06090193 CITY OF CUPERTINO Aw yrs .nlgeY^�u,' "'°~' ✓-.�
BUILDING DIVISIDN PERMIT CONTRA.CT()I2IiVI=0 n' tk QN
s:,yS}.n. '33z .�m� sea: tHna'"✓sl
BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT No.06090193
20800 HOMESTEAD RD # 16
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS VILLA SERRA 99 DUARTE AVE 09/21 /2006
E; SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHRECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+00 LICENSED CONTRACT'OR'S DECLARATION
:m F 1 hcrohy,affirm that l am licensed under provisions of Chapter 9(commraing Job Description
i<i with Secti.n]Of,U)of Division 3a(NC Businmv arld Professions CndC.alld my licensee
nfullfoadandcIfcct lJ12 3oY
Dale REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
Lie,Dole Clazs �� , � (N) RIDGEVENTr GUTTERS Se SPOUTS . CLASS A.
p CHITELTS DECLARATION CARPORTS 31 , NEW COMP
i¢s TurtlersundmyplansalullAcusrinspublicmcands , 32 , 33 , 34 : TEAR OFF SHAKES
)yU
aa� Licensed Pmfescia..I
S OWNER-BUILDER DECLARATION
<� 1 hereby affirm
that 1 am exempt from the Cantractoes License Law for this
Coe following mason.(Suction 7031.5,Business and Pmfecsi.m Cade:Any city or county
m(xi which metal.a permit in Co."allies,impmve.demolish,car repair any suuctum
-Zi prior mise issuance.also requirethe applicant for such Permit to rile a signed mmencm
iC that he u
licensed pursuant to He provisions of the Contracmh lJans,Law(Chapter 9 Sq.Ft.Floor Area Valuation
E� (commencing with Section 70110)of Division 3 of Ne Business it Professions Csade)ser $21220
Nat he u exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects He applicant to a civil Penalty of APN Number Occupancy Type
not more Nan five hundred dollars($500). P y yp
LuMw mdk(md pmpersy,mmY ampleyttd with Bred Boards
o rds((See
compensation,
will dabehic work ands,The
itnots Licenstended e
rAW redsneta(Sal.7044,Baseball
and property
Who
Code:The venusemrs License Law does net apply lf an owner of Required Inspections
own em who bustle i improves improve who dassucAworkhimselfor ciedthrough his
ownemployees.provided that rem rat is id wha are not immndWaro@ad for sale r-
builder.0m building or improvement u sold within ane year of cmnplcdaar He owe of
builder will have tite burden of proving Nat he did not Wild or improve fa purpose of
sold.).
❑1.as Marc,of be Pmpcny,am exclusively contracting with licensed mnosmrs to
constmct the project(Sec.7064.Business and Professions Cade:)Tie Caroni Li.
rue law dors not apply to an owner of property who builds at imposes Hereon,and.
who contracts for such Projects with a contractor(s)licensed pursuant aa the Con ssctari
License law.
❑lam TempunderSec .B&PCforMareason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury arc of He following declaratiau:
T have and will Mumma a CerdEnte of Consent in self-insure far Workers Compen.
sation,a provided for by Simmons 3700 of Nd Labor Code,for Ne performance of the
work fat which this permit is issued.
I have and will maimam Worker's Compensation Insurance,W myuired by Schon
3700.1'He Latour Cade.for Ne pRamunttofdm wank for which Nis .it is issued. '
My WaCrkers Compensation Insurance carrier and Policy number am:
Carder:7.'�vK FW y"f• Policy NM.: 2— 90oy L
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need rat bis completed if Lou permit Is forms,hundred dollars($100)
or less.)
I certify Nat in thc perromtanec of the work for which this pem,it is issued.I shall not
employ any Person in any manner an as m become subject to the Workers Compensation
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,aMr making Nu Certificate,of Exemption,you should
become subject in the Wort,rs Comperuauon provisions of Ne labor Cade,you moa
.J 0 forthwith comply with such provisions ar this permit shall be deemed rooked.
Z Di CONSTRUCTION LENDING AGENCY
Di
f-" I for
aRrm Hrmit kisaconswct 307,Civ,
agency for the Performance of
a L e duh for which Nu permit u issued(Sec.l09],Civ.C.)
Wh A Lenders Name
�z Lenders Address
U 0 1 anify that 1 have read this...licminn and sum Nn the:bow hif.romium Ls
L, f-^ c0nect.I agree to comply with all city and county on finances and scam laws aiming to
0rJ building commietion,and hereby authodm mP¢senutives of Nis city w enter upon the
W ow-ms,judg d pm.c costs
for impenses purposes.
(•+ (We)agree to save,indemnify and keep harmless the City o(Cupertin.against
N Iiacoisequene of the rase and expenses Which may in anyway attme against said City
(„),'� in consequence seri He granting of His permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNOfI-POINT Issued by: Date
SOURCE:;O �/�
Re-roofs
Signature of ApPlians centractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will on applicant.'future Wilding occupanlsmm or hendle harardons material
as dehncd by the Cupertino Municipal Code.Chapter 9.13,mark Haldt and SafctY
Code,Section 25532(1)?
C]Y. � All roofs shall be inspected prior to any roofing material being installed.
Will the applicant arfuture building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it harardnus air conumimna defired by the Bay Arta Air Quality Management all new materials for inspection.
District
❑Ye Nu
I haw mad he haallous mselialeayvimmeau unRrChapm'6.95 of the Calif.,-
nuHualN&Sofety Coda,Sections 25505,25533 and 25534.1 undersand thalifNe building O
does not currently haw a mom,Nat it is my responsibility to nodfy the occupant of He
myuirtmcnu which must el pdonuissuancc oft Ccrtifmam Mf OcyR��r Signature of Applicant Dat
d 61
Owner oraathorindAgent A /D/6 All roof coverings to be Class"B"or better
CITY OF CUPERTINO
3 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 # . . . : 06090193
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 16
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 22, 000 . 00 299 . 16 0 . 00 299 . 16 0 . 00
BSEISMICRE VALUATION 22, 000 . 00 2 . 20 0 . 00 2 . 20 0 . 00 .
----- ----- --- - ------ ------- - -- ----------
TOTAL PERMIT 301 . 36 0 . 00 301 . 36 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 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: V61cqy 1 `- PERMIT #
otel 01 LQ) — 0(01)9 G
OWNER'S NAME: emeuls PHONE # 4M-2r-]— I0(aQ
GENERAL CONTRACTOR: $ FAX # 510—-7 5-
1
I am not using any subcontractors:
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
41— 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: �f o �'I�e�s V, 1(a.S¢I/K
Job Site Address: -o Soo f f o w�C S rea a� 20 C Pyr l r o 5'
Roofing Company Name:
'I���o S t�cso wy 4 7 fi C
Applicant's Signature: `'%��_� Date: 446
. Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO Qggd �q 3
REROOF
• CUPERTINO PERMIT APPLICATION FORINT
APN# _32.LP0C1 05l ^ Date: ci ,zO I OXY
Building Address: 20500
O arm ("yOy�y�p�,.l-���-.1 n �.j I LP
"I
Owner's Name IJW .1Q, � t,11��P�it�G��iZ,�� .4/1 i I`-£,, Phone#: r ^' o
Contractor: �� �.' `�^q ,\nc License#: �k2
Contact:, clr� VU W1�OS�5�O���`T—�eoCI Cupertino Business License #:
11��11 Type of Roof Covering: 1
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ sphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Num er of existing coverings ElProvide I.C.B.O. Report#
To be Removed Cl Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off P lic :
• Job Description:-W r- 2)Q S , ICl S , 111
i n � S 1 A
Residential Commercial AI m- r W OI L!/^1 t 1nM1I
3 LO
Fire Zone: Yes ❑ No Confumed with Planning Dot. if
there are any restrictions: Lf
Cost of Project: 1 n� Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Grow
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
•