05071202 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ` CONTRAGTOB INFORMATION-�
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BUILDING ADDRESS: PERMIT NO.O S O 7 0 2 0 2
1124 KENTWOOD AV
OWNER'S NAME: PERMIT MUE DATE
LUZIA & RODNEY GUTTENS 07/29/2005
7A,RCHITECTIENGTNEER
0NE:
SANITARY NO. CONTROL NO.
: BUILDINGPERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATIONJob Description
I hereby atrrmNal I am licensed under provisions of Chapter 9(commencinghSection70011)ofDivOkm SofNC Busi.and Profasions Codc,and mylicc.is
�RmmnforceandeIT t._ REROOF-T/O TWO (E) SHINGLE ROOFS
A22 Liccnu 1 s Lic.g
i-21 Dam - Camra Sur
IN, PRESID � ®
ARCHITECTS Dater zv TIO
ov
1 undcreund my plans shall he used a public records
JyU
a H Licensed Pmfcssional J /a
S OWNER-BUILDERDECLARATION CO/ p
Y 1 herehy alRrm'her 1 am exempt from the C.........a License Law for the '/ 21105
a 0 following moon.sec tion 91131.5,Business and Professions Code:Any city or county
$ which reyuims a permit m construct,eller,improve.demolish,or.pair any structure
prior Or Its issuance.also requires the applicant forsuch permit to Ole a.signed statement-Z< l�(?)3 0 0 that he Sq.Ft. Floor Valu$
eSF•0 (commencing with Section 7000)of Division 3 of the Business and Professions Cadc)or
i
that he is exempt therefrom and the bash for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan Eve hundred dollen($500). 35931059 . 00
❑I,as owner of the property,or my employees;with wag”as their sole compensation,
will do the wark,and the swctum is not intended or offered for aalc(Sec.7044,Business
and Pmfaxamns Code:The Commetori License law dors not apply to an owner of Required Inspections
property who builds or improves thereon.and whodoessuchwmk himmlf orthrough his
own employees,provided that such improvements are not intended or offered for sale.If,
however.the building or improvement is said within one year of completion.Ne awner-
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively summering with Seemed contractors to
corouum the project(Sec.9014,Business and Professions Code:)The Contractors Li.
terse Taw dors not apply in an owner of property who Wilds or improves thereon.and
who contracts for such projects with a eonoactor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. ,B&P C far Nis mason
w r
Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRmr under penally of perjury one of the fallowing daelantiona:
❑I ham and will maintain a Certificate of Consent to selr-insum for Workers CumWn.
ration,u provided for by Section 37W of the labor Cade,for the performance of the
work rot which this permit is issued. .
®1 have and will maintain Worker's Compensation Insurance,as required by Section
3-700 of thc Labor Code.for Ne performance of the work for which this permit is issued
My Workcr's Compensation insure c careim and Policy number a m:
Carrier:5 Policy No.:J 3"17
CERTIRCATEO XEMPnON FROM ORRUS.
COMPENSATION INSURANCE
(9Th sectionneed non W completed if tk Permit Is(wont hundred dollars($100)
nr less.)
I certify that in to performance of to wok for which this permit is issued.l shall not
employ any person in any manner so as m become subject to the Workers'Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
heroine Subject to Ne Workers Compcnsauon provisions of Ne Labor Code.you most
.JO faMwah comply with such provisions or this ponni"hall W deemed ranked.
Z '--' CONSTRUCTION LENDING AGENCY
'r+ � I Wreby affirm that dere is a construction lending agency for the performance of
W'7 Ne work for which this permit is issued(S..3097,Civ.C.)
W Lendmi Name
z Lenders Address
U 0 1 comfy that I have read Nis application and sure Nat the above information Is
F' cortex 1 agree to comply with all city and county ordinances and sou laws relating to
0 building construction,and hereby authorize representatives of this city to enter upon the
shove-mend caned pmpeny for inspecuon purposes.
(~ G (We)agree to Save,indemnify and keep harmless the City of Caperton agairol
liabilities,judgment,costs and expenses which may in eny way accrue against said City
U Z in eonsequexe of the granting of this permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU REGULAT�NS.
Tj )QaZ 7Z�29-VT Re-roofs
Signature al ApplicanVConlrxelm Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will to,applicant or future Wilding occupant store or handle hazardous material
az dcfnned by the Cupertino Municipal Code,Chapter 9.11,and the Health and Safety
Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
pYa @ja
Will the applicant or future Wilding occupant use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanodous air contaminants as dapped by rhe Bay Area Air Quality ManagamaM all new materials for inspection.
District?
C]Yes No
I have read the bazallous mamnals rcquircuums under Chapat 6.95 of the Califon
nia Health&SaFetyCoda.Sections 25505.25533 and!15534.1 undcrsuM the ifdre Wilding
does not currently haw a tenam that it is my responsibility to mad fy the occupant of lie
rcyuire3w�tSphi' must mcspnrunissuanceoraCenifieamoffxeupaney. Signature of Applicant Date
% l m
Owner or authorized)gent _Z�DO. S All roof coverings to be Class"B" or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35931059.00
DATE ISSUED. . . . . . . : 07/29/2005
RECEIPT #. . . . . . . . . : 30579
REFERENCE ID # . . . : 05070202
SITE ADDRESS . . . . . : 1124 KENTWOOD AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LUZIA & RODNEY GUTTENS
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2922
RECEIVED FROM . . . . : NEIGHBORS ROOFING
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-------- ---------- ---------- ----------
BPERMFEE VALUATION 11, 000.00 180.36 0.00 180.36 0.00
BSEISMICRE VALUATION 11, 000.00 1.10 0.00 1.10 0.00
BUSLIC FLAT RATE 1.00 102.00 0.00 102.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 283.46 0.00 283.46 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ---______---_____-
CHECK 283 .46 1073
TOTAL RECEIPT 283 .46
1
Community Development Department
Building Division
City of Cupertino
• 116'� 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C�^J�•k—I�O 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.
S 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: LL)-Y-) 6- 1�0ll/1
Job Site Address: (/1 �'l( ffe✓Lk WOO W ai 1) " "
Roofing Company Name: �A"_&I,/g(Lb o ✓ Y-D o Ft.rl SL arl
V
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
UPE ITY TINO PERMIT APPLICATION FORM
APN # 3S'� S g Date:
Building Address:
12.11 00 J l o CCI.—
Owner's Name: Phone#:
z L ra, c,,, �o nt Etc S
Contractor: Phone : License #:
IVe I q o o I to 4 S rG
Co act: Phone#: Cupertino Business License #:
a Z ag
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
OL Asphalt Shingles III Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 2 ❑ Provide I.C.B.O.Report#
QQ To be Removed ❑ Provide Mfgr. Installation Specs.
Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Q�
Job Description:: r
ea tv O Ctt= Two
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
� Dfl0. o
Qty. if
Applicable Fee lD Fee Description Fee Group
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