06090200 CITY OF CUPERTINO a '��;<•ma fm�a ' •« �"' +'��' "`g"
BUILDING DIVISION PERMIT G,ON RAQT,OIRINFOORMATIQTI -'�
BUILDING ADDRESS: DUB IS ROOFING INC PERMIT NO. 06090200
20800 HOMESTEAD RD # 3
OWNER'S NAME: PERMIT ISSUE DATE
PROMETHEUS/VILLA SERRA 99 DUARTE AVE 2006
NE: SANITARY NO. CONTROL NO.
(510)793-9760
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION Job Description
FC 1 hereby al ion Nat I am licessed vale,Provisions of Clupter 9(mmmancing P
�iou with Section 7010)of Division 3 ofto Bu mosasM Fobuwm Code.nd my ties.Is
reninfit( ndeiftt 3 Lle.a $f-2- 1 REROOF- TEAR OFF SHAKES, INSTALL 7/160SB, 30YR C
;p= ummea>y
°a.c Dam Camracm, (N) RIDGEVENT, GUTTERS & SPOUTS . CLASS A.
AR HI EC'SOECLA¢AITON CARPORTS 68 : TEAR OFF SHAKES NEW COMP
i m< I understand my plans mat W Mind as public records r
)yu
°aG Licensed Professional
•y 3 OWNER-BUILDER DECLARATION
i I Wrehy IT,.that I am exempt form Na Comrscom,License Law for the
OO following reason.(Section 703 1.5,Business and Profusions Code:Any city or county
<69 which requires a permit to mnslrucL alter,improve,demolish,or repair any structure
Qiy prior it)its issuance.also requires the applicant for such permit o rib a signed statement
< that o u licensed pursuant to the provisions of the Contractor's license Law(Chapter9 Sq.Ft.Floor Area Valuation
i F O (commencing with Section 7")of Division 3 of the Business and Profasiom Cock)or $16420
sea,5$ Nat he u eaempt therefrom and Ute basis for the alleged exemption Any violation of
Section 7031.5 by any applicant fee a permit subjects the applicant ro a civil penalty of APN Number Occupancy Type
nor mom son five hundred dollars(5500).
❑1,as owner of the property,or my mophoyen with wage as their sok compensation,
will do the wort sew On structure u rot intended or oRerad foaale(sec.70a4,Business Required Inspections
and Professhoua code:The Commerce.License Law don MI apply m an ownere ns of q P
Property who builds or improves domeon,and whodoessuchwork himadfor through his
own employees,provided thatsuch improvements art not intended croffered forsale.It.
however,On Wilding or improvement is sold within one year of eomplwan,On ow.u.
builder will have the burden of proving Nat he did net build or improve for purpose of
sale.).
❑I,as owner of the property.am ucluaivcly contracting with licensed contractors no
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
ccese Law due not apply b an owner of propeny who W ibs or improve thereon,and
who comma for such projects with a contracsaga)licanmd pursuant to the Contractors
License Law.
Iomeaemptunder See .Bk Pcror Nismuon
Owns, Dam
WORKER'S COMPENSATION DECLARATION
1 to eby afore under penalty of perjury ane o(the folbwing dmlanlians:
I ham sod will maintain a CertiOam of C.sum.i m self-insurefor Worker's Compen.
cation,as provided for by Section 3700 of the Labor Code.for be performance of the
work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as required by Section
'RA
00 of the Labor Coda,for the performance of the wmk for which this permit is issued.
My Worker's ComMasation 1 c cam and Policy nun r rc
Cartier. Polity No.: OO 7
C TE�PnI N FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed ifthe permit is fore.hundred defy.(5100)
or less.)
1 certify that in the performac a the work for which his poor,u issued.I shall not
employ any person in any manner so as in become subject o On Workers'Compema0on
Laws of California.Date
Applicant
NOTICE TO APPLICANT:if,after making this Certificate of Exemption.you should
become subject in she Worker's Compensation provisions of the Labor Code,you most
.J ,z forthwith comply with such Provisions or this permit hall o deemed revoked.
z CONSTRUCTION LENDING AGENCY
[•+ k for hy,whalBrm ban,thereboun (!c..3nbnding agency,for On perbrma cur'
rl > L
On work for which this permit uissued/Sea.3097,civ.C.)
6W. Q Leaders Nance
7 z lenders Addrus
U C) I certify Nat 1 have road this application and sum Nat the move information is
(y F torten.1 agree to comply with all city and county ordinances and sum laws relating to
Q V Wilding convection,and hereby murmim mprecnutive of this city to enter upon the
a aaovomcmiunw prop c costs
(Or a penes pUrfowhich a
S.
(We)agree to save,indemnify and kap harmless the City of Cupertino against
into ampu dgmcnuegassing (this emit, may in any way accmc againtsaiO City
(„)z A APPLICANT
of due grating of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULA
2 Re•roof5
Signature a(Applicant/Canuacwr Dare
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding amupantstore or handle hacnJoua material
as defined by the Cupertino Municipal Cade.Chapter 9.11.and the Health and Safety
Code.Section lss3z(a)? All roofs shall be inspected prior to any roofing material being installed.
40 (]ll LJm
Will dte applicutt or/future Wilding attvpanl use cyvipmcns of devices which If a roof is installed without first obtaining an inspection,I agree to remove
mull ha.m us air contaminants as defined by the Bay Arca Air Only Management all new materials for inspection.
District?
❑Yes ❑N
Ihavertal Nva ochd�terialsmquimmcnsundcr Chaprcrb.95o[Ne Califon
nia Health&Safety Code.s m=25505,15533 and n534.1 undcnund thin if dte Wilding ?/
docs not curtendy have a tenan4 Nat in u su rec onsibilhy m notify the occupant of Wa t��7
reyuirtmcnu ie artxmnpriartai,aa,ngaoracgnirteatenrqym PT �//,a,a�� Signature of Applicant Date
/ ate All roof coverings to be Class "B"or better
Owner tar aushomed agcm Dam
CITY OF CUPERTINO
�m 9 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 # . . . : 06090200
SITE ADDRESS 20800 HOMESTEAD RD # 34
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 17, 000 . 00 245 . 16 0 . 00 245 . 16 0 . 00
BSEISMICRE VALUATION 17, 000 . 00 1 . 70 0 . 00 1 . 70 0 . 00
---------- --- --- ---- ---------- ----------
TOTAL PERMIT 246 . 86 0 . 00 246 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ---- ------ --------
OTHER 2534 . 80 VISA
TOTAL RECEIPT 2534 . 80
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
4/ Cupertino CA 95014
J' Telephone(408)777-3228
CITY OF Fax(408) 777-3333
e PEkTINO
Building Department
JOB ADDRESS: $ PERMIT #
otgl OI LQ I — OIOl GZCC
OWNER'S NAME: PHONE # 409-257- 10(0 0
GENERAL CONTRACTOR: DUba S FAX # S O--7 3"
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
2/ O�
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 r/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:
Job Site Address: Zo Boo l Fow�(�e S-re' 20 C„pyLr;w o 1 .—39
Roofing Company Name:
Applicant's Signature: �� � Date:
• Greg Casteel
Building Official
Revised 11/2/04
CITE' OF CUPERTINO
REROOF
CUPER�TINO PERMIT APPLICATION FORM
APN# 32.1D Oq-05LO Date: "I ZO I ou
Building Address: 2 O at o Honrie.-,ta.-d n �.► 4- 5+
!�r (�
Owner's Name- �ca V-i 1�In,
9, ,-n Phone`1#; ^ - B 1�C
Contractor: FF ,7pLAb.I S R �� C� n� License (Bt2:
Contact:, �UW}Q�S�S�O��I `����—I Cupertino Business i1
icense #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt 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 lie
• Job Description:-WY- ��4j '� ^7 r I , 1(1
I Cl S ,C A
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning D�e t. if
there are any restrictions: LJ
Cost of Project: LP I Type of Construction: Occupancy group:
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