08020091 1
CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,C�NaT,Rt1.�y_C)R,INE'�Q,WIOIV
BUILDING ADDRESS: PERMIT NO.
10761 TOHNSON AVE DADDARIO ROOFING 08020091
NEWS NAME: PEMIT RISSUE DAM
CYRUS MIRBAHA 1734 WILLA WAY. 02/14/2008
PHONE: SANITARY NO. CONTROL NO.
(831) 476-9109
ARCHITECnENGINEER: BUILDING PERMIT INFD
BLDG EIECf PLUMB MECH
�oo LICENSED CONTRACTORS DECLARATION 0 D D O
4(y 1 bacby affirm WI I am licensed under pmviuow perChip.9(cemmenc(n{ Job Description
nZj with Section 7")of Division 3aftheBusinenand!Professions Code.and mylkeseis RE-RF T/0 COMP INSTL PLYWD 30 YR COMP, 2PLY, CLS A
in full force ad aft
jZ License Cissa `�"I U.# 20.5'4
CS Dam r.?_ m 04 Contracts,e ARCHTIECI'S DECLARATION
y O I understand my platy Nail W used as public manrtla
g w� Licensed Pmfessional
OWNER-BUILDER DECLARATION
.� 1 hereby affirm that I em exempt(mm that Conasnors License law for the
0 o following mixed.(Section 703 1.3,Biomass and Professions Code:Any city OT County
S which mr,rima a Permit in cnn.Bua alter,improve,demolish.per repair any swctum
Zy Priorw in issumae.aiW requies lM applicant far such permit to Jim a signed Wmment
this he is licensed pursuant m the provisions of the ConOatera License Law(Charter 9 Sq.Ft. Floor Area Valuation
mmamenein{withSwtion 7000)of Division 3 of the Business ma Protections Code) $5650
Nat Im Is exempt therefrom and He bole ror the aileged exemption.Any violnlon of
Section 7031.5 by any applicant for a permit Wbjects the applicant to•civil penally ofNumber Occupancy Type
nal mem man five hundred dollars($500). 37531058 .Jff
❑Lu ownerofdkpropemy.ormyrmplayeca with a+gesutie'vsem mnpewdon,
and Prthewart,andthe he Communities
Licensor new do(wore(Sec.7014.Buow.
and enywhobu Cade:The Canaector.License Law dao or apply tf rt awder of Required Inspections
Who em who wild.viirepmwa Hereon,and who doessort work W.1firorelluaugh his
own employees,pmgdd WI such Improvements are not ear of completion.
mortexd ram sales IC
however.the building amimpmvemenluhat within ane)earperamovefortheowner-
builder will have the burden of pmv(n{that he tlitl dol build.improve for purpose of
❑1,as names of the progeny,am exclusively comracting with licensed eonlramn m
construct He project(Sea.7(114.Business ad Pmfassiaw Cade:)The Commune!,U.
awe law does not apply a as own.of property who Wilds or improves Henan.and. ..
who contracts for such projects with aconuanor(.)licensed pursuant in ft Co manatee
License Law.
❑I am exempt unC.Sec. .B&PC for this woe
Date
WORKER'S COMPENSATION DECLARATION'
I hereby affirm under pewty,of perjury one of the following declarations
❑1 Mw and WII mainuin a Cutificate ofCawenl m ml(-swore foe Wartcra Campers•
Mian,as provided for by Section 3700 of the lobar Code,fm the performance per He
work for which this Permit is issued.
Q 1 have and will asuman War ,Compewum.I..,u resulted by Season
3700 of the Latium Conn.fur the performance or the work for which this permit u Issued.
My Warkers Compensation imuncurer and Policy number am:
Carrier. v�al.)ve 1-- 7 PoI1Cy No.: OVO?,22')— ZOO
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
CTTi.Wetton need Ila,tie completed if the Permit is fmanc hundred dollars(SIW)
or kis.)
I unify that in the performance of the wort f.which His permll is Wood.1"I no,
employ any person in any manner W an to become subject to the Workers'Comp rmadon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.IC alcor matin{this Certificate of Exemption,you should
became subject 0 the Waiters Campewtion provisions of the Labor Code,you mon
�z forthwith comply with such pmvuinw or this permit ahail be decreed revels d.
z 51CONSTRUCTION LENDING AGENCY
rN. I Washy affirm this Hen 1.a construction landing.gency for the perromnanm of
Qi .moi the aeric for which this xmtit m issued(Sa.309'1.Civ.C.)
W Q Lender's Name
Z)z Landers Address
U O 1 c.dry that I have rad this application and rete that the above information k
IT. comms.I agree m comply with all city and county aNin uums and sum laws misting in
.
0 SVS building construction,and hereby mdWnx mprerenudws of thil city to anus upon the
W awve-mmntinnd Property for inspection purposes
C (Wa)agree to use.indemnify and kap halroleu the City of Corpsman against
(n liabilities,jd{mwWeowandexpewuwhkhniquitnywayaameaguwlxidaly .
U in<owequence of the jnnting afthis permit. r7 G/
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date G �L
SOURCE REGULATION
2—� Re-roofs �
cal r HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant per rumm building acupanlamm m lundlc heuNow materai
de0ned by the Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
Section 25532(a)?
QYw ONO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant per future wilding Occupant use equipmem per dcvias which If a roof is installed without first obtaining an inspection,.I agree to remove
emir hanardnw sir conumiwnu as defined by the Bay Area At,Owdily,Management all new materials for inspection.
Diauicl7
❑Yes No
I have read the huudonu muerab requirements under Charter 6.95 or the Califor.
nu Health&Safety Code,Sections 35505,25533 and 25534.1 uMvnand this Jthe Wilding
does TI cwrcntiy low•tenans WI it k mY rapowitiillty m iwdfy due o%xm1m of the
requirements which mutt he met pr. ' uancc ofa Carufcaseoroccupancy. Signature Of Applicant Date
'Dam° All roof coverings to be Class"B"or better
prima m ' .
CITY OF CUPERTINO
a
REROOF
•CUPE(�TINO PERMIT APPLICATION
Date:
APN#3_75 / 0 00 02 . 14.1— C 8
Building Address:
Io ohv1V% W-e-
Owner's Name: Phone #:
c r 1'k S yV95 777— N T O
Contractor: Phone #: �� t/ 7 7
Fax #:
Cupertino Business License #: Contractor License #:
3e �
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
d,-,4Csphalt Shingles M`Zsphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ .Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings / ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
�n r ( ( 1 woo CMCJ �7 Y¢a ✓ Lo- n�JcJi'f "V C I CQ�
Residential Commercial
Fire Zone: Yes ❑ No Lff Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
51 50- "0
to I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
7,Egna-e
CITY OF CUPERTINO
a REROOF
•CUPllF
Efi,TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES a-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
•
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) h1-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: CXYLAS M;Ybc? Ra
�/ 1 I
job Site Address: 107[moi/ j o ri vi S yr a G%er
Roofing Company Name: �a�`� L rI, d Woo -1
Applicant's Signature: U Date: o2-�y-og
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37531058 . 00
DATE ISSUED. . . . . . . : 02/14/2008
RECEIPT # . . . . . . . . . : BS000003940 .
REFERENCE ID # . . . : 08020091
SITE ADDRESS . . . . . : 10761 JOHNSON AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CYRUS MIRBAHA
ADDRESS . . . . . . . . . . : 10761 JOHNSON AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DADDARIO ROOFING
CONTRACTOR . . . . . . . : EDGAR MONTOYA LIC # 26245
COMPANY . . . . . . . . . . : DADDARIO ROOFING
ADDRESS . . . . . . . . . . : 1734 WILLA WAY
CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062
• TELEPHONE . . . . . . . . : (831)476-9109
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 5, 650. 00 0 . 60 0. 00 0 ..60 0. 00
1REROOFRES SQ FEET 20. 00 - 260.:00 0. 00 260.00 0. 00
------:-`-- ---------- ---------- ----------
TOTAL PERMIT 260. 60 0 . 00 260. 60 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- -------------- -------------------
CHECK 260 . 60 #22041
---------------
TOTAL RECEIPT 260. 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
Community Development
0 Torre Avenue
sf
Cupertino CA 9014
Telephone(408)777-3228
PCITY OF EI�TIN� Fax(408)777-3333
�U
rl 11�I Building Department
JOB ADDRESS: PERMIT #
C-1 (s I a 6tScV-1 at.,-C— 0�24v ��
OWNER'S AME: PHONE # qo8 -7 0 20
GENERAL CONTRACTOR: 1( q,,r'd iPao rr'h FAX # 6_ 71 o
I am not using any subcontractors: !: _O2 -/5=o 0
Sign tune 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
P un4bing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date