06090199 CITY OF CUPERTINO + '�'»# �"' •` `+�'"` „
BUILDIha:DIVISION PERMIT xCQ1 TRACT0R INFORMATION
BUILDING ADDRESS: DUB IS ROOFING INC P""'NG'06090199
20800 HOMESTEAD RD # 31
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: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
i00 LICENSED CONTRACTOR'S DECLARATION
us 1 hereby affirm Nat 1 am de
licensed unr provisions of Chapter 9(commencing lob Description
:zM wiN&clion7")of DivWon3.fthe Businms Nofessiuna COde.andmyliecrcia
<. in fullfortcandeifecLG; REROOF- TEAR OFF SHAKES, INSTALL 7 160SB, 30YR C
�c Dam Canvasser aim (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
' Oq CHf1ECfSDECLARATI0N CARPORTS 60 , 61, 64 , G5 :64 , 65 : TEAR OFF SHAKES
S a< I understand my plans shall be used u public words r , NEW COMP
:EU
y Licensed Profetuonal
3 OWNER-BUILDER DECLARATION
if I bercby affirm the I son exempt from the comoscoses License Law for the
p o following reason.t5ectiun 1113 L5,Business and Professions Code:Any City Or county
3_[a which requires a permit in construct,alms,improve,demolish,aro repair any suuctum
_Z< prior m its komnc..alsu requires Neapplicut fofsuch pconiuo file.sigoednamment
Ibar he is licensed purwanllo lM pmvisiom of Joe Conuacoh Li¢rc Law(Chepmr9 Sq.Ft. Floor Area Valuation
2 f-o (commencing with Section 700()of Division 3 of the Busineuand Professions Code)or $32349
Nat be is eas apt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not mom than firm hundred dollen(3500).
0 I,u owner.f the pmp.ny,m my employco with wages u Noir sale compe=don,
will do the wart,end the souctum u notimmrdcd mORered tonal.(Sec.7014,Business
and Professions Cade:The Conuacmrs License Law does not apply m an owner of Required Inspections
progeny who Wildsorimprovu IWrcon,and who doessmh work himaelfmlhrough his
own employees,provided that such improvements arc not intended oraRered forsale.If.
however,the building or improvement uaold within one you u(c.mplcum.the owner-
builder will have the burden of moving dust he did Mt Wild or improve for purpose of
sale.). .
0 1,as amber.!IW property am ueluurmly conuvniog with littrued mnuacors to
mmtmct Ne projem(Sec.7()14.Business and Podesdom Cede.M Conuas ora LL
came Law does not apply to an owner of property who Wild.or impoves Hewn,and
who comracm for such pmjnm with a eonustrun(.)licensed puossam to the Cont%toes
License Law.
O I.m....rundo Sec .B&PCfoutins.
Owner Dam
WORKER'S COMPENSATION DECLARATION
41 1 hereby Wron under penalty of perjury mm of the following declar4tiom:
0 1 have Ond will mainmin a CcniRca r of Comem m x117-imuro for Wmker'a Compm-
sation,as provided for by Section 3700 of the Labs Code,for the performance of dre
work for which Ni.permit is issued.
1 have and will maintain Wouk.rs Compemuian Insurance,as required by Secuan
3700.(on LaWr Code,for due per(mm usee of due work fmwhich this permit is issued.
My Workces Compcoold l�y�troux m and Peliry n Wr are:
Cartier.��.�'rt h-✓Z P.Iiq ZZM: ;;�no L-t zob
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(This section need net be Completed if the permit is fmonc hundred dollars($100)
Ise.)
I cenify Nm in Ne performance of the work for which this permit is issued,1 shall not
employ any person in any mmmr o an in become subject to NC Workers'Compensation
Laws.f California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become suhjce,to she Workers Compensation provisions of N Labor code,you must
., O forthwith comply with such provisions or this permit be deemed mvoked.
Z'" CONSTRUCTION LENDING AGENCY
V
IWmhy hum that Nem isaConstruction 3M,ding agcmy lar the performs cut
�i N.work for which this permit is lssmd(Sec.7097,Civ.CJ
:D Q lenders Name
a 2 lenders Address
U C) I«airy that I harm rod Na appuesti.n and sum that the.Were i.formatiun it
L[. correct.I agree to comply with all city and county Ordinances and state laws relating in
0U Wilding construction.and hereby auth.rine mprescnutives ofthis city to enter upon lW
rat aWvo-m.judgndpmpertyal rte iupcNun es whichpurposes.
(We)agree to save,indemnify and kcap harmod.the COY.f Cupertino again
UZ in comesqueco of th.eoauand uthispemitChmay in anyway accron agaiutsaid City
uICANT .fthegrantingof A D WIL Issued by: Date
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL Nj)N
SOURCEREG F(J1 ?4
Re-roofs
Signature of ApplicmUCom /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Willy t e Cupar or forum building me Chapter
store or handle haustious
and
as Conn.
Section
the Cupertino Municipal Code.Chapter 9.13,and N Health and Safety
foJe,0tion25533(a)? /// All roofs shall be inspected prior to any roofing material being installed.
Yes
Will Nc applicant or fuwm Wilding accupanl use cyuipmcnl err Jcvius which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air comaminano as Jchood by IW Bay Area Air Quality Management all new materials for inspection.
District?
0Yc Nu
I hats real Jre haaament smaterials mquiremrats wrier CWprer 6.95 ofJm Califor.
nix Hcahh h SafctY Costs.SCcumn25505.35533 and 35534.1 makrmmd Jon if the Wilding O�
dms not currently boon a tenant,than it u my responsibility Or notary Ne......i da;
requircm ltwli bemmpriermissuaux.fa Certificate of Occupoq..
l�J� Signa[ureaof Applicant Date
Owner m amhrisd agent Dare All roof coverings to be Class"B"or better
CITY OF CUPERTINO
0m 8 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 # . . . : 06090199
SITE ADDRESS . . . . . : 20800 HOMESTEAD RD # 31
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 33 , 000 . 00 393 . 12 0 . 00 393 . 12 0 . 00
BSEISMICRE VALUATION 33 , 000 . 00 3 . 30 0 . 00 3 . 30 0 . 00
- --------- ---------- ---------- ------ --- -
TOTAL PERMIT 396 .42 0 . 00 396 . 42 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
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: $ PERMIT #
01,0�01 (01 - 0(oc)q
OWNER'S NAME: PHONE # AMS"]— I WO
GENERAL CONTRACTOR: S FAX# 510- a-
6
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
Owner/Contractor Signature Date
Community Development Department
r_ 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
I 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 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 / VI
Job Site Address: 2-o Soo f-F o w��S r/e�ca� 20 C pater w o ��S' 1 .-39
Roofing Company Name: ���0 5 t�c9 0 l�• �7 tij c_
Appficant's Signature: �� Date: /,:�7�_
• Greg Casteel
Building Official
Revised 11/2/04
CITE' OF CUPERTINO
10110-
REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# 2n ' n_ Oq_01D ^ Date: /� ZXY
O I O
BuildingA`dddrreless: 00 205Home � 4— 311
Owner's Nam a � VW ` r � �� 1 Phone. a IU-0
Contractor: �•1 � License#: �t
Contact:, ^QYV VUoe;1S i 1 Cupertino Business License #:
1", W Type of Roof Covering: 1
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ _A,phalt Shingles Asphalt Shingles
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:-Wy-
i rl s 1 A
Residential Commercial1�r �Sr Ni IInSin11
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy 32 u q -sem y gR A_
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
•