal:Any city or county
Sm� which requires a remail to ennsvxt.alar,borrow.demolish,or repair any mai
-Z` prior N its issuance,atm rtquires Nc applicant for such permit to Ek a signed summcu
chatW uliccatcJ punuantmNc rrovisions mftbeConvxmh Littnw law(Chartm9 Sq. Ft.Floor Area Valuation
0 (commencing wish Section 7000)of Division J of lin:Business and Professions Cmc)or $18020
$ that be is exempt shnmfrnm and the buts for the alleged exemption.Any violation Of
Section 7031.5 by any applicant for a permit subjects be applicant In a civil penalty of APN Number Occupancy Type
net mom dun five hundred dollars
❑I,u owner a!she property,ar my wployw wiN wage u tW'u wl eompensstinn,
will do she ii and the swaore u not intended at offered bar sale(Sm.T(Is4,Business - 81
Required Inspections
and Prefessiom Code:The Communities Liaise law does not apply m e an owner o! q P
propai who Wildsarimproves Naraon,andwod daawch work himselforturni his
own employees,provided that men improvements Are not intended unoRued forxal.If,
however.the building or improvement is sold union*an year of empledon.the owner-
builder,will have the burden of proving dust he did wt Wild or improve for purpose of
sal.).
❑1.As owner a the progeny am uclusively contracting with licensed rnnvac ce;in
construct the project(Sec.7614.Business and Professions Code:)The Contractors Li-
cents law was not apply to an owner of property who Wilds or imposes Nemon,and
who concocts for such projects wiN a conuxmr(s)located pursuam in the Corrector's
Lhcemx law,
1 am exempt under See. .B&P C for this mason
Owrcr Da ,
7CIlyWORKER'S COMPENSATION DECLARATION
I hereby aRm under penalty o(perjury orc of the following declarations.
1 ham and will maintain a Ccrtifinm or contend to whir-insum for Wei Compcn-
,
an,uprovided far by Section 7700 of the labor Cade,for the pcnformauca of the
k for which this permit is issued.
I have and will maintain Workeh Compensation Insurance,az mquimd by Section
of Ne labor Cade,far the pwroetwe of Ne work for which that permitu issued. '
WorkecfsCnmpensauon sunrce artier and Poliry nu berrier J;A;;; Poliry No.: �DY L
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu scrum need rot W completed ifre permit is fmarc hundred dollars($100)
or less.)
1 certify that in orc performance of thc work far which data Permit is issad,I shall am
amploy any person in any mon ire,as as become subject m led Warkcri Compcnsafian
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If.after making this Certificate of Exemption.you should
become subject an the Workers Compedauon provisions of the Later Coda you muss
.,O foMwith comply with such provisions or It.permit shall he dameA sevaked.
z CONSTRUCTION LENDING AGENCY
(-+4 I hereby afnrm that Nem is a construction lending agency for the odwoamx of .
a? the work for which that Permit is issued(Sec.3097,Civ,C.)
SIA Q Lenders Name
r7 Z Lender's Address
V Q I ect ifY that 1 have lead this application and sate that Ne shove information is
E^ correct.1 agree to comply with all city and county do inmm3 and sum laws relating to
Q U Wilding construction,and hereby authorim representatives of this city In enter Orion the
pra
W in consistence
on istenc o the granting
inspectionOthipurposes,
F•,6. (We7 agree m save,indemnify and Wcp harmless ted City of Goren.against
rq Iiabiliti
(We)
agree
to ease.and capoy and Imp may in anyhe City f Cupc net said City
V z A APPLICANT
of the RSTNof this Permit.
r--s APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RFJG�NS.
gi 111 I . u Re-roofs
Signature of ApplicanUCanmxor etc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will t e Carta on future building occupant more orhandlet HeardousdSaflmaterial
As dcfirmd by the Cupcnino Municipal Cade.Chapter 9.@,and the Health and Safety
Col,Section 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
40 r-IYcs 'o
Will the applicant or future Wilding occupant sew equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove -
emit hvadnus air contaminants As defined by the Bay Ara Air Quality Management all new materials for inspection.
District?
❑Yes 71
I have mad the hvaNsaumatariats mquiremcnls underou ror 6.95 offt Califor.
ria Hrald,6 Safety Cade,Sections 25505.25573 and 25534.1 understood thaz if dm Wilding
Jou not currently have a Meant,that it u my responsibility An notify the occupant Of Nc
mquimmcntswhichmustWmaprioroiumanceof.cortlOcamoroccupancy� Signature of Applicant Date
Dome,or wthonred.gear ��i Data All roof coverings to be Class"B" or better
CITY OF CUPERTINO
2 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 # . . . : 06090192
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 12
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 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 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
Community Development
y Ii 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
:UPERTINO
Building Department
JOB ADDRESS: PERMIT #
cxg 7 Ot Lo I - OWC R
OWNER'S NAME: PHONE # 4M-257— 10(0 0
GENERAL CONTRACTOR: VLAWS FAX #.S O— 3-
51
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
�
• —C '2_1
O�
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 L997 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: Trow the s Vi 1(a SQjr,
Job Site Address: Zo Soo aldgs' -39
Roofing Company Name: ,�o S Fcso �+-*�� C
Applicant's Signature: `L/��� Date:
• Greg Casteel /
Building Official
Revised 11/2/04
CITY OF
�c�a�I�TINo
• CUPEkTINO PERMIT APPLICATION FORM
APN# 320_ pq'05U Date: ci ZO ou
Building Address: 2 0
5 0 �iom st-,�.-d n �.1 _* I"
Owner's Nam t tli 8�������i1 i�-E�� Phone L#: „ _ I Coo
Contractor: �.' � License
Contact:MQY.1, p1,tb��S 51��1�'k-OISc��1 Cupertino Business License #:
F— Type of Roof Covering: ,
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ /lsphalt Shingles �Aspbalt Shingles
g� 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:-Wr- 2ACCMS r -1 M
i n r A
Residential Commercial
Fire Zone: Yes ❑ No Continned with Planning Ds,pt. if
there are any restrictions: LJ
Cost of Project: 1 Q iQ-2_0 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 Check Fee BUILDING
BUSLIC Business License BUILDING
•