06090194 CITY OF CUPERTINO + a ` ` h-m+ "'�" �`"'� eq,
BUILDING D3VISION PERMIT -4CQNTRAQx0"NFaORMA' PIO.N
BUILDING ADDRESS: DUBOIS ROOFING INC PERMITNO' 06090194
20800 HOMESTEAD RD
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 09/21/2006
NE: SANITARY NO. CONTROL NO.
(510)793-9760
ARCHITECTfENGINEER: BUILDING PERMIT INFO
BLDG EIFCr PLUMB MECH
0 0 0 0
ipp LICENSED CONTRACTOR'S DECLARATION Job Description
i u Fj 1 thereby affimh that 1 am lived under Provisions of Chapter 9immigratingOesGrlP
ing
w with Section 7f(It)ofDlvision 3 ofthe Business and Professions Code.and my license is
:mayiofullrarceandcrfmL '�t2 30`7 REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
,12 z License Chis Lie.N
•:❑ Dr. n°.°so ur RATION (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
CARPORTS 37 & 38 : TEAR OFF SHAKES, NEW COMP
i e 1 understand my plans shall W asst n public rtcmrJs
Old
l
s o Licensed Pmfcssionel
S.attempt
OWNER-BUILDER DECLARATION
if 1 W mhy.them that 11. nempt from Ne Canmana o License law,for ted
❑o followingmason. rossit1 III3LSBus[Sussand PmRaimn Code:Any city orcounty
f_� which dquirn a permit d cmnmruc4 aide.Wprore,demolLN,or repair any atmcture '
-zy prior d its commc.ailed require ted applicant for such Permit tri file a signed smteaem
Nat he is littnmd pursuant to she provisions of the Conrmtorilmage Law(Cltxpdr9 Sq.Ft. Floor Area Valuation
.'R$ (commencingwith Smdon7000)of Divuion3ofthc Businevand Prormians Codc)or $18020
Wt he u exempt therefrom ed b
and ted for the alleged exemption.Any violation of 7
Section 7031.5 by any applicant for a Permit subjects IW applicant in a civil penalty of APN Number Occupancy Type
not mare Nan Gas hundred dalWrs(SSW). _
1,u owner of the propmy,n my wploycn with wage u Ne'v sole campcwtan,
Milmlhe wart..nd theswctute is rwtimtended err artemd faraalc(5m.]o4a,Bwixn Required Inspections
Slid Professional Cade:The CommedLimned
r's Law don d e net apply an owner of q P
properly who Wildamiroprovn therms,and whodausnch work Israelithrough his
awn employes,provided that such improaxmmts art not intended ororteend for sale.If.
hawevn,to Wilding or improvement is sold within one year of completion,the owner.
Wilder will haae the burden of Proving that M did rot Wile a improax far purpose of
Sale.).
❑I,as owner of to properly am excimively contracting with licensed commands to
convect the project(Sec.7644,Business and Profnsians Cade:)The Cunaacmrs U.
cone taw,dors mot almly to as owmr of Properly who Wilds or inprovn the..,and
who contracts for such projects with a comrmtor(a)licensed punwm w the Contractors
LKeve Law.
Q 1 am agents under Sec. ,B k P C for this¢anon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declaration:
I ham and will mainrain a CutiOn¢of C..tot1.self-insum fa Warkce.Campen-
sstion,ss provided for by Section 37W of tm la air Cade,fm the performaam of the
work for which this permit is issued.
have and will maintain Workers Compensation Insurance,u required by Section
I]W of the laWr Coda.for the,performance of the work,for which this permit u issued
My WinkceCsCComprenYsaU. Insunnm cortin enc Policy nu/y�Wr art:
Cartier. FFJ Policy Na,: ZZ9 900 V 6
CERTIFICATE OF EKEMPITON FROM WORKERS'
COMPENSATION INSURANCE
(Thu xenon Sued no,W completed if Use Permit is foram:hundredmllan($]M)
err less.)
I e sty Nct in the Performance of the we&for which this Permit is leaned.I shall nor
employ any person in any manner an as in become subject in the Wor4ri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificam of Ercmption,you should
become Subic"to Ne Workers Compensation provisions of me Labor Code.you must
.J O forthwith comply with such provisimn or this permit stall W domed invoked.
Zy CONSTRUCTION LENDING AGENCY
[—� I newly ilion that there is a cmmuetimn lending agency far the perrormmm of
[�> that work der whim this permit u issued(Sec.309],Civ.C.)
2.25
0 Leader Nanc .
z Lenders Address
U 0 1 ent that 1 New read his applicamn and sal¢Nat the aWve information is
F' comet.1 agree to comply with all city and county ordinances and sal¢laws relating to
0(� building construction.and herchy adhorive representatives of Nis city to comrupon the
r a ahavc-mentes ioned propertycosts
for inspection patios purposes.
(we)agree to max,indemnify and YccP harmless the City of Capering against
tiZ incoiucquena ents,of
cosuand ofthis Pa iich may in any way notion againswaid City
U z A APPLICANT
of the RSTAgramaing of this permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLPOINy Issued by: Date
SOURCE R NS.
/POI
/�
Re-roofs
Signatum of APPbblsr ammacdr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding account more Orhublc havaNaw material
u defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Cade,Section 15532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea
If a roof is installed without first obtainingan inspection,I agree to remove
Will Ne applicant or forum Willing incurioususe equipmentor devices;which P g
emit hanodow air comernments at defined by the Bay Arca Air Quality Management all new materials for inspection.
Distrin? ��_aaaeee���
❑Yu ?n
I have mail the mainalms materials requirements under Chapter 6.95 ofthc Califor.
niaHmith k Safc,y Cade,Sections 25505.25533 and 25534.1 undersand and if Nat Wilding O
don not carcmly new a tmans Nat it u my responsibility n early Nat mcupam of the L
reyuircmcna wIn be pmrdimaande ora cemrrca laP cy Signature of Applicant Date
06
Owner or aut�hg/fid agent �D„c All roof coverings to be Class "B” or better
CITY OF CUPERTINO
4 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 # . . . : 06090194
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 18
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 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
10300 Torre Avenue
t t� Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
4UPEkTINO
Building Department
JOB ADDRESS: S PERMIT #
Q1,v 7 01 LQ 1 - 0(0C)q 1
OWNER'S NAME:mmeMews PHONE # 4M-25-7- 0(00
GENERAL CONTRACTOR: $ FAX # S O- 3-
4
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
�_' i /06
Date 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 m;n;mum 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: �(o �'I�e S / V1 1(a S.e!/'C�
Job Site Address: Zo Soo C„pmt W o a(kj,r V-39
3
Roofing Company Name:
��o S Fc90 �v Ott ytij C__
Applicant's Signature: ``���—� Date: �(_
• Greg Ca-steel /
Building Official
Revised 11/2/04
CITE' OF CUPERTINO
.CCS- REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# 3,LU_ Oq_05U 20 ou
Building Address: 2 0 810 "���y�-,1..,�, d P�j _* 11b
Owner's Name(-Q VAr1f A_A Si ilVi����G�� M�`�� I Phone#; r _ G �` �E � �
Contractor: Fl �.I � � ` License
/#����
Contact: Ckr1 A VU)0C;j Z_S'0 ` 1`7—��� Cupertino Business License #:
t", F- W Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ /lsphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Num er of existing coverings C3Provide 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 he :
• Job Description:T6{I' 1 i
s 1 A
Residential Commercial ear ; rOffS I tInSb11 60
Fire Zone: Yes ❑ No Confirmed with Planning D,qt. if
there are any restrictions: U
Cost of Project:,F 18 10 2Z Type of Construction: Occupancy group: PA
Qty. if
Applicable Fee ID Fee Description Fee Group
1 BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISNECRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•