06090198 CITYOF CUPERTINO s " r<ts �``" "'Pq -
BUW OING DIVISION PERMIT <,0NTRAc,TaR�I.NFORMATIO
BUILDING ADDRESS: DUBOIS ROOFING INC PERMIT No' 06090198
20800 HOMESTEAD RD 4 12
OWNER'S NAME: \ PERMIT ISSUE DATE
Ilk PROMETHEUS VILLA SERRA 99 DUARTE AVE n9/21 /9.nnr
NE:
SANITARY NO. CONTROL NO.
(510) 793-9760
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ioo
LICENSED COFRRACIOR•SDEOLARATION IobDescription
1 thereby Rum
that I.
licensed
uncar pmvism.of Chapmr 9(commuting
N Scctian 70110)of Division 3 ofthe Businessand ProfessionsCode.and my hceom is
;�=�a nrfull to.andCrfeer. $f2 Q i REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
Liecnhaclns 3 Lm.g
�o Dam Cmuseeler (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
ARCHf1HCTSDECLARATIO CARPORTS 62, 63 , 66, 67 : TEAR OFF SHAKES
1 undcrsunJ my plans shall W used ss public records , NEW COMP
Eau
a�tn Licensed Professimnal
OWNER-BUILDER DECLARATION
I Wrehy air,.thea I am exempt from the Contractors Liecnm Law for do
p O following ressrn.(Section 7031.5,Business and Professions Code:Any city or county
which mqui.a Parson to construct alter.improve.demolish,or repair any muccu e
prior at its issuance,also requires the applicant for such permit to file a signed statement
< thatheisransedparmanttotheprovisiomofdwCantracum'sLlanseLaw(Chapter9 Sq.Ft.Floor Area Valuation
2 (commencing with Srrtion7000)ofDivision 3ofthe Business and Professions Carlo)or $21220
5$ that he u exempt therefrom end the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicmc for a permit subjects the applicant a civil penalty of APN Number Occupancy Type
not more than firs hundred dollars(35110).
I,as nu ar of the propcot or my cmployces with wages as Neo hale compensation,
win damewanalaada:TheComneux'sLicousarafemdroaaaripplyasshowatmss Re uiredInspections
firand Professional who ns Code:The Conuonam, ndlubso law does oat apply bf m owner is q
Ow nery who Wildsaimgaw therm',mtwW the
work ornmlfathrouge his
own,mplar ees,Provided that such improvements are oat earn ofo araQerW don a fit r.
builder,the Wilding ar(mpromnem u halt within one year ofi m rove for
Ne canter.
of
builder haw n,as the haNm of pmmms that Ire Iia net dJlt a improve Sur purpose or
sale J.
❑1.as Owner of the property,am exclusively annealing with licensed contractors to
construct the project(Sec.7004.Business and Profeatlom Cade:)The Contratars Li.
ecma Law does out apply in an owner of property,who Wilds or improves Uremon,ad
who contracts for such projects with a conearor(s)licensed pursuant to the Contractor's
Lic'.Law.
❑lamexemptoodr See .B&I'crorthumahan
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby arRno under penalty ar perjury me of the fallowing dalaremse
I have end will maintain aCertifiam ar Careens m mlf-imam for Workers Campcn-
saamn,as provided for by Section 3700 al'the Labar Cade,for the performance of the
work for which Nis permit is issued.
1 have ad will maintain Workers Compcusatian Insumace,ns required by Section
3700 of the Labor Code,for the prrormaee orthe work for which this permit is issued. '
My Worke's Compensation Insuran <artier and Policy num r am:
Cartier. Policy No.: 6 S a Do y
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu satins reed athecanpmrcd If the permit is faome hundrNdollm(SIM)
or less)
1 ttnify that in the prforenmec of Eric work for which this permit is issued.I shall not
employ any person in any examerha n to became subject to the Workers''Compensation
Laws of Califomia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become Subject in One Worker's Compensation provisions of the Labor Code,you must
,J ,$ foMwith comply with such provisions or this Permit she W deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
F 1Wrchy aRrn that then is aconseucunn lending agency far tW Performea of
FL> the work fm which the permit Is Eased(Sec.3097.Civ,C.)
ELI Landers Name
0.Z Lenders Address
V 0 1 certify that 1 have rad this application and arm drat the shout information is
LL f-^ correct.I agree to comply with all city ad county ordinances and sum laws¢lacing to
0U building construction.and hereby authorim nepmsenurives of this city to enter open the
roc eWvem,judgid Propertym ad expenses
phgeus.
(We)agree to saw.indemnify and keep harmless the City of Cupertino against
rFaZ inconsequudgmeoiccostsad ex penmamit. may in try way scene against said Cicy
t)z m consequence of the gracing of Nu permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-PO NT Issued by: Date
SOURCE REGyL. NS. Q
�A. T- Re-roofs
Signature of AppliaHAZA acts m
HAZARDOUS MATERIALS DISCLOSURE or URE Type of Roof
Will the a Cupertino
or(Mans Wildingacupacsmm or hurdle Health ad Seely
az defined by Ura Cupertino Municipal COM,Chapter 9.11.ad the Health mJ Surety
Coca,Sitio.25531(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ys 40Will the applicant orfuturebuilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
,.It haxaNrus air tammina rs ai Mfrned by Ne Bay Area Air Quality Management all new materials for inspection.
Disein7 P
❑res
I have mal the hazardous ma rnalsrequirements un erChomerd.95 orthe Cefor.
nu Kc.lUrh SetlyCeM,ScNom 25505.25533 amd25534.1 undersand thatifthc Wilding
dao tit comm ndy have a hours,dent it u my responsibility"'unify Ile occupant robs r!
mquirmty Cyn Wmdapriarairsa aracdrdree or � / Sig nature of Applicant Date
Owner or amhadxsd agent Dam All roof coverings to be Class "B" or better
CITY OF CUPERTINO
7 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 # . . . : 06090198
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 32
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 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
J 10300 Torre Avenue
N - Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: S —39 PERMIT #
0tvCA01 LV 1 - 0(00q Q,1
OWNER'S NAME: PHONE # ACG-25-7- 0(00
GENERAL CONTRACTOR: $ FAX # S O- 3-
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 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 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 i/4 " per foot slope and demonstrate
that there is no ponding.
2. An LC.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 wti l�e u s / V i G, ScI/K
Job Site Address: 20 $oo ( 1 owc(n�� S-r-e.4cet 20 C„py�,T P, 0 � ^j S' -39
Roofing Company Name: I0"�o S _ O (.r� I /� v
Applicant's Signature: `` �— Date:
• Greg Casteel
Building Official
Revised 11/2/04
�, CITY OF CUPERTINO
`, - REROOF
• CUPEkTiNO PERMIT APPLICATION FORM
APN# J2 ' n O'1 rry�0�5� �y�p�{�,-� n Date: ( I zo I ou
Building Address: 20500 Hct „1� teCd M`'d � 3221
Owner's Name: V / Phone#:
ce
Contractor: -ExAb6i S Inoknci License#: �8 1 Q_S ® , l
Contact: 5�C) � 4_��-1 Cupertino Business License 4:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
sphalt Shingles E�Asphalt Shingles
❑ A
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Num er of existing coverings ❑ Provide LC.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:'WI' I �
i rl s 1 A
Residential Commercial I InI�
1 `
(pie,(0-7 CA
Fire Zone: Yes ❑ No SK Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Projects I ,�n 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