06090196 CITY OF CUPERTINO
BUILDING DIVISION PER `y�-'+�,CONTRACTOR`INFURMATIQN `
BUILDING ADDRESS: DUBOIS ROOFING INC PERMITNO.06090196
20800 HOMESTEAD RD # 28
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: BUIfDINO PERMIT INFO
BLDGELECT PLUMB MECH
I= E E (�
18'z LICENSED CONTRACTOR'S DECLARATION Ib Description
i
u5 1 knotty affirm that I ma I'peued under provOlP
isma of Chapter 9(commencing
,Zru with section]0(m)of Division 3 of the Business and Prefeuiou Code.and my because is
± b„ in full fora and err«t� Q`Z 'j'Q(� REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
I t2Z Li«OR Clat, IJc.Ry
-moo Dam Con annr � (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
3�8 ARCHITECTSDECLAR UN
CARPORTS 52 54 55 : TEAR OFF SHAKES
i m e
s1 understand my plans shall W u«d ss public w1mck , , , NEW COMP
)yU
ot; Liceucd Professional
OWNER-BUILDER DECLARATION
iI hereby alTirm that 1 am exempt from the Contractor's License Law for be
00 following moon.(Section 7131.5,Business and Pofessieo Code:My city or county
m which mquh"is permit in construct,alter,impmve,demolish,at repair any stn«tum
3Z„
inner or is iuu,nco.alis rsqu es;the applicant rot such permit to file a signed sum
temt
ci< thaLWislkcocdpurs"nlmt pmvisio"ofd Cww«mr'sli=Uw(Chapw9 Sq.Ft.Floor Area Valuation
`l- (commcndngwiOSven T000)o(Mvaion3nrthe Busin mditfmiom Cede)w
that hu $19620
e exempt therefrom and the basis for the alleged exemption Any violation of
section 7031.3 by any applicant for a permit subjccu led applicant he a civil penally of APN Number Occupancy Type
am mere man nK baedrtd dollar,(S5WL P Y YP
I,u owner o(um poprny,or my wDloym wire wag"uthe'v mkeempewtion,
will do he work end me swctme is net intended m Weted person(Sec.104x,Redness 326G9056 . 00
and Prafessiou Cad.The Conuacmrs Liecue Law does not apply an an owner of Required Inspections
property who builds or improves ther«n,and whodoessueh work himselforNmugh his
awn employees,provided that such impmsements are not intended orolRrtd forsale.If.
however,the Wilding or improvement is sold within one you of completion,the owar-
builder will have the Wrden of proving that bo did not build or improve for purpose,of
sake).
❑1.as owner of the prepeny,an"elusively contracting with licensed contractors in
construct this project(Sec.7D44,Business and Pnefessiou Code:)The Contractor's U. _
cams Law does one apply to an owner of property who Wilds or improms thereon.and
who contracts For such projects with aconuactm(s)licensed yursecon to the Contractors
Lkerse La-
0 l an.exempt under See ,B&P C rw than reason
Owner new
WORKER'S COMPENSATION DECLARATION
1 hereby aMon under penalty of perjury one of the following declarations:
I have and will maintain a Certificata of Conseil to self-insure for Wakes
u provided fon by S«tion 3700 of Um Labor Cade,far ftper(ormanco of the
work for whim this permit u issued.
nave and will maintain Workers compensation Insurance,as required by Section
31"of the Labor Code.fon the performance of che wort for which tris Permit u issued. '
My Work CompenssuchLij3ppuW--r. 'm and Policy nu er
Carrkr. �_ /�le Policy No.:
RTIFlCATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thu scctmn need act W completed if the permit is form¢hundred dollars(5100)
or Ices.)
I cmufv that in the performance of the work for which this permit is issued,)shall not
employ any'penon in any manner to u in become subjecuo the Wiftic'Compensation
Laws of California.Das
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject in the Worker's Comfamamon provuie"of the Labor Code,you must
.J ,Z forthwith comply wit such provision or this permit shall W d«med wvol ed,
Z OCONSTRUCTION LENDING AGENCY
[-+� I Wmby affirm this thete as construction kndingagcnyfar the pcdermarkaa
lY dp work fur which chis permit Is issued(sec.W.Ci,C.)
D.Q Lender's Name
D. Landers Address
U C) I certify that I have read this application and sure con me above information is
U. F correct.I agree m comply with all city and county oblinences and sem laws relating to
O V building construction,and hereby anchorite mpmuntaums of this city to enter upon the
4
above-mentioned Property for iexpenses
pe n es purposes.
(We)agree to save,indemnify and k«p hamlus me City of Cupcnino against
Uz incoltiequenemens.coss;an and of[his
srnit. they in anY way we=agd"kala City
(„)Z in consegnence of chc granting a(this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NP N- NT Issued by: Date
SOURCE REGyt N5.
J ,tel 6 Re-roofs
srgnuurt of Appli"nuConuacmr
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will has applicant or future Wilding occupanlsmre or handle ha"rdou material
as defined by ted Cupertino Municipal Cade.Chapter 9.13,ant me Health and Safety
Cade,mon 25532(a)] All roofs shall be inspected prior to any roofing material being installed.
41 Y"
Will chc applicantr M building occupant use equipment er dcvias which If a roof is installed without first obtaining an inspection,I agree to remove -
emit hanrdnus sir comaminans as defined by he Bay Arca Air Quality Managcmcnl all new materials for inspection.
Davi"? ��-�JJJJ
❑Y" Pwe
I haw read de havardo"materials mquircmcros abet,Chapter G95 artW Califor.
iia mtc Safety Cadelm=L 255iE, m33w mi5ilitymdersandcoccomhuiirise aC/� i— Z1 O�
doss rpt currently Wase a tenan4 chis it a my msporsihility ic ratify the asupant of the
Ownimm,atawnkn parw�esenmar,cwrNaw sway. / Signature of Applicant Date
Owner or aemorized sent /�q'�te/O—� All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 6 of 9 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp : Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32609056 . 00
DATE ISSUED. . . . . . . : 09/21/2006
RECEIPT 4 . . . . . . . . . : 36157
REFERENCE ID # . . . : 06090196
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 28
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
OEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- -- -- --- - ' -------- ---- - --- - ------ ---------- --- ------- ------- - - - ----------
BPERMFEE VALUATION 20, 000 . 00 277 . 56 0 . 00 277 . 56 0 . 00
BSEISMICRE VALUATION 20, 000 . 00 2 . 00 0 . 00 2 . 00 0 . 00
-- -------- --- ------- -------- -- - ---------
TOTAL PERMIT 279 . 56 0 . 00 279 . 56 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
•
W. Community Development
} e 10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
:UPEkTINO
Building Department
JOB ADDRESS: S PERMIT #
cxgl OI LQ I — Otol Qzcc
OWNER'S NAME: PHONE # 4M-25-7— 0(00
GENERAL CONTRACTOR: putas FAX # S O—7 3"
t
I am not using any subcontractors:
Signature Date
Please check a hcable 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 '
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 U 13C 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 VI 1(a
Job Site Address: 2-0 Soo S-reao•C 20 { C.per,w o acw
Roofing Company Name:
Applicant's Signature: r/ Date:
• Greg Casteel /
Building Official
Revised 11/2/04
CITE' OF CUPERTINO O UDW
REROOF
crilior
CUPERTINO PERMIT APPLICATION FORM
APN# 32-0— OCI O5' n te:Da ,zO I o lY
n
Building Address: 2 OQr "omestecd
� 4- 28
Ownet's Nam � G a Phone#:
Contractor: �.I � � _ ryLicense
Contact:A ayt �US� T � Cupertino Business License�#:
I�1 Type of Roof Covering: t
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ tphalt Shingles Asphalt Shingles
W, Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Num er of existing coverings E3 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:
• JobDescription:Thr el l S r 1 . mSM11`10
i w1 s Q
Residential Commercial
Fire Zone: Yes ❑ No SK Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
1.9',In20
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